President Obama’s Affordable Care Act has been labeled “a radical liberal plan” and “socialized medicine” by Republican opposition. Yet the roles were reversed in the early 1970s when President Nixon proposed his health plans. A new article in Pediatrics compares the proposals of both presidents and how opposition responded to them.
While many would hesitate to draw similarities between Nixon and Obama, the article by academics from the University of Michigan Medical School demonstrates that extent of partisan political rhetoric in health policy debates.
“It’s not that one is right and one is wrong,” says author Dr. Gary Freed. “But more that this is a chance to address the appropriate place of political rhetoric when it comes to improving public health, and the dangers of elevating blind partisanship over meaningful debate about important issues for our nation’s health.”
The authors illustrate that had Nixon’s proposals gone through, more people would have had insurance coverage than the number currently covered by the Affordable Care Act, also known as Obamacare.
Nixon’s initial National Health Strategy proposal in 1971 ruled that all employers would be required to provide basic health insurance to employees and that most of Medicaid for poor families would be replaced with a federal plan open to any family whose income was below a certain level.
After this proposal had failed, Nixon came back in 1974 with his Comprehensive Health Insurance Plan. This proposal stated that all employers were required to insure full-time employees and that Medicaid would be replaced with a plan available to those unable to get employee health insurance or afford their own coverage.
President Nixon explained the thinking behind his approach:
“Those who need care most often get care least. And even when the poor do get service, it is often second rate […] This situation will be corrected only when the poor have sufficient purchasing power to enter the medical marketplace on equal terms with those who are more affluent.”
Dr. Freed believes that the US of today would be a very different country had the Nixon proposals been passed. “Instead, we had 30 more years with one-third of the population uninsured,” he states.
In comparison, the Affordable Care Act of 2010 ruled that employers with more than 50 employees are required to offer affordable insurance including a minimum set of benefits to most employees, or pay employees extra if they are eligible for tax credit to buy marketplace insurance.
The act defines “affordable” insurance coverage as that which costs less than 9.5% of a household’s income.
In the 1970s, the Democrats declared that Nixon’s proposals did not go far enough and instead offered a health proposal that the authors of the article consider far more liberal than anything the party has suggested in recent years.
It appears these changing perspectives are more indicative of the two parties’ opposition toward each other than what they stand for in terms of health care. Positions can change over time, but it appears as though the Democrats and Republicans are inflexible when it comes to their disagreements.
“We need to put health care in a historical perspective, and not go to extremes for political purposes,” Dr. Freed concludes. “I would hope this history will help policy makers think about what the policy is trying to accomplish for the American people, and not turn a blind eye to proposals simply because they’re proposed by one party or the other.”
Last year, Medical News Today reported on a study investigating state-specific difference in Medicaid provision that found cancer screening could be affected by different reimbursement and eligibility policies.