Stassencare?

David T

In his 1947 book *Where I Stand* Harold Stassen--ex-Governor of Minnesota and a very serious candidate for the GOP presidential nomination in 1948--tries to advocate a middle path on health insurance. He opposes the Wagner-Murray-Dingell bill for national health insurance, saying that "It would strike at that most priceless of American ingredients, the independence of spirit, and it would have a debilitating and deteriorating effect on our medical men and women." (*Where I Stand*, p. 191). However, he adds (p. 194):

"I am opposed to having the Federal Government take over the payment of all hospital and medical bills. But I do believe that provision should be made for a federal-state insurance approach to the exceptionally heavy doctor and hospital bill.

"Every American now on the Social Security rolls could be provided with insurance against hospital or medical expense in excess of $250 a year.

"Such a program would leave all the normal hospital and medical costs--those under $250 in a single year--to be handled as they are now. This would avoid placing the Government in an overshadowing bureaucratic role, and would keep the medical profession from becoming subordinate to a government insurance agent.

"...As for those not affected by Social Security, they could enter the insurance plan on a simple basis by payment of an annual fixed fee.

"By limiting the coverage to major cases, the extreme difficulty of administering all hospital and medical bills would be avoided, the urgent economic need would be met, and various voluntary private insurance plans or personal payment would continue to meet the vast majority of bills, which are small, and also the first $250 of the heavy bills..."

Suppose Stassen is nominated (not implausible) and elected (not too likely because unlike Dewey he probably won't carry New York, and that may cancel out any advantage he has over Dewey in the Midwest--but still not totally implausible). It will be hard for him to get Stassencare (as it won't be called) through Congress; some conservatives will oppose it as the entering wedge for completely socialized medicine, while some liberal Democrats might foolishly help to defeat it because they still insist on the obviously un-passable Wagner-Murray-Dingell bill. But suppose it's enacted. What are the consequences, especially as inflation makes the once formidable $250 deductible almost meaningless (unless Congress periodically increases it or indexes it to inflation)?
 

AdmiralBlake

I don't know about the economics of it, but it certainly seems reasonable.

Stassen was always considered part of the liberal wing of the party though, and in 49-53 Robert Taft is still going to be influential in congress.
 

Gannt the chartist

I think you run into the fundamental problem that wage controls in WW2 had led to health insurance being used as part of the remuneration package. Yes you can do it but there are a lot of knock on consequences. You are really asking for the renegotiation of most of the employment contracts of the nation.
 

Workable Goblin

I suspect that, like Medicare and Medicaid, there will be multiple attempts at tinkering with the plan over the years, many of them altering the funding formulas. Certainly Congress will adjust the deductible to follow inflation at some points, though obviously the exact changes are unpredictable.

The consequences...well, the United States basically has a single-payer catastrophic and old age health insurance plan. Like Social Security and Medicare, I suspect it will quickly become popular enough to be radioactive, and even when and if the country's mood begins to lean conservative the idea of radically modifying it will only be red meat for the base, much as with converting Social Security to a private investment scheme. Hence, there is no real question of it being abolished, even if it might be modified or a Medicare Part D-type parallel private insurance system created. I also suspect that it will basically always cover heavy hospital and doctor bills, at least, and there's a good chance that Congressional inaction, especially in the 1970s and 1980s (assuming inflation bites like IOTL) could lead it to becoming a de facto single-payer scheme. That will be much too popular to fully reverse, most likely. Extension may or may not be needed to prescription bills, which could be a major thing in the 1960s or 1970s.

This could help urban hospitals (with a large uninsured clientele) a lot, especially trauma centers (because trauma is expensive) and other hospitals with an unusually large number of expensive cases (e.g. cancer centers). I'm not sure how it would affect rural hospitals, though it would probably be more of a mixed bag. Of course, any specific policy modifications that Congress makes in the future to the program would alter this. It might lead to somewhat more rationalized costs, especially for prescription drugs if it becomes a proper single-payer plan.
 

TheYoungPretender

I could see this happening, in a kind of Bismarck-y way if Stassen won. It's a "let's give them some healthcare before they listen to the reds and demand it all" type of thing.

It's having every single person pay the government for health care, but remember - as recently as March, 2009, mandating that every person pay health insurance premium had been the decades-held position of the American right on health insurance. So Stassen's proposal is hardly ASB - more along the lines of Richard Nixon's price-controls, a thing that had to be done for the public good.
 

GeographyDude

And it's straightforward enough that it might constitute an experiment. Do you like this part, or not like this part?

So, among the better case scenarios might be that for a fair number of persons this leads to an advancement of their skills as citizens. Not just drawing out political theory and debating theory, but getting a healthy interchange going between theory and practice.
 

TheYoungPretender

It doesn't provide a dime towards preventative care, so you still have a lot of the negatives of the OTL system: people not going to the doctor until a $20 problem has become a $20,000 problem. On the other hand, it provides a framework to which you can start adding preventative in the intervening decades - likely to control costs. But the downside is that if that doesn't happen, it could cost like the NHS without preventive care. Not necessarily a good thing.

But there's no plausibility problem to it - Stassen in 1948 is most certainly in the GOP before 2009, absent any blue boxes.
 

GeographyDude

Thanks.

(and I rather like the idea of a middle-of-the-roader, either a liberal Republican or a more conservative Democrat becoming president. And in OTL, I think in a number of ways Eisenhower was moderate Republican, right?)
 

GeographyDude

The Family and Medical Leave Act (FMLA) might be a very good example of straightforward legislation. There's a few provisions, such as the fact that it's unpaid leave, that it applies to companies with 50 or more employees. I mean, you can probably put the whole thing on one half of one side of a piece of paper. And then it's an open possibility of moving onto the dynamic level of understanding how it works in the real world.

As an analogy, think about a card game where players understand it well enough to anticipate each other's moves, have a good feel for when to take some chances and when to hold back and play more cautiously. And compare this to a flat game where it's all players can do is to keep track of the rules.
 
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