“Forced down their throats”

I’m enjoying Jonathan Oberlander’s The Political Life of Medicare. I can’t help but share some quotes, like this one from page 28:

Vice President and presidential aspirant Richard Nixon hailed the apparent defeat of Medicare [in 1960], arguing “The American people … do not want, they must not have, a compulsory health insurance plan forced down their throats.”

Clearly America has a rich history of health reforms forced down throats. We also have a rich history of political parties posturing as defenders or supporters of Medicare. Here’s Oberlander on pages 29-30:

[T]he circumstances of the Johnson victory [in 1964] caught Medicare advocates unprepared. […] Now, when the stunning electoral outcome permitted a broader vision, Medicare advocates stuck to their original proposal, which had been conceived at a time when the political constraints on Medicare were far stronger than they were in 1965. […]

Whereas supporters of Medicare did not alter their strategy, Republicans perceived that Medicare’s passage was now inevitable and rushed to avoid being seen as obstructionists. They criticized Medicare for offering inadequate benefits. […]

Interesting that Oberlander suggests Johnson and the Democrats missed an opportunity to pass a more generous or expansive Medicare. Then again, through legislative and political ingenuity, they did achieve more than they originally planned. Oberlander continues,

The final Medicare legislation […] combined what were seen as mutually exclusive alternatives, the Johnson administration, AMA, and Republican bills, together into a “three-layer cake” of hospital insurance for the aged (Medicare part A) a voluntary program of physician’s insurance for the elderly (Medicare part B), and [a …] program of federal assistance for state medical services payments for the poor (Medicaid). […] The move stunned both Medicare opponents and proponents. Wilbur Cohen, then assistant secretary for legislation in the Department of Health, Education, and Welfare […] believed that: “It was the most brilliant legislative move I’d seen in 30 years. The doctors couldn’t complain because they had been carping about Medicare’s shortcomings and about its being compulsory. And the Republicans couldn’t complain, because it was their own idea. In effect, Mills [the architect of the legislation] had taken the AMA’s ammunition, put it in the Republican’s gun, an blown both of them off the map.”

By some reckoning, the next morning Americans awoke with very sore throats, the likes of which they would not experience again for 45 years.

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