‘What’s In A Name?’: U.S. Health Care Branding As A Political Wedge

In President Franklin D. Roosevelt’s 1944 State of the Union Address, he introduced his Economic Bill of Rights, calling for additional New Deal-era regulatory overhauls and governmental services, which included “the right to adequate medical care and the opportunity to enjoy and achieve good health.” From the very beginning, F.D.R., and eventually his Presidential successor Harry S. Truman, fought an unsuccessful uphill messaging battle over the establishment of a national health care service in the United States. If today’s American Left is to lead the way toward de-commoditizing access to “adequate…medical care,” a fundamental human right reinforced and articulated in the U.N.’s Declaration of Human Rights, it’s necessary to understand how the deck was stacked against the public in the first place.

Democrats need to look no further than the anti-communist smear campaigns of 1940’s lobbyists for the origins of 2017’s linguistic and ideological stalemate. (Campaigns for Single Payer in the U.S. have been attempted as far back as 100 years ago, which coincidentally faced legislative roadblocks that nearly mirror the snags hit in New York and California health care reform campaigns this year.) One of such lobbying groups, The American Medical Association (A.M.A.), founded in 1847, was developed under two guiding principles: “One, all doctors should have a ‘suitable education’ and two, a ‘uniform elevated standard of requirements for the degree of M.D. should be adopted by all medical schools in the U.S.’” These initial mission statements, while having evolved over the years, prove essential to understanding the stakes that medical societies have often had in health care debates dating back to their inception: they are first and foremost doctor advocacy groups.

So when President Truman made clear that since “most of our people cannot afford to pay for the care they need[,] I have often and strongly urged that this condition demands a National Health Program,” and when he saw a piece of legislation with such aims in the Wagner-Dingell Bill of 1947, he went all in and jumped aboard, unaware of the dark money avalanche awaiting him.

The A.M.A. spent an unprecedented 4 million dollars in lobbying efforts, distributing over 55 million pamphlets in doctor’s offices and hospitals around the nation alleging the proposed service was nothing more than “socialized-medicine.” In an On the Media interview, Jill Quadagro discusses why lobbying groups like the A.M.A. took such a strong stance against the establishment of a national health service from the get-go; “Doctors were opposed because they were afraid that if there was a third party payer involved it might take over control of doctor’s charges and…practices.”

Jonathon Greenberg of The Atlantic lays out the raw numbers spent during the A.M.A.’s self-serving, anti-reform campaign: “In one two-week period right before the 1950 congressional elections, the AMA spent more than $1 million on advertising, and persuaded large health-related companies to co-sponsor $2 million worth of similar ads.” He continues, “This paid for full-page anti-reform ads in each of the nation’s 10,000 newspapers and on 16,000 radio stations.” The only private lobbying group in support of the reform, The Committee for the Nation’s Health, with an annual budget of $36,000 dollars in 1950, amounted to a dull roar in the messaging war.

The A.M.A. wasn’t alone in its smear campaign. Fellow medical society-run lobbying group the National Physicians’ Committee (NPC), took out a full page ad in Editor & Publisher offering a $3,000 prize for submissions depicting political cartoons against the campaign for a national health insurance program. Though many journalists and artists around the country condemned the move, the overall anti-campaign was successful. Out funded, and eventually out-campaigned in the 1950 midterm elections, the Wagner-Dingell Bill died on the operating room table.

Much like the labeling of national health insurance as “socialized medicine” during the Wagner-Dingell Bill debate and later the1990s “Harry and Louise” ads aired against health care reform initiatives under then-President Bill Clinton, yet another effective smoke and mirrors campaign occurred more recently under the push for President Obama’s Affordable Care Act (A.C.A.) in the late 2000s. The A.C.A. quickly became known as Obamacare, as dubbed by health care lobbyist Jeanne Schulte Scott in a health industry journal in 2007, linking the legislation to partisan politics rather than policy. According to N.P.R. in February of this year, the rename-game waged through relentless Republican advertising still weighs heavily on the American conscience with as much as one-third of Americans unaware that The Affordable Care Act and Obamacare “are one and the same.”

Lost in the shuffle, seven decades after Roosevelt’s call to action, millions continue to lack access to basic health care in the United States. As Republicans enter the August recess empty-handed and dumbfounded that “health care [reform] could be so complicated,” in the elegant words of current Commander-in-Chief President Trump, now seems to be the time for Democrats to take control of the messaging war. Even without majority sway in the Legislative or Executive branches, they seem to have the moral high ground.

The life expectancy for the top 1 percent of American men remain nearly 15 years longer than the bottom 1 percent of male income earners; among women of the same income brackets, the respective disparity is a little over 10 years, according to an MIT study conducted last year. Eric Schnurer of The Atlantic has also weighed in on today’s disparities in care: “For those who do have private coverage, the costs of care remain a heavy, and growing, burden,” he continues, “These problems tend to reinforce each other. For instance, the cost[s] of care for those lacking coverage get absorbed by those who have it. An emphasis on expensive, technologically-advanced treatments for catastrophic illnesses raises costs across the board, driving many away from obtaining less-critical care that could keep more people healthy.” While such a cycle may seem devastating to most, it has often fallen on deaf legislative ears.

“This time, we’re bailing out the big insurance companies. Why? Partly because of the crony capitalism that pervades the culture in the swamps of Washington,” Kentucky Senator Rand Paul wrote in a Washington Examiner op-ed on an effort that now has bipartisan support to ensure the federal government continues to reimburse insurance companies that provide coverage for low-income Americans. With Paul’s profoundly distant conceptions of the realities faced by Americans in his own state, one of the biggest beneficiaries of state-run services like the A.C.A, where is Democratic rebuttal?

Medicare-for-All has polled well among the majority of Americans. A recent YouGov poll found that 60% of Americans want such a system in place at the national level. Despite the fact that Medicare-for-All-style policies like that of Senator Bernie Sanders of Vermont tend to look a lot like a Single Payer system, a June Pew Research Poll found just 33% of Americans approve of the near-identical program.

The economic route now seems the most logical for Democrats to take to shake the “socialized medicine” connotation. In comparison to other wealthy nations, the United States, the wealthiest in the world, currently spends far more—around 17 percent of GDP, almost 50 percent higher than France, who are the next highest spender at 11 percent on their national health care service—to provide some of the worst coverage with respect to both access and the quality of care. With cost-cutting implications like allowing a governmental entity much more negotiating power as a sole provider, and the elimination of competitive insurance advertising (which have accounted for up to 15% of total expenses for private insurers), if implemented, single payer has the potential to dramatically cut U.S. spending in the industry.

The messaging wing of the Democratic party has so far unveiled an economically oriented, yet largely health care reform-deficient campaign in its Better Deal 2018 midterm elections platform. Senate Minority Leader Chuck Schumer of New York, however, says single payer is still “on the table.” In recalling Truman’s ambitions that “our ultimate aim must be a comprehensive insurance system to protect all our people equally against insecurity,” why not fire up a campaign waged against disparities in health care coverage and access as a national security risk for all Americans? Call it Medicare-for-All, human rights, or something entirely new. Where is the Democratic War on Sickness?

Emmet Teran