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Eisenhower to Biden on Health Care: “Enlarge the Problem.”

Posted on | December 16, 2021 | 2 Comments

Mike Magee

My good friend, Kim Bellard, in a piece published in Medium titled “The Eisenhower Principle”, shines a light on this genuine American hero’s seminal military, political and management insight – “If a problem cannot be solved, enlarge it.”

In Kim’s astute health care analysis, he notes We’ve learned only half of Eisenhower’s adage: we’ve got the letting the problem get bigger part down, but we’ve forgotten the part about how/when to come up with solutions.”

In the spirit of uncovering solutions, it is worthwhile to retrace Eisenhower’s steps, supported by his own commentary, in the decade that followed WW II.

Section 1: The Chance For Peace.

The  “Chance For Peace” speech was delivered on April 16, 1953, shortly after Stalin’s unexpected death. In the speech, Eisenhower stated:

“Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed…This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children. The cost of one modern heavy bomber is this: a modern brick school in more than 30 cities. It is two electric power plants, each serving a town of 60,000 population. It is two fine, fully equipped hospitals. It is some fifty miles of concrete pavement. We pay for a single fighter with a half-million bushels of wheat. We pay for a single destroyer with new homes that could have housed more than 8,000 people…This is not a way of life at all, in any true sense. Under the cloud of threatening war, it is humanity hanging from a cross of iron.”

For those who actively criticized President Biden’s unilateral disengagement from Afghanistan, consider the anti-war stance of our nation’s most decorated general. As President, in foreign affairs, he demonstrated enormous restraint, even as his supporters questioned his decisions. For example, he did not take any advantage when Stalin died unexpectedly in 1953, and he resisted being drawn into Indochina in 1954 when the French departed, electing to “wage peace” rather than engage in another war. Similarly, in 1956, when Hungry was invaded by the Soviets, he chose (at least publicly) to stand down. In the midst of the Cold War, he envisioned a negotiated truce with the Soviets on nuclear weapons, a long range goal that was eventually scuttled near the end of his second term by the shooting down of an American U-2 spy plane over Soviet territory. He did take definitive action on two occasions, in 1955 and 1956, when he believed American interests were at risk. In the first case, when Communist Chinese appeared ready to attack Taiwan, he seeked and gained Congressional approval to use force “if necessary to assure the security” of Taiwan. The Chinese backed off. A year later, when the United Arab Republic seized the Suez Canal, and Israel invaded Egypt, American allies, Britain and France, were ready to enter the fray, which would likely ignite a broader conflagration. Eisenhower immediately involved the UN and all parties were forced to stand-down. Crisis averted.

Section 2: The Pivot.

While Communism and the Cold War must be managed, Eisenhower had strong ambitions for his domestic agenda which he labeled “the middle way” to domestic prosperity. This included balancing the budget, building up America’s highway infrastructure, and continuing the New Deal commitments – a decision that more than raised the eyebrows of the Republican Old Guard. He extended insurance coverage through Social Security and bumped the minimum wage from .75 cents an hour to 1$ an hour. For passage he relied on Democrats to support key legislation.

Believing “what was good for business was good for the nation”, he stacked his Cabinet with successful millionaire businessmen including Secretary of Defense Charles E. Wilson (General Motors CEO), Secretary of the Treasury George M. Humphrey (M.A. Hanna Steel Company), and Secretary of the Air Force Harold E. Talbott (a director in both TWA and Douglas Aircraft Company). He saw this as simply a common sense, pragmatic approach. Would Americans rather he choose “some failure…or a successful businessman,” he asked.  Clearly the new president intended to be activist in the domestic arena, and signaled this early to the business community with corporate tax cuts. Prosperity and expansion of the middle class were his key objectives.

Seven months before his heart attack, on January 31, 1955, Eisenhower delivered his “Special Message To Congress Recommending A Health Program.” This needs to be appreciated in the context of what had occurred over the past twenty years in the health insurance arena. When FDR declined to use political capital required to pass Social Security legislation to advance health insurance in 1937, opposition was abundant. The American Medical Association was fully engaged and pulled out all the stops. This included an FDR lunch with famous neurosurgeon Harvey Cushing, Roosevelt’s son’s father-in-law, the day before FDR’s announced decision to delay action. Into the resultant void came the non-profit Blue Cross and Blue Shield plans.  For-profit companies watched from afar through the 1930s. Once profitability was clear, they streamed in behind the Blues, so that by the time the country was prepared for post World War II expansion, the private insurance infrastructure was firmly in place.

In the early years of the war, the economy super-heated and caps were placed on employee salaries to prevent inflation. Employers, competing for scarce workers, began to layer on benefits, including health insurance. By 1949, the government ruled that benefits were part of the negotiated wage package, and five years later, the IRS exempted employer-provided health benefits from income tax. Coincident with this, labor and management dueled over the issue. In 1949, the United Auto Workers Toledo local began a drive to create a regional pension plan that would spread risk across many auto industry suppliers. The reasoning was that even if your particular company went bankrupt, your benefits would be safe because they came from a regional pool, not directly from your employer. Business owners and large employers disagreed with the concept. They felt that collectivization threatened the free market and business owners’ autonomy. In the United States a year later, Eisenhower’s future Secretary of Defense, Charlie Wilson, then president of General Motors, began offering GM workers health care benefits and a pension. The offer was more defensive than beneficent. In the single decade between 1940 and 1950, the number of Americans covered by employer-sponsored health care increased from 21 million to 142 million.

The opening paragraph of Eisenhower’s 1955 Special Message on Health Care reads, “ Because the strength of our nation is in its people, their good health is a proper national concern; healthy Americans live more rewarding, more productive and happier lives.”

Section 3: Tipping His Hat To Truman.

By now, President Eisenhower clearly had determined that health care deserved to be at the center of his domestic agenda.  His second paragraph in the 1955 State of The Union address focused on chronic disease. “Deaths from infectious diseases have diminished. During the past year, important progress has been made in dealing with such diseases as rheumatic fever, high blood pressure, poliomyelitis and tuberculosis. Intensified research has produced more knowledge than ever before about the scourges of heart disease and cancer.”

Two paragraphs later, he highlighted President Truman’s accomplishments noting the 1947 Hospital Survey and Construction Act (known also as the Hill-Burton Act) as a critical achievement that had greatly expanded America’s caring capacity. It provided federal funding in support of communities advancing local hospital construction to expand access throughout the country to 4.5 hospital beds per 1000 citizens. In return for the grants, hospitals had to commit to non discriminatory behavior based on race, creed, color or national origin; agree to provide a “reasonable volume” of free care to needy residents (though “reasonable volume” was not defined for another twenty years); and the community had to demonstrate the long term economic viability of the hospital construction that was to be funded.

Eisenhower then acknowledged the 83rd Congress’s expansion of this law saying, “The 1954 amendments to the Hospital Survey and Construction Act opened another new chapter in the national drive for better health. Under these amendments, further provision was made to help build health care facilities for the chronically ill; to aid in the construction of nursing and convalescent homes; to provide for more diagnostic and treatment centers for patients who do not need hospital care; and to help make centers available for the rehabilitation of the disabled.”

And yet,  Eisenhower said clearly in 1955, we can do more. In his words, “These achievements represent a major gain for the immediate and future welfare of countless Americans – in the health of both mind and body. Recent advances do not, however, represent our full capacity to wage war on illness and disability throughout the land. As a nation, we are doing less than now lies within our power to reduce the impact of disease. Many of our fellow Americans cannot afford to pay the costs of medical care when it is needed, and they are not protected by adequate health insurance. Too frequently the local hospitals, clinics, or nursing homes required for the prevention, diagnosis and treatment of disease either do not exist or are badly out of date. Finally, there are critical shortages of the trained personnel required to study, prevent, treat and control disease.”

Section 4: The Solutions.

Eisenhower then laid out a long list of recommendations that read remarkably progressive for it’s day. It includes:

Lower the Cost of Care: Expanding the numbers covered by health insurance and the scope of benefits with a special focus on protection against catastrophic costs, coverage for the disabled and those in rural areas, and coverage for low income Americans.

Health Facility Construction: Improved access to funding mechanisms with federally backed support for privately funded construction loans to health care facilities.

Health Manpower: Grants to support expanded training of nurses and public health specialists including those focused on mental health.

Expansion of Public Health Programming: Expanded grants for the Public Health service, the Children’s Bureau of the Social Security Administration, and the Food and Drug Administration.

Environmental Health: Expanded research on air pollution control, and water purity.

Mental Health: Increased funding for training of mental health professionals, expansion and improvement of mental health facilities, and strategies to manage mental health in the community rather than in large institutional settings.

International Health: Stronger support of the World Health Organization (WHO). His positioning for support was new for the day. As he said, “For half of mankind, disease and disability are a normal condition of life. This incalculable burden not only causes poverty and distress, and impedes economic development, but provides a fertile field for the spread of communism.”

These were not simply words for Eisenhower, they were backed up by organizational action that he had taken in 1953.

On April 11, 1953, the president provided his signature of approval and HEW was created. Within its’ umbrella were sheltered Social Security providing 70 million Americans with $4 billion annually on the back of proceeds from a $19 billion dollar trust fund; the Public Health Service and its’ new National Institute of Health (NIH) and National Cancer Institute (NCI); the Office of Education overseeing national education policy; the Food and Drug Administration; The Office of Vocational Rehabilitation; the Children’s Bureau; the American Printing House for the Blind; the Columbia Institute for the Deaf; and St. Elizabeth’s Hospital for the Mentally Ill.

In a bipartisan slight of hand, Eisenhower appointed Democratic Texan, Oveta Culp Hobby, as HEW’s first Secretary. She had been a strong Eisenhower supporter in 1952. He backed her up by appointing Nelson Rockefeller the under-secretary. Rockefeller accepted the role against the advice of his handlers who felt it was beneath him to be the number two. But as he stated, “I’m responsible for creating this baby. I have a responsibility for seeing to it that it succeeds.”

Section 5: In Summary – Eisenhower Gets The Final Word.

In his contemporary review, Kim Bellard reflects, Yet still the outlines of a solution continue to elude us. It seems there is no health problem so big that we can’t turn it into a political issue, not even a pandemic.”

But in shining a light on this remarkable American, Bellard reminds us that Biden is on the right path in promoting peace time oriented spending priorities, confronting the enemies of truth, and believing that the health of Americans is the critical determinant in the economic and political future of our American democracy.

Eisenhower had no second thoughts about the wisdom of such investment. As health care expenditures hit $4.1 trillion this week, controlling 1/5 of our GDP, Eisenhower would likely advise President Biden to “lean in” to the problem, expose the liars and haters, and do the right thing.

Our former President gets the final word:  “I believe that the social gains achieved by the people of the United States, whether they were enacted by a Republican or a Democratic administration, are not only here to stay but are to be improved and expanded…Anyone who says it is my purpose to cut down Social Security, unemployment insurance, to leave the ill and aged destitute, is lying. Should any political party attempt to abolish social security, unemployment insurance, and eliminate labor laws and farm programs, you would not hear of that party again in our political history.”

Comments

2 Responses to “Eisenhower to Biden on Health Care: “Enlarge the Problem.””

  1. Ryan Mazun
    December 17th, 2021 @ 10:04 pm

    The historical context you bring to our current healthcare industry issues are very insightful – thank you!

  2. Mike Magee
    December 19th, 2021 @ 9:16 am

    Many thanks, Ryan. Greatly appreciate the feedback and support! Best, Mike

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