WASHINGTON — Even before Democratic presidential hopeful Hillary Clinton unveiled her new health-care plan, Republicans attacked it as socialized medicine. They neglected to mention, however, that her plan bears a striking resemblance to changes that were proposed in 1974 — by the late President Richard M. Nixon.
"It was an extremely extensive plan, as I remember, that would have given universal coverage" for health care, recalled Rudolph Penner, a former director of the Congressional Budget Office and economic official in the Ford administration.
Nixon introduced his Comprehensive Health Insurance Act on Feb. 6, 1974, days after he used what would be his final State of the Union address to call for universal access to health insurance.
"I shall propose a sweeping new program that will assure comprehensive health-insurance protection to millions of Americans who cannot now obtain it or afford it, with vastly improved protection against catastrophic illnesses," he told America.
Nixon said his plan would build on existing employer-sponsored insurance plans and would provide government subsidies to the self-employed and small businesses to ensure universal access to health insurance. He said it wouldn't create a new federal bureaucracy.
The Nixon plan won support from a Time magazine editorial on Feb. 18, 1974, which noted that "more and more Americans have been insisting that national health insurance is an idea whose tune (sic) has come."
Fast-forward 33 years to the American Health Choices Plan, which Clinton outlined Sept. 17, and to similar plans by Democratic rivals Sen. Barack Obama of Illinois and former Sen. John Edwards of North Carolina.
A CBS News poll earlier this year found that 64 percent of Americans support federally guaranteed health insurance for all citizens. Clinton's plan, like Nixon's, calls for building on the existing private-sector health-care system and using government subsidies and tax credits to get all Americans under an umbrella of health coverage. Like Nixon, Clinton said her plan "is not government-run. There will be no new bureaucracy."
Nixon's plan didn't require all Americans to purchase health insurance, as Clinton's does, something that's known in health-care parlance as an individual mandate. Clinton's rival Edwards also favors government-mandated purchases of health care. Obama would mandate only that all children be insured.
Like today's Democrats, however, Nixon sought help for small businesses and sole proprietors to pay for affordable health insurance.
Health care is among the top domestic issues in the 2008 presidential campaign in both parties. Three decades after the failed Nixon plan, the same drivers of debate are at play.
A growing number of Americans — 47 million — are uninsured. Medical costs continue to outpace inflation, albeit not nearly as fast as they did in Nixon's day. And Americans then and now fear that a single serious health problem can bankrupt a family.
If the next president decides to push for health-care restructuring, it will be the fifth such effort since World War II, when the practice of getting health-care coverage through employers began. (This grew out of wartime wage freezes; businesses tried to offset wage controls by giving workers greater benefits.)
The national health plans proposed by Presidents Harry Truman, Jimmy Carter and Bill Clinton also failed. Every time, the criticism was the same: They amounted to socialized medicine. The public support for health-care restructuring that built up during the campaigns waned as soon as the revisions began. That's because there hadn't been any upfront discussion of the difficult tradeoffs involved, said Robert Blendon, a health-care historian at the Harvard University School of Public Health.
In Nixon's case, there also was a timing problem.
"We had a few distractions then," joked Ray Price, who as Nixon's chief speechwriter crafted the State of the Union address and other speeches on health care.
Nixon's health plan followed his pivotal support for creating health maintenance organizations. But the effort was sidetracked by the widening congressional investigation into the Watergate break-in and cover-up, which eventually forced his resignation.
"The wagons were not only circling, but they were heavily arming and out for blood. It was very difficult to get anything through at that point," Price recalled.
Nixon first proposed national health insurance as a conservative California congressman in 1947. He grew up poor and lost two brothers to tuberculosis, which marked him for life. He frequently pointed to the cure for tuberculosis as a medical marvel that underscored the need for a public-private partnership on health care.
"It was something personal for him," Price said of Nixon's health-care push.
Despite the heated politics of Watergate, national health-care legislation was proceeding in Congress thanks to a compromise brokered by a young Democratic senator from Massachusetts, Edward Kennedy, a Nixon nemesis.
But then, according to a 1974 political almanac published by Congressional Quarterly, the AFL-CIO and the United Auto Workers lobbied successfully to kill the plan. Unions hoped to get a better deal after the next elections.
The rest was, as they say, history.
Nixon resigned that Aug. 8. Four days later his successor, Gerald Ford, addressed Congress and sought a bipartisan effort to pass national health-care insurance. But the economy soured, Ford sought to rein in government spending and national health care languished.
"Today, I think there's national consensus that everybody should have health insurance. That consensus wasn't there then," said David Matthews, who served as President Ford's health secretary from 1975 to 1977. "There is more of a consensus that everybody should have it, but the real uncertainty is still about who should play what role."
In his 1992 book, "Seize the Moment," Nixon repeated his support for national health insurance, sounding remarkably like today's leading Democrats:
"We need to work out a system that includes a greater emphasis on preventive care, sufficient public funding for health insurance for those who cannot afford it in the private sector, competition among healthcare providers and health insurance providers to keep down the costs of both, and decoupling the cost of healthcare from the cost of adding workers to the payroll," he wrote.
Details of the 2008 presidential candidates' health-care proposals: http://www.health08.org/sidebyside.cfm
McClatchy Newspapers 2007