Teaching Healthcare History in the Age of Obama

I should have seen it coming. Really! But when I planned a class discussion on the origins of Medicare, I hadn’t considered the implications for our ongoing national conversation about universal healthcare. Fortunately, my students are more perceptive than I am, and they instantly made the connection for me.

“So, even back then people were trying to stop us from getting health care?” 

“I have heard that Medicare is basically a socialist system and that we would be better off as a country without it.” 

“It sounds like the Republicans were against Medicare before they were for it.” 

These are just some of the comments students offered as we considered the history of America’s most popular social program (OK, Social Security is equally popular). The implementation of the Affordable Care Act (or, “Obamacare,” as both proponents and opponents refer to it these days) has forever changed the way we teach the history of American health care. I should start by acknowledging that I’m more fortunate than most professors in one respect: A large percentage of my students haven’t really been exposed to the alternate, right-wing reality that is Fox News. However, I always have at least one or two students whose main role in these discussions is to repeat debunked assertions about the ACA, Medicare, or the historical movement for universal health care. So . . . there are plenty of opportunities for lively discussion.

After my brief presentation on the passage of Medicare and the politics that drove it, students were eager to make connections to our present-day push for universal health care. Here are some of our takeaways:

1) If the history of Medicare is any indication, Obamacare is here to stay. The debate surrounding Medicare’s passage indicated a robust division of opinion and offered no assurances that it would become a fixture in the American landscape. And yet it did, far sooner than most predicted. To put it bluntly, even the most conservative politicians are loathe to advocate taking away a right or benefit once it is in place. With media outlets report an Obamacare “surge” (see here and here), it’s becoming clear that millions of uninsured Americans will soon have coverage for the first time. Conservatives have never been able to end universal coverage for seniors, and they’re not likely to do so for the newly insured this time around.

2) Expanding health care has always been controversial. My students were struck by the intensity of opposition to Medicare in the 1960s. They’ve grown up in an America in which Medicare is not just well liked, but overwhelmingly popular. New York Times articles like this one, though, are a reminder that huge numbers of seniors originally saw Medicare as a government intrusion or even as a socialist conspiracy. That they turned out to be wrong shouldn’t dim our historical memories: the opposition to Medicare was fierce. It also faded drastically as people came to understand (and rely on) the program.

3) Passing a law is difficult; repealing one is nearly impossible. It’s amazing how little traction the movement to repeal Medicare received, even as the program got off to a rocky start. For whatever reason, even many people who opposed the law were reluctant to embrace repeal once the program reached millions of Americans. Most of my students concluded that the recent flurry over Obamacare’s roll-out is basically the “last gasp” of the opposition. I agree with them. Who will sponsor the bill to kick young people off their parents’ coverage? Or to send Americans with pre-existing conditions back onto the rolls of the uninsured? Will conservatives ask for repeal of the exchanges once millions have used them to sign up for coverage? History reminds us that it’s unlikely.

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