Henry Kaiser, born in 1882, was a self-made man. His first job was as a clerk in a department store. Eventually he owned construction companies, an aluminum manufacturing company, auto manufacturing plants and lines of automobiles long since discontinued. His companies helped build the Boulder (Hoover) and Grand Coulee Dams.
He also owned four shipyards on the West Coast and when the war came those shipyards began to produce what came to be called Liberty Ships and later larger ones called Victory Ships. They also built about 100 small aircraft carriers for the Navy.
The shipyards tuned our prodigious numbers of ships in record time. Between Nov. 8 and Nov. 12, 1942, for example, Kaiser’s Richmond Shipyard Number 2 set a record when it built the Liberty Ship SS Robert E. Peary in four days.
Building that many ships that fast meant you needed a lot of workers but in a nation that had a population of 140 million in 1940 and would by the end of the war have put 16 million people into uniform, the competition for civilian workers was fierce.
Kaiser didn’t need riveters like Rosie because one of the reasons his shipyards could produce so many ships so fast is that they developed a system to weld ships together. But that takes a lot of welders and other workers – men and women — and at its peak the Kaiser shipbuilding enterprises employed over 20,000 workers.
One way to lure and compete for employees turned out to be providing health coverage and health care. Books have been written about how Henry Kaiser and the doctors he employed created that health care system. In simplest terms, they created managed care.
Today it is called Kaiser Permanente — a massive inter-related, inter-organizational complex — the nation’s largest managed care system, a system of hospitals and permanent Medical Groups.
As of 2015 it had 10 million members (3% of the U.S. population), 186,000 employees, 18600 doctors, 51,000 nurses, 38 medical centers and 622 medical offices.
Just a side note: Why Permanente? A word that sounds like it has some over-arching policy purpose or connection? In fact, nothing of the kind. Kaiser was also in the cement business. His first cement plant was on the Permanente Creek in Cupertino, Calif. Mrs. Kaiser liked the name so when the Kaiser medical center opened in Oakland in 1942 it got named Permanente Hospital.
Other employers competing for workers noticed and began to offer health coverage. But the thing that nailed it came in 1943 in a ruling by the Internal Revenue Service that employer health coverage could be offered as a tax-free benefit.
In 1940, some research says, only 9 percent of the U.S. population enrolled in employer-based health care. By 1953 that reached 63 percent and by the mid-60’s 70 percent, as pretty much everyone with a job expected health coverage to be provided by the boss.
But what if you didn’t have a job, had retired and didn’t have continuing benefits or were too poor to pay for health coverage even if you worked but maybe your employer didn’t pay for health coverage?
President Truman, after President Roosevelt, tried mightily to get a national health plan passed. One reason he failed is because segregationist southern Democrats, forbearers of today’s southern Republicans, were leery of a federal health program they thought could force racially integrated care.
Lyndon B. Johnson came to Washington as a young congressman in the late 1930s as a New Dealer. He knew the New Deal had unfinished business and when he succeeded to the presidency and won election in his own right he determined to finish some of it. He proposed Social Security amendments that won passage and created Medicare, the federal health insurance program for people over age 65, and Medicaid, health coverage and care for income qualified poor people.
President Nixon attempted some forward-looking improvements in the health care system but was mostly stymied.
President Clinton famously put his wife in charge of health care policy and lost the war but won a battle when Congress adopted the Children’s Health Insurance Program, called CHIP, an expansion of Medicaid to cover children.
That takes us to 2009 and passage of the Affordable Care Act, which the Republican mob in congress has been howling to dismantle for seven years and which the House Majority is desperately trying to round up votes to do as this is being written with a bill that is a dog’s breath.
These Republicans might pause to consider that in 1965, 70 House Republicans joined 237 Democrats to enact Medicare and Medicaid, while 13 Senate Republicans joined 57 Senate Democrats to pass the legislation.
Yes Virginia, once we had bipartisan government and there were moderate Republicans.
Today, 44 million people are enrolled in Medicare. There are some 74 million enrolled in Medicaid, including 5.5 million kids in CHIP and there has been a 16.2 million-person increase since October 2013, reflecting expansion of health care under the Affordable Care Act.
This means the total number of Americans without health coverage has been cut more than 40 percent since the ACA took effect, from about 50 million to 29 million today.
The Congressional Budget Office estimated last week that the Republican substitute would soon throw 24 million people back into the uninsured category. Shouldn’t the objective be to get to zero, not to turn 29 million into 53 million uninsured?
The Republicans say they are conservatives. If they truly are they should follow the example of that noteworthy 19th Century German conservative, Otto von Bismarck. They should do what Germany did in 1883 and move to convert Medicare into a universal national health care system, relieve employers of the burden of providing and administering health insurance, and do all that while preserving each person’s private choices of physicians and hospitals.
Bismarck understood the way to head off revolution is to allow social advancement that disarms the revolutionaries. Republicans are slow learners. They still, 135 years later, have not learned the lesson of his 1883 Sickness Insurance Law.
Now, as I look back, this piece has been posted to this blog for about four days and here today, Sunday, is this piece in the NY Times, which confirms everything you have read here and lays out the plain, simple case for a national health care system — a Medicare for all system:
Peeling the Onion 