America's health system isn't going to be changed without a struggle. Reform advocates would be well advised to study past battles the way generals do. In the 1960's Medicare's opponents co-opted the medical community, launched Ronald Reagan's political career, and arguably invented 'viral marketing' ... forty years before blogging and YouTube.
What makes you think it'll be any easier this time around?
The war against Medicare dated back to the 1940's, when Harry S. Truman attempted to to create a national health insurance system. (Yes, this debate's been going on intermittently for more than half a century.) He encountered a well-organized and financed opposition that included insurers, large corporations, the American Medical Association ... and the usual conservative interests of the time.
In the Red-baiting language of the day, the PR experts of the day introduced the phrase "socialized medicine" into the public lexicon. (Then, as now, conservatives and their consultants seemed to have a gift for phrasemaking.)
The interests aligned against public health insurance had few more effective organs than the American Medical Association. As Max J. Skidmore explains, the AMA had taken the following radical right-wing position as far back as 1939:
"...all forms of security, compulsory security, even against old age and unemployment, represent a beginning invasion by the state into the personal life of the individual, represent a taking away of individual responsibility, a weakening of national caliber, a definite step toward either communism or totalitarianism."
The author of those words was Dr. Morris Fishbein, the AMA's President. Dr. Fishbein was a pretty talented phrasemaker himself, warning the public against "peasant medicine" and "medical Soviets."
Truman was forced to retreat in the face of a successful anti-"socialist" campaign. Yet the health problems of the elderly remained especially pressing. Of 12 million seniors in the 1950 census, two-thirds had income of less than $1,000. By the early 60's the number of seniors had jumped to 17.5 million, and hospital costs were escalating at a rate several times greater than the cost-of-living index.
A series of incremental reforms were passed in 1960 creating the "Old Age Assistance" and "Medical Assistance for the Aged" programs, but these extended only limited coverage. When John F. Kennedy became President in January 1961, he began to work for comprehensive health coverage for both elderly and low-income Americans.
Enter the AMA. As Skidmore and Larry de Witt recount, Ronald Reagan was hired as part of a covert campaign to undermine support for Medicare and Medicaid. "Operation Coffeecup" was born.
Reagan recorded an LP (or "long playing" record), "Ronald Reagan Speaks Out Against Socialized Medicine." The AMA sent it to the "ladies' auxiliary" of the Medical Association in each county (unthinkable as it is now, medicine was so male and gender roles so different that each county had a "ladies' auxiliary" for doctors' wives.)
The "ladies" were instructed to "put on the coffeepot," play the record for their friends and fellow physicians' wives, and then get out the stationery (scented, no doubt) so that each of them could write personalized letters to their Senators and Congressmen. (Yes, they were called "Congressmen" then, even if there had already been some heroic women among them.)
There was no public announcement of the recording, or of "Operation Coffeecup." The idea was to make it seem as if the letters were spontaneously written by distressed citizens. Portions of the recording were also reportedly broadcast as radio commentary.
Max Skidmore writes:
(Reagan) no doubt terrified many of his listeners with his conclusion, telling them that if they did not prevent the passage of Medicare, "one of these days you and I are going to spend our sunset years telling our children and our children's children what it once was like in America when men were free."
This was a very imaginative tactic for the time. "Coffeecup" meets today's criteria for a "viral" marketing campaign: It was designed to appear spontaneous rather than organized and well-funded. It used word-of-mouth communication backed by prepackaged content. And that content that used some of the finest media technology then available - full sterephonic sound reproduction!
The "Socialized Medicine" record was Ronald Reagan's first venture into political speech. It didn't just represent smart, well-funded political strategy. It also launched a career that in turn brought about the conservative revolution. Reagan's efforts in "Operation Coffeecup" were so well-received that he was invited to give a speech for Barry Goldwater at the 1964 GOP Convention.
The rest, as they say, is history.
Medicare and Medicaid were created under Lyndon Johnson's Presidency in 1965. Dr. Fishbein's position had changed dramatically by then. He was even quoted as saying ""when conditions become so severe they can no longer be handled by private initiative, the government must step in."
But the struggle over Medicare spawned new political techniques and gave birth to an revolutionary and powerful conservative movement. A similar coalition of forces came together to defeat the Clinton Health Plan in the 90's, using a clever marketing campaign built around the "Harry and Louise" television ads.
Health reform is a popular topic now, and it polls well among American voters. But the other side has not yet begun to fight. Reform was popular during the Clinton era, too, until they managed to eviscerate it in the media. Advocates for change would be wise to begin planning their war effort now.
The role of doctors in the health policy arena may be very different this time than it was in the 1960's, or even in the 1990's. (I discuss the changing medical community and its potential impact on the debate in The Sentinel Effect.) Business' role is different, too. As I predicted some time ago, certain businesses are supporting health reform this time around - especially the Wyden proposal, which lifts the burden of employee healthcare from their shoulders permanently.
Nevertheless, powerful interests are lining up to oppose health reform. Those who would lead future health battles might do well to study the campaign they called "Operation Coffeecup."