By Timothy White

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As we head into the 2020 presidential campaign, the No. 1 issue for most of the Democratic candidates is some version of universal medical coverage for all Americans.

Republicans will challenge the need for universal medical coverage by stating that U.S. health care is the best in the world and there is no reason for change. If only this were the case. Unfortunately, the U.S. annual per capita cost of health care is nearly $12,000, 2 1⁄2 times that of the next country. And for this expense, U.S. life expectancy ranks 33 in the world according to the World Health Organization. But facts don’t win elections.

As I campaigned in the Democratic primary for Oregon’s 2nd congressional district in 2018, I clearly stated, yes, universal health care was the right thing to do. It would be cheaper and provide better coverage for all, and it did not have a proverbial snowball’s chance in hell of happening. My argument was that health care is a $3 trillion annual business, providing the highest management compensation of any industry, and is firmly backed by the highest lobbying expense of any industry.

Here is a brief history of the issue. Universal health care is hardly a new idea.

As the industrial age began to explode in 1880, the rural populations migrated to the cities where they quickly became industrial pawns with no limitation on working hours for subsistence wages. As a result, disease, sickness and poverty flourished. The industrialized countries of Europe, namely Germany, England and France, took note of this inequity, and by the turn of the century had initiated compulsory health care insurance and old-age pensions.

The U.S. attempted to follow suit. In 1915 the American Association for Labor Legislation drafted a bill for the implementation of Universal Medical Coverage. Yes you read that right … 1915. It was endorsed by the Journal of the American Medical Association. Yale economist, Irving Fisher, pointed out in 1916 the U.S. has the unenviable position of being the ONLY great industrial nation without compulsory health insurance. Congress debated the bill and let it die.

Sixteen states attempted to put the bill into place on their own. When California attempted to this, a federation of insurance companies took out an ad in the San Francisco Chronicle warning the bill will spell disaster for the U.S. They sent a pamphlet to every voter in the state with a picture of the German Kaiser on the front with the words “Born in Germany.” They claimed the bill was “UnAmerican, Unsafe, Uneconomic, Unscientific, Unfair and Unscrupulous.”

Obama knew to get the ACA passed, he would have to make a deal with the devil and allow the insurance companies to provide the coverage.

Despite creating record profits for these companies, resulting from an additional 24 million customers, they still viewed the ACA as a threat. The ACA was too expensive, made affordable only by government subsidies.

As the subsidies were scheduled to subside and be picked up by the states, which would not have the funds to support them, the potential outcry of 24 million Americans forced to participate was going to be significant.

This is why eliminating compulsory participation was the primary focus of Republicans representing the insurance interest. The companies knew that compulsory participation meant eventually people would get used to it, want to keep it and demand the government do something about the cost. And therein, Obama laid the groundwork for the eventual implementation of real universal health care in the U.S.

Democrats, the issue is NOT universal health care. The issue is how to win an election. First you win. Then you go after the insurance giants with tax policy to dismantle their wealth and reason for existence.

Only then will you be able to implement universal medical coverage for all.

— Timothy White lives in Bend.