When Richard Nixon was a teenager, he watched two of his brothers die. His little brother went first, at age 7, of a sudden and mysterious illness. Then his big brother died at age 22, after a long battle with tuberculosis. It was the 1920s. Health insurance hardly existed. The sicknesses sapped his parents’ meager resources. His mother stopped baking pies for the family’s little grocery store to care full time for her ailing son. Nixon worked as a janitor to earn extra money, and turned down a scholarship to Harvard because it didn’t cover room and board.
When Nixon, a staunch Republican, became president in 1969, he threw his weight behind health care reform.
“Everybody on his cabinet opposed it,” recalled Stuart Altman, Nixon’s top health aide. “Nixon just brushed them aside and told Cap Weinberger ‘You get this done.’ ”
Nixon had other reasons, beside his dead brothers, to support reform. Medicare had just been passed, and many Americans expected universal health care to be next.
“We had the same problems then as we have now,” Altman said. “A lot of people uninsured, and health care costs were considered too high.”
Ted Kennedy, whom Nixon assumed would be his rival in the next election, made universal health care his signature issue. Kennedy proposed a single-payer, tax-based system. Nixon strongly opposed that on the grounds that it was un-American and would put all health care “under the heavy hand of the federal government.”
Instead, Nixon proposed a plan that required employers to buy private health insurance for their employees and gave subsidies to those who could not afford insurance. Nixon argued that this market-based approach would build on the strengths of the private system.
“Government has a great role to play, he said, “but we must always make sure that our doctors will be working for their patients and not for the federal government.”
No one breathed a word at the time about Nixon’s plan being unconstitutional. Instead, it faced opposition from Democrats who insisted on “single-payer.”
Over time, Kennedy realized his own plan couldn’t succeed. Opposition from the insurance companies was too great. So Kennedy dispatched his staffers to meet secretly with Nixon’s people to broker a compromise. Kennedy came close to backing Nixon’s plan, but turned away at the last minute, under pressure from the unions. Then Watergate hit and took Nixon down. Kennedy said later that walking away from that deal was one of the biggest mistakes of his life.
“That was the best deal we were going to get,” Kennedy told me before he died. “Nothing since has ever come close.”
When Obama ran for office, his aides contacted Altman, a key architect of the Nixon plan, and asked him to serve as an adviser. By this time, Altman was a battle-scarred veteran of four decades of health care wars. Indeed, policy wonks even coined a term — “Altman’s law” — to describe the stalemate that sets in when everyone wants reform, but only if they get their own way.
For Altman, co-author of “Power, Politics and Universal Health Care,” it was a chance to turn a good idea into a reality, 40 years later.
To expand coverage, without bankrupting the system. To stop insurance companies from excluding the sick, the very people who need it most.
Although the two plans are different — Nixon’s mandated companies to buy insurance, while Obama’s mandates individuals — both bolster the system of private insurance instead of creating something new.
Sometimes changing what already exists is more complicated than starting from scratch.
“Every once in awhile Obama would say, ‘Wouldn’t single-payer be simpler?’” Altman recalled. “The answer is yes. But America wasn’t ready for it.”
When Congress finally passed the bill, Altman knew that it would take years to perfect it. But he felt extremely proud.
He never imagined that the Supreme Court could throw a wrench in it. That would never have happened in the 1970s.
“If we had passed something in the Nixon administration, nobody would have questioned it,” Altman said. “Back then, everybody had a plan for universal coverage. America was much more ready for it then.”