The Fair Deal Universal Health Care Proposals: Historians’ Perspectives from 1970 to 2003

Abstract

Throughout the Truman administration’s Fair Deal era, ideas for a national system of publicly financed universal health care were developed, debated, and even proposed in Congress. In spite of public support for health care reform, each legislative proposal that embodied these ideas failed, and the dream of truly universal health coverage has never been resurrected. Historians who have examined the failure of the Fair Deal proposals have generally agreed that opposition from within Truman’s own party and from congressional Republicans, combined with opposition from organized medicine, contributed to the ultimate failure of the proposals. But an examination of historical accounts of the Fair Deal health proposal failures written during a period beginning shortly after Medicare and Medicaid were enacted and ending amid President George W. Bush’s calls to privatize Medicare and Social Security shows that over time, historians’ interpretations of the failures shifted in two major ways. First, historians’ answers to the question of why the proposals failed changed. Over time, the roles played by politicians opposed to the programs and by organized medicine were viewed as less central to those failures. And second, historians began to ask a broader set of questions than simply “why did the proposals fail?” Later historians in this period asked about the ways in which the “universal” programs, had they been enacted, would have neglected many marginalized groups, and about the larger impacts of the proposals’ failures. This paper begins in Part I with a brief history of the Fair Deal proposals for a public, compulsory, universal system of health care coverage. In Part II, the accounts of five historians, written over a period of 34 years, are examined, with a focus on the factors to which each attributed the proposals’ failures, and on the broader implications — if any — that each historian addressed. And in Part III, I posit that two developments during the period in which these historians worked — the ascendency of a new conservative movement and the failure of the Clinton health care plan — partially account for the changes in their interpretations of the Fair Deal health proposals.