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Jimmy Carter’s Complicated Healthcare Legacy

By: David Ostrowsky

In the Bicentennial Summer of 1976—during which Jimmy Carter was campaigning for president—there was nonstop pageantry. Patriotism reached fever pitch as parade floats washed in red, white, and blue streamed through smalltown America while Uncle Sam-inspired merchandise flooded the shelves of department stores across the entire union. But overshadowed by the unprecedented amount of hoopla was the sobering reality that the then-two-century-old nation had a broken healthcare system: at this moment in time, 26 million Americans lacked health insurance altogether while another 28 million possessed only minimal coverage. And Carter, who grew up on a backwoods Georgia peanut farm with neither running water nor electricity, sympathized with the plight of the working poor by endorsing the concept that America needed universal healthcare coverage—to the extent that it was economically (and politically) feasible.  

Now, nearly 47 years later, in light of the 39th US President having recently entered hospice care, his role during this momentous time in the history of American healthcare bears consideration.

Undeniably, Carter was in favor of there being comprehensive national health insurance in America. He knew that hospitals from coast to coast were profiteering at the expense of millions of uninsured Americans and didn’t particularly care that many Republicans were referring to national health insurance as “socialized medicine.” But Carter was also a pragmatist and, after getting elected, he preached patience on this front, stressing that a program of national health insurance, while ultimately the end goal, would need to be phased in over the years ahead due to federal budget constraints.

Carter’s predisposition toward incrementalism alienated many leftists in the Democratic Party, in particular Massachusetts Senator Edward Kennedy, a lifelong staunch advocate of universal healthcare who later ran against Carter for the Democratic nomination for president in 1980. Throughout Carter’s one-term presidency, he would engage in spirited ideological conflict with Kennedy, holding fast to the notion that Kennedy’s ambitious plan, one that called for a single-payer, non-profit insurance plan to cover every single American and effectively eliminate every single private health insurance carrier, would potentially cost the federal government well over $100 billion—if it was even approved by Congress in the first place. Instead, Carter, in conjunction with his top domestic policy advisers, championed the existent employer-employee health insurance relationship and wanted to ensure that private insurers adhered to federal government standards and were held responsible for prioritizing preventive medicine, outpatient care, and total coverage for infants and children. Most notably, Carter’s proposal stipulated that the federal government had to offer universal health insurance for “catastrophic” medical issues; subsequently, such insurance would account for emergency medical expenses over a flat ceiling of $2,500 annually for every American family. (For senior citizens and the disabled, out-of-pocket expenses would be restricted to $1,250 per individual.)

Although Carter’s proposal did not represent a universal, single-payer system, it promised to provide vastly improved coverage to tens of millions of American laborers and perhaps usher in an actual comprehensive federal health insurance program down the road. But Kennedy was not satisfied, adamantly insisting on one comprehensive healthcare bill and at one point refusing to meet with Carter in person. Even when the president and Massachusetts senator ultimately did sit down in the Cabinet Room, they couldn’t effectively navigate their irreconcilable differences. Soon thereafter, Kennedy held a press conference in which he ripped Carter’s healthcare program, referring to it as both “catastrophic” and “unacceptable” while promising to “take the issue to the people.”

In the end, it was “the people” who suffered the most as the Carter-Kennedy feud would deprive millions of hard-working, tax-paying Americans of more robust, cost-effective health benefits. Sans Kennedy’s support (he barred Carter’s bill from advancing past his Senate health committee), along with that of the liberal wing of the Democratic Party, Carter’s proposed program—and eventually Kennedy’s as well—floundered. American families continued to pay well over $2,500 annually for healthcare while employers were not held responsible for offering employees basic health insurance.

In a twist of irony, three decades after Carter and Kennedy were locked in impasse, President Barack Obama shepherded through Congress a universal health insurance bill, colloquially known as “Obamacare,” that bore fairly strong resemblance to Carter’s proposal. As it would turn out, Obamacare had the full support of all Democrats in the Senate, including Kennedy, who months before its passage would succumb to brain cancer.