Barack Obama is hardly the first president, or even the first viable presidential candidate, to propose universal healthcare. In 1912, former Republican President Theodore Roosevelt ran as a third-party progressive against his successor, William Howard Taft. His platform included the first serious proposal for universal health care in the United States.

As it turned out, Taft and Roosevelt split the GOP vote more or less down the middle and put Democrat Woodrow Wilson in the White House. And the Wilson administration, to say the least, had other concerns.

The next attempt was made by Franklin Roosevelt during his first term, in the depths of the Great Depression. Roosevelt’s bill was initially part of the Social Security Act, but Roosevelt removed the universal healthcare portion in order to ensure passage of the larger bill. His successor, Harry Truman, also attempted universal health care as part of his “Fair Deal” program, but had little support in Congress, and it was never enacted.

In the mid-1960s, Lyndon Johnson was able to successfully pass bills creating the Medicare and Medicaid programs, but change since then has been incremental. Several bills have extended private insurance under certain circumstances, but the goal of universal coverage remained elusive. In 1993, President Bill Clinton (and first lady Hillary) presented a detailed reform program to Congress which resulted in legislative disaster and paved the way for the Republican Revolution of 1994.

The current conventional wisdom says that Obama will see something passed, but as this goes to press, it is far too early to say what exactly that might be. Learning, apparently, from the Clintons’ mistakes, the Obama White House has said it that it will leave the precise reform mechanisms up to Congress. But as a candidate and as president, Obama has put forth a list of goals which he expects reform to accomplish.

According to www.whitehouse.gov, the benefits of reform fall into the three basic categories: those affecting people with insurance, those affecting people without insurance and those benefiting all Americans.

Under the first category, Obama calls for an end to discrimination against people with pre-existing medical conditions, which would “prevent insurance companies from dropping coverage when people are sick and need it the most, caps out-of-pocket expenses so people don’t go broke when they get sick, eliminates charges for preventive care (and) protects Medicare for seniors and eliminates the ‘doughnut hole’ gap in the coverage for prescription drugs.”

Examples of preventive care listed on the White House Web site include mammograms, flu shots and diabetes testing “to improve health and save money.”

For the uninsured, Obama asks for legislation that will “create a new insurance marketplace — the Exchange — that allows people without insurance and small businesses to compare plans and buy insurance at competitive prices; provide new tax credits to help people buy insurance and to help small businesses cover their employees; offer a public health insurance option to provide the uninsured who can’t find affordable coverage with real choice (and) offer new, low-cost coverage through a national ‘high-risk’ pool to protect people with pre-existing conditions from financial ruin until the new exchange is created.”

The portion of the plan benefiting all Americans would “rein in the cost of health care for our families, our businesses and our government,” according to the Web site. Specifically, the program Obama calls for “won’t add a dime to the deficit and is paid for upfront; creates an independent commission of doctors and medical experts to identify waste, fraud and abuse in the healthcare system; orders immediate medical malpractice reform projections that could help doctors focus on putting their patients first, not on practicing defensive medicine, (and) requires large employers to cover their employees and individuals who can afford it to buy insurance so everyone shares in the responsibility of reform.”

The Case for Change

“The healthcare status quo is not an option for our states,” Obama writes on the site. “If we do nothing, by 2019 the number of uninsured people will grow by more than 30 percent in 29 states and by at least 10 percent in every state. The amount of uncompensated care provided will more than double in 45 states. Businesses in 27 states will see their premiums more than double. And fewer people will have coverage through an employer. The time for health insurance reform is now.”

In Alabama, according to White House figures, some 666,000 uninsured and 188,000 people with non-group insurance could get affordable coverage through the Exchange. Another 418,000 would qualify for tax credits to help them purchase insurance, and 804,000 seniors would receive free preventive services. Another 143,000 seniors would have their brand-name drug coverage costs in the Medicare Part D “doughnut hole” cut in half, and 47,100 small businesses would qualify for a tax credit to make their premiums more affordable.

The statement goes on that Alabama’s 4.7 million residents will also benefit from insurance companies being banned from “placing lifetime limits on the coverage they provide. Use of annual limits will be restricted, and they will not be able to arbitrarily drop coverage. (Furthermore) 11 percent of people in Alabama have diabetes and 33 percent have high blood pressure, two conditions that insurance companies could use as a reason to deny health coverage. Reform will establish a high-risk pool to enable people who cannot get insurance today to find an affordable health plan.”

In addition, “39 percent of Alabama residents have not had colorectal cancer screening, and 23 percent of women over 50 have not had a mammogram in the past two years. Health insurance reform will ensure that people can access preventive services for free through their health plans. It will also invest in a prevention and public health fund to encourage prevention and wellness programs.

According to the site, an estimated 109,000 people from Alabama have early retiree coverage through their former employers, “but early retiree coverage has eroded over time. A reinsurance program would stabilize early retiree coverage and provide premium relief to both early retirees and the workers in the firms that provide their health benefits. This could save families up to $1,200 on premiums.”

The site also lays out the benefits for “Alabama’s 804,000 Medicare beneficiaries.” This would be accomplished by “lower(ing) premiums by reducing Medicare’s overpayment to private plans; reducing prescription drug spending and covering free preventive services.”

Small businesses, “which make up 70 percent of Alabama’s businesses,” would be helped by the tax credit. “Only 48 percent of (Alabama small businesses) offered health coverage in 2008. 407,100 small businesses could be helped by a small business tax credit proposal that makes premiums more affordable. And these small businesses would be exempt from any employer responsibility provisions.”

The states individually would benefit from reduced premiums for state employees and reduced uncompensated care.”