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His successor's views on health insurance were not known in advance, but it soon became apparent that the new President, Harry S. Truman, would support the proposal enthusiastically and make it a key item in what he later labeled the "Fair Deal" program. On November 19, 1945, after the Japanese surrender, Mr. Truman sent a revised health message to Congress along with a re-drafted Wagner-Murray-Dingell bill. Thus, for the first time, the Congress had before it an official administration proposal for a general program of Government health insurance (sponsors called it National Health Insurance).
The next 5 years of conflict over this issue, which ended in yet another defeat for the proponents of Government health insurance, featured one of the notable political debates of modern times. And, as such, it was a singular example of the fifth element in the social welfare policymaking process-public debate and voter referenda. It is appropriate, therefore, to make use of that episode for illustrative purposes. This discussion will also point out some of the reasons why a program operating successfully in virtually every other industrialized country failed once again to be enacted in the United States.
When the revised Wagner-Murray-Dingell bill was first introduced, its supporters felt the time was propitious for passage. America had just won a great war. The United Nations was being born in a mood of optimism about the postwar world. The incumbent President had committed himself to press the health insurance issue vigorously. In addition, wartime public opinion polls had indicated broad public support for Government health insurance. A 1942 poll by Fortune magazine had found no fewer than 74 percent of the respondents in favor, and in the following year a nationwide Gallup poll recorded 59 percent in favor.
Yet appearances were deceptive. For one thing, the new President did not command the prestige enjoyed by his predecessor. Historians have come to admire President Truman's performance, but in the beginning the plain, blunt-spoken man from Missouri was widely regarded as an accident of history, and his opinions carried little weight. (In 1946 the President's popularity sagged to a record low of 32 percent.)
Another factor was the conservative tone of the postwar Congress, especially the House of Representatives and its key Ways and Means Committee. This was in part due to technical considerations: the malapportionment of many congressional districts in favor of rural areas; the existence of one-party States, coupled with the seniority system in Congress, which favored Representatives from "safe districts"; and the fact that American political parties are loosely structured and locally based, giving leaders relatively little power to impose "discipline" on party legislators. But there was also a war-delayed reaction to the New Deal--to the high taxes, regimentation and control imposed by the Government during the war years, and to big government in general. This reaction was exacerbated by the strains of conversion to a peacetime economy, which included a spurt of inflation and a wave of strikes.
Taken alone, these factors would not have posed an insurmountable obstacle to a health-insurance measure had there not also been a deep cleavage on the issue between major interest groups in the community.
One of the key elements in political decisionmaking involves bargaining or negotiations between various interest groups. But what if bargaining fails to produce agreement? What if there is an irreconcilable conflict? This is where the fifth element--public debate and voter referenda--enters the picture.
From time to time, political writers in this country have asserted the well-meaning but idealistic notion that America's Government is, or should be, controlled by public opinion--that legislators should behave as though public opinion polls are instructions on the part of the voters. Thus, if 59 percent of the electorate favor Government health insurance, the argument runs, it should be passed forthwith. But what if the 59 percent are only mildly in favor of the proposal, while the other 41 percent are strongly opposed?
The answer is that highly controversial legislation must be treated as a special case. No system of representative government can truly be equitable--nor can it survive in the long run--unless it takes into account the intensity with which opinions are held. Although the principle of majority rule is deeply ingrained in the Nation's political tradition, Americ.ans are equally committed to the principle that the majority must not tyrannize the minority, or deprive the minority of basic rights. As columnist Tom Wicker noted recently in The New York Times: "One of the features of the American political system, in fact, has been the restraints it exercises on 'pure' democracy--or what some call mob democracy. Allowing each state two senators, regardless of size and population, and interposing the electoral college between voters and candidates are only two examples." (3)
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