1977: Incremental approach instead of universal coverage
We negotiated long and hard in 1977 to compromise on a single-payer system and agree instead to support a plan built on our existing system of private insurance provided that coverage was mandatory and universal.
In November 1977, Carter made it clear
that he had no intention to hammer out a legislative proposal. The moment called for bold leadership and swift action built around a single piece of legislation. We continued to work toward that end. And Carter continued to slow down the process.
By the summer of 1978, I felt that the president was squandering a real opportunity to get something done. The Jimmy Carter who had declared that he wanted mandatory and universal coverage and had a plan that was nearly identical to mine had
now been replaced by the President Carter who wanted to approach health insurance in incremental steps, over time, if certain cost containment benchmarks were met--and after the 1978 midterm elections.
Across-the-board cap on hospital charge annual increases
In his first address to Congress after succeeding Nixon, President Gerald Ford urged lawmakers to approve a national health insurance bill, but President Ford's short tenure was dominated by high inflation and other economic woes.
Jimmy Carter also focused on inflation when he became president in 1977. Even though he had supported universal coverage during his campaign,
President Carter decided that his first foray into health care would be an attempt to rein in costs, not expand coverage. In the previous decade, the consumer price index had increased by 79.7%, while hospital costs had risen 237%.
President Carter proposed an across-the-board cap on hospital charges that would limit annual increases to 1.5 times any rise in the consumer price index.
Carter was not successful in gaining support for his national health-insurance bill or his proposals for welfare reform and controls on hospital costs. He was unsuccessful also in gaining congressional approval of plans to consolidate natural-
resource agencies within the Department of the Interior and expanded economic development units in the Department of Housing and Urban Development. Also, his tax-reform proposals were not favorably received by Congress.
Source: Grolier’s Encyclopedia, “The Presidency”
, Dec 25, 2000
National health insurance addresses gross inequities on poor
On national health insurance, we have an abominable system in this country for the delivery of health care, with gross inequities toward the poor-particularly the working poor-and profiteering by many hospitals of the ill.
The buffer between expensive
medical care and patients' ability to pay at the time of illness is provided by insurers. Many people have no hesitation about unnecessarily entering a hospital, receiving expensive diagnoses while they are there, staying an extra day or two, and
accepting the most elaborate service and treatment. Some even see it as a way to get back their investment in the insurance premiums.
At that point, both doctors and hospital owners benefit, while the patient is an unwitting contributor to higher
medical costs and inequitable distribution of medical care. From the enormous profits, unnecessary hospital facilities can be built. Normal competitive restraints on excessive costs are almost nonexistent.
Lost to lobbyists on hospital-cost containment law
For most of my term, I fought the hospital and medical lobbyists, trying to initiate hospital-cost containment measures designed to insure adequate health care at a reasonable expense. This was not an unproven idea.
Several states had already implemented such a system, with notable results: much lower costs to patients and adequately sustained profits for the hospitals and doctors.
I was never able to succeed in this effort, which would have saved the American people more than $50 billion (!) in the first 5 years-after leaving the hospitals free to raise their prices
50% faster than the prevailing inflation rate. In the final showdown, Congress was flooded with money, in the form of campaign contributions from the health industry.
Carter’s politics fit no simple category. He could be conservative on abortion and welfare reform and taxes, and simplifying the federal bureaucracy, liberal on programs like National Health Insurance, Day Care, ERA, cutting the defense budget.
Like Robert Kennedy, he became a new kind of liberal, leapfrogging over the old liberalism he thought to be obsolete, unworkable, divisive. He questioned the old shibboleths of welfare and federal paternalism.
Source: [X-ref Principles] How Jimmy Won, by Kandy Stroud, p. 13
, Jan 1, 1977
Supports national health insurance
Let me outline for you some of the goals of the next administration in the area of health [insurance]:
We must have a comprehensive program of national health insurance.
We must have government reorganization that will end the bureaucratic
fragmentation that now frustrates any hope for a rational and effective national health care policy.
We must encourage alternative delivery systems such as HMOs and rural group practices.
We must clean up the disgraceful Medicaid scandals.
Source: Public Health speech, in “Good As Its People,” p. 231-33
, Oct 19, 1976
Supports more funding for education & research
Let me outline for you some of the goals of the next administration in the area of health [education and research]:
We must stress health and nutrition education. Our public schools could do more to teach our young people the dangers of drinking,
smoking, using drugs, overeating, and eating the wrong kinds of food.
We must mount a renewed attack on cancer and other diseases caused by toxic chemicals in the environment.
We must continue and expand biomedical research and be sure that it
serves the health needs of all our people.
We must encourage nursing home standards of safety, sanitation, and care, and we must encourage programs that will serve elderly people in their own homes whenever possible.
Finally, we must, by
scholarships, by loans, and by other means, provide medical education to more students, for minority and low-income families and also to more women, and we must encourage young health professionals to train and practice in rural and inner city areas.
Nationwide comprehensive mandatory health insurance
Carter says he favors a nationwide, comprehensive mandatory health insurance program. His plan is that such a program would be financed through both the employer and the payroll taxes, as well as general revenue taxes.
Patients would still be free to choose their own physician, but the federal government would set doctor's fees and establish controls to monitor the cost and quality of health care.
Carter's proposal is very similar to the Kennedy-Corman health security bill now before Congress. Interested in promoting preventive medicine,
Carter would also like to have more supportive personnel, as paraprofessionals and nurse practitioners, available to patients.