When President Nixon wanted to overhaul the health care system to provide universal coverage, his administration turned to Stuart Altman.
Ten years later, when Congress created a commission to improve the Medicare payment system, Altman led the effort. And, in the early ’90s, when newly elected Bill Clinton assembled a team to guide his health care policies, Altman was among the first chosen.
There may be no single person with a longer or deeper history in the health care overhaul efforts of the past 40 years than Altman, a professor of national health policy at Brandeis University in Waltham. He has advised five presidents, both Democratic and Republican; authored countless articles about health policy; and served on a variety of task forces aimed at fixing health care on both the national and state levels.
These four decades as policy maker, adviser, and scholar play a central role in Altman’s new book, “Power, Politics, and Universal Health Care,’’ which traces 100 years of debate and confrontation over one of the nation’s most intractable issues. With President Obama’s health care overhaul under attack from Republicans - and certain to be a defining issue in the November election - Altman and his coauthor, former Brandeis fellow David Shactman, show that today’s controversies have roots in the political and philosophical battles that raged a century ago.
In 1915, for example, the American Association for Labor Legislation, a workers advocacy group, proposed that the US government provide health insurance for low-income workers and their families, similar to programs adopted in Germany and England. Special interests, including the insurance industry and American Medical Association, lined up against the plan. Conservatives, raising alarms about government intervention into the private sector, joined the opposition.
“Opponents claimed that national health insurance was a tool of socialists and communists - rhetoric that still reverberates today in the halls of Congress,’’ Altman and Shactman wrote.
Altman first became involved in health care reform in the early 1970s. He earned his doctorate in economics at the University of California, Los Angeles, where he wrote his dissertation on unemployed married women, then went to teach at Brown University. Former colleagues, working at the US Department of Health, Education, and Welfare during Lyndon B. Johnson’s administration, recruited him to study the supply of registered nurses in the workforce.
When Nixon was elected president, Altman stuck around. Although a Republican, Nixon was eager to propose a universal health care plan to compete with more far-reaching alternatives pushed by liberals such as Massachusetts Senator Edward M. Kennedy. Altman was asked to examine policy options. “I was sort of thrust into it,’’ Altman said.
The challenges he confronted - ballooning health care costs and high numbers of uninsured - were “the exact problems we have today,’’ he said. Watergate intervened before the administration’s proposal got very far, and Altman returned to teaching, at Brandeis, after Nixon resigned. But his involvement in policy making was far from over.
From 1984 to 1996, Altman chaired the congressional Prospective Payment Assessment Commission, an independent panel created to oversee Medicare payments to hospitals to help control health care costs. He worked on Clinton’s transition team, only to see his recommendations to build on the existing system rejected in favor of a more sweeping plan that died in Congress.
Altman later served on the Commission on the Future of Medicare during Clinton’s administration, and advised Obama on health policy during the 2008 campaign. Altman conceived the idea for his book during the early debates over Obama’s health care proposals. Ultimately, Obama got his overhaul passed without a single Republican vote.
Altman wanted to explore why health care has proven such a difficult, divisive issue, and why so many attempts to make it more available and affordable did not succeed. Franklin D. Roosevelt, Harry S. Truman, John F. Kennedy, Nixon, Clinton, and any number of lawmakers all failed to push through major proposals.
In fact, Altman and Shactman began their book assuming that Obama, too, would fall short. The book’s working title: “Failure Again.’’
Health care reform has been so intractable because it provides a lightning rod for long-running political and philosophical conflicts over the role of government, according to Altman. While the left favors a social safety net, the right fears creeping socialism. Conservatives prefer to let market forces meet health care needs, but liberals distrust the motives of private business. Advocacy groups representing special interests such as doctors, hospitals, and senior citizens fight any proposal that may cost them money, jobs, or influence.
With these opposing forces constantly in play, the history of health care reform is replete with attempts at compromise, but short on success stories.
In 1974, in a church basement near the US Capitol, opposing factions met in secret to craft a deal on universal health care. Among the attendees were Altman, representing the Nixon administration, and an aide to Kennedy, then advocating a single-payer system, similar to those in Europe and Canada.
“It would make a good ending to the story if the secret church meetings in June resulted in a successful compromise, but it was not to be,’’ Altman and Shactman wrote. “Neither side felt they could agree to the concessions necessary to make a deal.’’
At 74, Altman remains immersed in health care policy. He advises lawmakers, administration officials, and nonprofit groups about health care economics. Chris Jennings, a consultant in Washington who worked with Altman in the 1980s and ’90s, said Altman “is still incredibly relevant.’’
“He continues to be viewed as a substantive and intellectual health policy reform expert,’’ said Jennings.
Altman said the Patient Protection and Affordable Care Act, aka Obamacare, will reduce the number of uninsured Americans - if it survives court challenges and repeal efforts. If the law is undone, Altman predicted, the nation faces “the worst of all worlds’’: high numbers of uninsured and soaring medical costs.
Altman has donated to Democratic candidates, but he is more pragmatist than partisan. Incremental, rather than revolutionary, change, he said, is the best approach for improving the complex patchwork of government programs and private coverage that has evolved over the past century.
The insurance industry remains important to the US economy and must be included in overhaul efforts, he said. At the same time, the federal government’s involvement is vital to ensuring that all have access to health care.
“The idea that you can do it without the government is pure nonsense,’’ he said. “People have a legitimate concern with ‘too much government,’ but the question is, where is the balance?’’