I'd like throw a new thought into our current national debate about health care, by looking back in time to the Rural ElectrificationAct of 1936. This Act was established during the Great Depression to provide farms and other rural locations with inexpensive electricity, for lighting and other purposes. Why did Congress bother to pass this law? We had reached the point in society where electricity was necessary, but the market cost to install and service electrical lines out from cities to rural locations was prohibitively high. TheREA was set up as a subsidized loan program, with loans going to governments and local co-ops, but not directly to individual consumers. These days, the REA has evolved to add pilot programs for high speed (gigabit) Internet to rural areas of the U.S.
Fast forward to the early 1960’s, and health care for seniors. At that point, health care for senior citizens had become like electricity for rural citizens a generation earlier: necessary, but too many were beingpriced out of the market. The solution was Medicare, which was a subsidy like rural electrification funding, with funding being a “single payer” model to caregivers, but it wasn’t done as a loan. Still, it was done to solve a problem that the free market was having trouble addressing, and Medicare has been viewed as a popular success since it became law in 1965.
Medicaid, which came later, and then the Affordable Care Act of 2009 attempted to address similar issues, but with a different population. Rather than focus on groups defined by geography or age, this time the concern was health history and/or economic status. Those with pre-existing conditions or lack of sufficient financial resources were being priced out of the market. Medicaid and the ACA attempt to make necessary health care affordable for these groups of people. It has been a mixed success, as we know, and now Congress is considering repealing the ACA.
But, let’s go back to the REA for a moment and imagine if that had been a more recent creation with a more recent President. Here’s a paragraph from an alternate reality version of Time magazine:
In order to achieve universal electrification, Obama and the Democrats passed the Rural Electrification Act. At the time the Rural Electrification Act was passed, electricity was commonplace in cities but largely unavailable in farms, ranches, and other rural places. The Republicans branded it "ObamaPower" and did everything they could to prevent its proper implementation, including court cases, filibusters of related bills, and the famous "You Lie!" moment in Congress. They ran on repealing ObamaPower, and remarkably won seats from the rural districts most likely to benefit from the Act.