If anything should have put the socialized medicine boogeyman to rest, it was the passage of Medicare and Medicaid. By the mid-1960s, the Cold War was thawing. Arms control and superpower summitry eased tensions with the Soviet Union. Postwar prosperity had quelled most fears about the welfare state, and politicians who fulminated about communism and socialism attracted more ridicule than support. John F. Kennedy, according to Arthur M. Schlesinger's newly published journals, mocked Dwight Eisenhower for "attacking medical care for the old under Social Security as 'socialized medicine'—and then getting into his government limousine and heading out to Walter Reed." As bills to implement Medicare and Medicaid wended their way through Congress, the AMA again cautioned of the "dangerous adventure in government medicine" that would produce "mountains of red tape." But the arguments now had a tinny ring. The two plans easily passed Congress in the summer of 1965. Lyndon Johnson signed them into law at the Truman Presidential Library, with the former president at his side, beaming.
In the following years, the public seemed to demand more, not less, government involvement in guaranteeing social provisions like health insurance. Indeed, so great was this public pressure that even Richard Nixon, traditionally a champion of small government and free-market economics, found himself forced to forgo attacks on socialized medicine and to propose his own version of national health insurance instead.
Even Bill Clinton's failure to pass health-care reform suggests that the specter of statism had lost some of its political force. In 1994 the term socialized medicine was heard less often than in previous battles. One of the few who used it was Clinton, when he donned Truman's mantle to deride those critics of the former president who had stooped to use what Clinton implied was a shrill and overwroughtcharge. ("What did they say? 'Harry Truman's a radical liberal. He's for socialized medicine.' … Well, the truth is, Harry Truman … had this old-fashioned notion … that people who work hard and play by the rules ought to help one another.") To be sure, Republicans made hay with less archaic-sounding phrases such as the "government takeover of the health care system" (even though Clinton's plan relied more on market mechanisms than on government ukases). Newt Gingrich, then House minority whip, blasted Clinton's plan as a throwback to the kind of "centralized, command bureaucracies" that were dying across Eastern Europe.
But if these attacks ginned up some hostility to Clinton's plan, the real problem was more fundamental. As political scientist Jacob Hacker has argued, the basic obstacle was nothing less than the government's failure to have adopted a comprehensive health insurance plan decades earlier. As a result, the system that emerged by 1994 entailed such a crazy quilt of private interests—corporations, small firms, insurers, doctors, unions, HMOs, and so on—that moving all Americans into a new framework without worsening anyone's situation had become virtually impossible. Many of these interest groups (including doctors) actually favored reform in the abstract. But no particular plan was going to please them all.
Perhaps, then, the socialized medicine scare tactic really has run its course. The Republicans' decision to dust it off for one more battle may say more about their party's continued sprint to the right-wing extreme than about any intrinsic public hostility to government social programs. If this is the case, then Democrats might be wise to offer health-care proposals that don't upend the status quo, while brushing off the socialized medicine attacks as atavistic Cold War-era alarmism. Which seems to be, for the moment, precisely what they're doing.
The author would like to thank Jonathan Cohn, Geoffrey Nunberg, and Paul Starr for their assistance.