Starr Outlines Historical Drama of 'War' on Health Care in F&M Talk

  • Paul Starr, a Princeton University sociologist and Pulitzer Prize-winning author, spoke at Franklin & Marshall College Sept. 6. (Photo courtesy of Paul Starr)

The "war" over health care is a century-old, uniquely American conflict that continues to rage this election season following the passage of "Obamacare," health care expert Paul Starr told a Franklin & Marshall College audience.

America's health care battle has played out like a "historical drama," said Starr, a Princeton University sociologist and Pulitzer Prize-winning author. The conflict began a century ago, when most European countries adopted a package of "social insurance" programs protecting employment disability and health care. The United States soon followed with its own series of government aid programs—covering everything but health care—with some calling universal coverage "socialized medicine" that stemmed from enemy regimes.

"Among the rich democracies of the world, the United States stands out, not only because we have some 50 million people without health care, not only because we have by far the highest health care costs in the world, but also for the sheer rancor of the conflict over health care," Starr explained in his lecture at F&M on Thursday, Sept. 6."We have been at each other's throats over health care for just about a century. And in no other democracy is health care a central issue of ideological conflict," said Starr, who won the Pulitzer Prize in 1984 for his landmark book, "The Social Transformation of American Medicine."

Starr, who served as a White House adviser during President Bill Clinton's failed health care reform effort, offered a sometimes firsthand account of the exploration of American health care to a crowd of nearly 775 students, faculty and staff at Mayser Gymnasium. His talk was part of Common Hour, a weekly series held midday each Thursday during the academic year, when no classes are in session.

The series is intended to bring the entire F&M community together for culturally and academically enriching events and to promote dialogue on vital international, national, local and institutional issues, said Annalisa Crannell, chair of the Common Hour committee. The events allow students to interact with leading figures on issues ranging from the environment to technology, religion and the presidential election. Most events are open to the public, although some are reserved for the College community.

As he does in his most recent book, "Remedy and Reaction: The Peculiar American Struggle Over Health Care Reform," Starr outlined in his lecture the continuing struggle for universal health care for all Americans, beginning with the earliest efforts in the late 20th century to the Nixon administration, the Clinton era and the Affordable Care Act today, which recently was upheld by the U.S. Supreme Court.

"How did we get to the situation that we have such acrimonious debates over health care?" Starr asked. "Some say it is because Americans are individualistic."

But the United States has a system of public education, he said. With health care, the nation adopted a series of measures that made the system "much more complicated and expensive" than systems elsewhere.

"The United States ensnared itself in what I describe as the American health policy trap," Starr said.

The battle for health care has faced some unusual struggles. Presidents Franklin Roosevelt, Harry Truman, Dwight Eisenhower and Richard Nixon all initiated some kind of health care reform. Nixon, a Republican, might have been successful if he had not faced his own personal scandal, Starr said.

"Richard Nixon's (proposal) in 1974 was to the left of any plan that any Democrat has proposed in recent years," Starr said. "Nixon would have required any employer to pay for health insurance and then he would have created a government program for everybody else.

"But what happened with Richard Nixon? Watergate happened to Nixon," Starr said. "I believe if Richard Nixon had only been wounded, and not destroyed, by Watergate, we might have actually had an agreement that year in 1974 and adopted a national health care plan."

Starr, who worked on the Clinton campaign and then in the White House on the issue of health care, said his group, like the reformers in early 20th century, believed Congress was on the verge of passing legislation. But the issue became "politically treacherous" for Clinton.

"There was no agreement or consensus at that time. The proposal collapsed for lack of support, among even the Democratic party," Starr said.

Later, an unlikely advocate—former Massachusetts governor and current Republican presidential candidate Mitt Romney—would push forward universal health care in 2006 in Massachusetts, a move Romney now says would not be good for the country as a whole. But President Barack Obama and the Democrats used parts of that plan as the basis for their 2008 campaign for health care reform.  

"Why did Obama succeed in 2010 in passing legislation whereas Clinton had failed in the early 1990?" Starr asked. "I think the No. 1 difference is the achievement of a consensus that embraced Democrats in Congress and the major interest groups in health care: hospitals, doctors, the pharmaceutical industry."

The consensus did not include Republicans in Congress, so they challenged it in the Supreme Court, Starr said. The Affordable Care Act—known widely as "Obamacare"—was upheld as constitutional, but the debate continues.

"The next scene will be played out in the election," he said.

To view video highlights and full recordings of this and other Common Hour lectures, visit the Common Hour website.

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