The most strident opposition to nationalized healthcare for the elderly
had arisen from the AMA, calling Truman’s initial proposals “un-
American” and “socialized medicine,” fearing that congressional oversight
of medicine would lead to poor doctor pay. During the forties and fifties,
“government solidified the private health-care system through corporate
tax breaks that subsidized companies offering insurance to their workers.
More workers were brought into the private system through this indirect
and hidden form of government assistance, creating even greater
resistance to the idea of the federal government directly providing
insurance.”^13 While the AMA and its physicians had little power in the
1800s, the modernization of medical education, and the purging of
pretender medical schools in the aftermath of the (Carnegie Foundation–
funded) Flexner Report of 1910, resulted in the monopolization of power
by physicians, as Pulitzer Prize–winning medical historian Paul Starr has
advanced.^14 Flushing snake oil down the drain after the Pure Food and
Drug Act of 1906 and shuttering counterfeit medical schools after the
Flexner chronicle endowed doctors with ever-increasing prestige and
negotiating power.
The first Congressional bill to address healthcare for the elderly was the
Kerr-Mills Act (Social Security Amendments of 1960). Although the
dream of compulsory national health coverage for all Americans had died
decades earlier, even limited coverage for the elderly had been a slog.
Oscar Ewing’s chief advisers Wilbur Cohen and Isidore Falk, therefore
developed an “incremental approach” to accomplish their (as of 2019, still
unrealized) goal of universal coverage. “The idea [of incrementalism] was
to bring about the passage of a modest program of insurance for a small
number of people, and then gradually to expand that program until it
covered the entire population.”^15 The Kerr-Mills Act had tremendous
bipartisan support, as opposed to Sen. John F. Kennedy’s alternate
compulsory health insurance proposal, to be financed with an increase in
Social Security taxes. While there was an increasing number of retirees
who had health insurance (31 percent in 1952, 44 percent in 1956, and 53
percent in 1959),^16 the Kerr-Mills Act depended upon states agreeing to
participate and the efficiency of federal administration, two of the factors
that limited its effectiveness.
Incrementalism is a fruitful tactic if a restricted or pilot program
thrives; alternatively, incrementalism can also be a winning strategy if the