Both in the run up to the vote on the Affordable Care Act1 and since its passage, there have been a number of stories about how President Richard Nixon pushed for a similar bill in 1974. According to conventional wisdom, that dream died, at least in that form, on August 9, 1974, when President Nixon resigned in the wake of the Watergate Scandal.
Like so much conventional wisdom, however, this is at once both an over-simplification and incorrect, revisionist history. It also overlooks the role that one Arkansan played both in getting the United States close to having universal health care and in ultimately ending any chance that the bill might have had.
That Arkansan is, of course, longtime Representative Wilbur D. Mills (D-Searcy), who served as Chair of the powerful Ways & Means Committee from 1958 to 1974.
A Record of Health Care Reform.
It is no stretch to say that Wilbur Mills had a larger role in creating much of the government-run health care that we know today. But his interest in providing health care for the less-fortunate actually predated his arrival in Congress; in 1934, Mills, as White County judge, created a program that set aside county funds for the neediest Arkansans in the midst of the Great Depression.
On the national stage, Mills entered Congress at a time when universal health care (or something close to it) was a common topic of conversation, albeit one that seemed to have very little traction. A national health care system was first suggested in a recognizable form by President Roosevelt in 1934, but, aside from the Social Security Act of 1935, Roosevelt never acted upon these underpinnings of an idea of a comprehensive plan during his administration. The discussion fell by the wayside to a large extent during World War II, but was revived once the war ended and America’s economy began to proposer.
Following a string of failed proposals from other politicians and interest groups in the early 1950s regarding national health care, the powers that be decided on a more incremental approach.2 In 1956, President Eisenhower and Congress acted to add disability benefits to the Social Security Act. Following his appointment as Chair of Ways & Means in 1958, Wilbur Mills began to use his new-found clout to push for additional changes and additions to the health care system.
In 1960, Mills and Senator Robert Kerr3 (D-OK) worked for passage of the Kerr-Mills Act (aka “Medical Assistance for the Aged”), which created an early system of Medicare by allocating federal funds that the states could use to provide health care for the poor. Unfortunately–if somewhat predictably those of us here in 2013–the Kerr-Mills Act suffered and was unsuccessful as a stand-alone measure because many states refused to enact legislation that would allow them to actually use those funds.
In 1964 and 1965, Ways & Means, under the leadership of Mills, conducted hearings on a number of possible plans for expansion of low-income health care, both for the elderly and in general. Rather than adopt any one of the proposed plans, however, Mills created his own bill that combined what he felt were the best parts of each of the major proposals.4 Mills’ bill, ultimately adopted as the Social Security Amendments of 1965, created a health insurance program for nearly all elderly Americans (Medicare Part A) and a voluntary, supplementary insurance program (Medicare Part B). The bill also greatly expanded the reach and impact of the Kerr-Mills Act by providing assistance for the elderly with out-of-pocket medical expenses (copays, deductibles, etc.) and by creating what we now know as Medicaid by expanding the Kerr-Mills Act to cover other groups such as low-income families with children, the disabled, and the blind.
The Renewed Push for Universal Coverage.
Spurred by the creation of Medicare in 1965 that, for a time at least, there was suddenly a renewed interest in certain quarters for universal health care for all Americans. By 1971, Sen. Edward Kennedy (D-MA) was busily working behind the scenes, among several different groups, interests, and constituencies, to craft comprehensive legislation, at a cost of roughly $60 billion5, that would have created a single-payer, government-run health care system for all Americans.
Around the same time, President Richard Nixon was pushing a different health care package built primarily around the private insurance market. Nixon’s plan included an employer mandate, funneled some Medicaid money into private insurance, and created insurance pools to provide low-cost insurance to poor people. Initially, Kennedy was strongly opposed to Nixon’s plan, which he saw as simply a way for the government to pay money to insurers without improving or ensuring coverage.
Through late 1972 and more or less all of 1973, the two sides appeared to be at an impasse. Nixon, however, decided to go all-in, spelling out his vision for health care reform during his 1974 State of the Union address.
Which, again, brings us back to Wilbur Mills.
1974: Everything Is Coming Up Milhous.
By any measure, 1974 was a terrible year for President Nixon. While, ultimately, it would be Watergate that led to his resignation in August, it was a joint House-Senate investigation into the President’s income taxes that was the headline grabber in the early part of that year. That investigation discovered that, for the years 1969 through 1972, President Nixon had paid about $78,000 in taxes on an adjusted gross income of about $1.1 million, and he’d paid no income taxes in Washington D.C. over that time.
Owing both to his position as Chair of Ways & Means and to some calculated political maneuvering, Wilbur Mills was right at the center of President Nixon’s tax problems. In early February, Mills reached out to a top Nixon aide and suggested that the President should try to beat the Joint Committee to the punch by filing amended returns immediately. Nixon rejected this plan, taking a hard-line stance against admitting any wrongdoing under the assumption that the investigation would ultimately turn up little.
On March 9, while in Little Rock to announce his bid for reelection to the House, Mills answered a reporter’s question by suggesting that the tax investigation would ultimately hurt Nixon more than Watergate. On March 15, Mills spoke to another Nixon aide and again suggested amended returns. Again, the President rejected such a notion.6
Mills took the whole thing up a notch on March 24, 1974, before the tax investigation was completed, when he went on Face The Nation and opined that Nixon would be out of office “by November” once the results of the investigation were released. By April, Mills was featured in People magazine, saying much the same thing regarding Nixon’s tax troubles.7
This full-frontal attack on Nixon makes much more sense when you consider that, simultaneously with his public statements about Nixon’s taxes, Mills was also working on crafting a long-term plan for passage of a health care bill different from the one Nixon had introduced. As Mills saw it, while Watergate was already hanging over Nixon’s head, it was so esoteric that it did not register with a lot of Americans. Mills understood that taxes always resonate with Americans, especially in the middle of a recession. By publicly attacking the President over taxes, Mills sought to weaken the President to the point that Nixon was forced to abandon his own health care plan and endorse something closer to what Mills envisioned.
In an even more shrewd move, Mills also signed on to the President’s health care bill as a sponsor in early 1974. He did not do this because he liked the plan, but because being a primary sponsor on the bill would allow Mills to get it in front of Ways & Means, where Mills’ power was immense.8
Ultimately, the plan to weaken Nixon began to work. While still refusing to admit any wrongdoing regarding taxes or Watergate, Nixon slowly became willing to work across the aisle to find a compromise solution on health care that would garner support from the public (and, he hoped, improve his image in the process). Nixon, therefore, quietly reached out to Sen. Kennedy to see what could be accomplished.9
With Nixon tacitly on board, Kennedy then reached out to Mills to try to craft something that would appeal to the Republican President, the liberal Senator, and the conservative Congressman. Despite his strong preference for single-payer, Kennedy realized that it was, then as now, a non-starter among several blocs of congressional votes, not to mention the President. Kennedy and Mills, therefore, crafted a plan that, while expanding coverage, would do so with the health insurance industry still playing middle-man in a government-administered program. Once Mills had come up with compromise bill, Kennedy set up further meetings with Nixon and his aides to sell the idea.
And, for a moment, it looked like the entire thing might actually happen.
Unfortunately, the compromise bill did not appeal to everyone. The American Medical Association called the Kennedy-Mills bill “socialist” and suggested that it would lead to the destruction of American medicine as we knew it. The National Federation of Independent Business said the bill was “a first step towards socialized medicine.” Ronald Reagan, then governor of California and eyeing a 1976 Presidential run, spoke out against the bill.10
From the left, labor unions also came out in force against the bill. As Watergate grew in the public consciousness through the early summer of 1974, organized labor began to collectively assume that Democrats would retake the Presidency in 1976. They wondered, then, why it was necessary to compromise with Nixon at all if waiting until 1976 would get single-payer and remove insurance companies from the bill entirely.
After over two years of investigation into Watergate and steadfast refusal of Nixon to admit wrongdoing, the final unraveling and end of his Presidency came rather swiftly. On July 24, 1974, the Supreme Court ruled unanimously that Nixon could not claim executive privilege to avoid releasing Oval Office recordings. On July 27, the House Judiciary Committee approved the first article of impeachment against Nixon for obstruction of justice. On July 29, the committee approved the second article of impeachment for abuse of power. A third article of impeachment for contempt of Congress was approved on July 30.
Also on July 30, Nixon released most of the Oval Office recordings to the public. Then, on August 5, the so-called “Smoking Gun” tape was released. That recording, from June 23, 1972, was a discussion between Nixon and Chief of Staff H.R. Haldeman that detailed the initial cover-up of the Watergate break-in. In the discussion, the two planned to block investigations by pitting the CIA against the FBI and having the CIA claim that national security was at stake. On August 7, Senators Barry Goldwater and Hugh Scott and Congressman John Jacob Rhodes met with Nixon in the Oval Office and explained that Nixon would absolutely be impeached and removed from office if he did not resign. On August 8, Nixon gave a televised resignation speech to the American public. On August 9, Nixon left the White House for good.
Which, yet again, brings us back to Wilbur Mills.
The Argentine Firecracker.
Historical revisionism suggests that the push for health care reform in 1974 died with the resignation of Nixon, but this is not the case. Rather, Wilbur Mills used the resignation of Nixon as an opening to push for a modified version of the Kennedy-Mills bill–one that, oddly enough, was closer to what Nixon had originally sought than to what Kennedy wanted. Then, on August 20, 1974, Mills got approval for most of his bill on a 13-12 vote in Ways & Means.
The slim margin in committee left Mills hesitant to bring the bill to the full House for a vote. Sensing (correctly) that the 1974 elections would be good for Democrats and give them stronger majorities in both chambers, Mills pronounced on August 21 that he was likely shelving his health care bill until 1975.11 Editorials throughout September noted, however, that there was actually little opposition to health care reform nationally, and that all of the quibbling was, ultimately, over form rather than substance.
By the end of September, it seemed as if health care reform might actually happen in 1974. On October 7, perhaps realizing that a stronger Democratic majority in 1975 would make a more liberal bill likely, the American Medical Association released a statement, proclaiming that they were in fact “open to a compromise” on a bill in 1974.12 A strong argument can be made that October 8, 1974, when newspapers around the country carried word of the AMA’s willingness to compromise, was the closest America would come to large-scale health care reform for over twenty-five years.
Unfortunately, October 8, 1974, was a day after October 7, 1974.
Just after two o’clock in the morning on Monday, October 7, 1974, U.S. Park Police stopped a car near the Washington D.C. Tidal Basin. When the officer approached the Lincoln Continental, a woman jumped from the back seat and fled into the Basin. Inside the car were a former Nixon aide as driver and, in the backseat, an intoxicated and somewhat battered and bloody Wilbur Mills, who had apparently been fighting with the woman, identified as Annabelle Battistella, an Argentinian stripper better known as Fanne Foxe.
Because this was 1974, news of the incident did not spread as quickly as it would if the same thing happened today. Mills was not identified as the bloodied passenger in an Arkansas paper until the morning of Thursday, October 10.13 On that same day, Mills released a written statement, in which he claimed that the whole thing was just an unfortunate series of misunderstandings and would not impact his ability to serve in Congress or as Chair of Ways & Means.
The statement also claimed that Mills intended to be back at his D.C. office on Friday, October 11. In fact, Mills was absent on that Friday and for all of the following week, citing a “family illness” that was keeping him at home. By the time he returned to the public spotlight in the week of October 21, the story was no longer front-page fare and it seemed unlikely that it would cost Mills his re-election against (then) little-known Judy C. Petty.
Mills defeated Petty on November 4 (though the challenger received 42% of the vote in central Arkansas in a heavily Democratic year). Then, less than a month later, in an amazingly self-destructive move, a visibly drunk Mills sauntered up on stage at a Fanne Foxe show at Boston’s Pilgrim Theatre, then did a press interview backstage with Foxe and her husband, in which he referred to her as “my little old Argentine hillbilly.”
Within days, House Speaker Carl Albert asked Mills to step down from his Chairmanship of Ways & Means, which Mills did on December 10, 1974. Mills’ replacement in the position, Al Ullman (D-OR), had little interest in health care reform and was more concerned with budgetary policy and how he could influence those decisions. Without Mills’ clout pushing the bill on the House side, Kennedy saw little chance of getting the bill passed by both houses and signed by Gerald Ford, who also had little interest in the matter. Even with Kennedy’s pull in the Senate, the cause was lost for the time being.
Hopeful proponents assumed that, if and when the Democrats took the White House in 1976, then universal health care would be revived as an idea and would sail through relatively easy. Instead, with America still recovering from the 1973-1975 recession and President Carter more interested in piecemeal legislation on health care rather than an overarching bill, universal coverage did not happen. By the time Ronald Reagan took office in 1981, the dream was dead for the foreseeable future.
On October 1, 1977, after not running for re-election in 1976, Mills remarked that we would have had a national health insurance program in 1974 “had [he] not been an alcoholic.”14 With all due respect to the late, great Mr. Mills, his statement misses the point by quite a bit. It wasn’t drunkenness that delayed health care reform for 35 years–hell, there have been plenty of drunks in Washington D.C. who remained powerful and effective legislators.
No, it was something much more basic that doomed health care in 1974: the lustful inability of a country boy from Kensett, AR, to stay away from an Argentine showgirl.
Calling it “Obamacare” without some seriously scary music in the background just seems wrong.↩
One early measure that was not unsuccessful was a 1950 act that provided federal matching funds for state payments to medical providers on behalf of individuals receiving public assistance payments.↩
Of the Kerr-McClellan Arkansas River Navigation System, among other things.↩
The three proposals: “Medi-care,” proffered by Democrats, which created a universal, government-run health plan for seniors; “Better-care,” submitted by Republicans, that created a voluntary health plan for seniors funded by a combination of premiums and general tax revenues; and “Elder-care,” a bipartisan plan, with the backing of the American Medical Association, that expanded Kerr-Mills to state programs that supported the indigent, the disabled, and seniors in nursing homes.↩
Roughly $347B in 2013 money.↩
Rowland Evans, “White House Rejects Mills’ Advice on President’s Taxes,” Washington Post, Mar. 20, 1974↩
Clare Crawford, “Wilbur Mills: Taxes Will Be Nixon’s Downfall,” People Magazine, Apr. 15, 1974↩
Gazette Press Servs., “Health Care Plan Sent To Congress For Early Action,” Ark. Gazette, Feb. 7, 1974↩
“Nixon Presses Health Plan; Would Accept Compromise,” Washington Post, May 21, 1974↩
Reagan had also spoken out against the 1965 Social Security amendments. Because Ronald Reagan hated poor people. Never forget that.↩
“Health Bill Seen Dead This Year,” Wash. Post, Aug. 22, 1974.↩
N.Y. Times, Oct. 8, 1974.↩
Roy Bode, “Man Identified as Mills Bleeding, Appeared Intoxicated, Officer Says,” Ark. Gazette, Oct. 10, 1974 at 1A.↩
“Five Years Ago Today,” Tuscaloosa News, October 1, 1982.↩