This is the one-year anniversary of the health care reform bill that was finally dragged, kicking and screaming, into becoming the law of the land. On that day, after a century of bruising and ugly battles to get some kind of comprehensive health care package done, the final ugly battle got completed — successfully this time. There is a lot this bill didn’t get done, but one year ago today the United States finally enacted a law that established health care coverage of the entire population as a goal and value of our government. We stated as a country that it should be the right of every American to have health insurance. We declared that insurance companies should be subject to certain humane and commonsense restrictions when it came to denying people coverage — like an insurer had to keep covering people even if they got sick, and they had to keep covering people even when it cost a lot of money. We came squarely down on the side of seniors getting prescription drugs, young people being able to stay on their parents’ plans for a while, more of the working poor being covered by the government, and everyone getting preventive care.
There were flaws aplenty. We provided no competition or check on the power of private insurance through a public plan, which will drive costs up. We chose not to lower drug prices for the federal government by having Medicare bargain with drug companies, which also will drive costs up. We totally screwed up the abortion coverage issue. These and other things big and small need to be fixed, and soon. But here’s the thing, the reason that every progressive member of Congress voted for this: it gives us a platform to stand on. It’s a rickety platform because of those construction flaws, and there are plenty of folks trying hard to burn it down. But it is a platform that can be repaired and expanded and strengthened if we keep working on it, the same way Social Security was, the same way the minimum wage and Medicare and Medicaid have been.
One of the earliest issue battles I remember following, back when I was just getting interested in politics, was the health care debate of the early ’70s. It didn’t happen then, or a few years later in the Carter years when Teddy Kennedy and Jimmy Carter couldn’t come to terms on the issue. I was thrilled to be working on comprehensive reform in the Clinton White House in the early ’90s, but that effort went down in flames. I have read about Teddy Roosevelt first proposing comprehensive reform in the 1910s and it going nowhere; about FDR passing Social Security, bank regulation, labor law reform and all the rest, but not having the strength to get health care done; about Truman pushing for it in the ’40s and it going nowhere fast; and about LBJ passing civil rights legislation, the war on poverty, Medicare, and Medicaid, but not having the guts to pass a more comprehensive health care bill. I knew all that history, and knew that every failure made the next time around that much tougher. Getting this platform to stand on was never going to be the end of this battle, just the first step forward, but if you get blown up on your first step, the next dozen- or hundred- never happen.
So now we have a platform. First we have to defend it from the mob with torches. These Republicans who don’t want there to be “government run” health care are happy to take it for themselves when they are members of Congress, or use Medicare when they get older, or use VA care if they are veterans, or take state government health insurance when they are state Senators, or county government health care when they are county commissioners. But heaven forbid if some working class guy gets sick and dropped from his coverage because his kid develops diabetes, because that would mean government “runs” our health care.
Now clearly, the messy way this thing got passed and the bad messaging from the White House didn’t help us in terms of public opinion, but this issue is like every other bit of social progress in the last couple hundred years: right wingers try to scare the hell out of everyone, have some initial success, but once the bill becomes law people start to get used to what they like about it. That is the phase we are going through now, as polling shows the repeal message has less and less support over time.
Once we successfully defend the idea of health security for everyone, we have to begin the improvement process, because there are some very important things we need to fix. I am optimistic that we can do that in the coming years, as people continue to get hurt by insurers, and continue to rely more on the protections and security the new health care has for them.
Nothing in the course of history is certain. This law might get picked apart, worsened, even repealed by right-wing Republicans if they gain more wins in the next election or two. But my guess is that when we look back on this at the 10-year anniversary of this bill, we will see a law that is rapidly becoming as politically well-established as Social Security, and is being improved over the years just the way Social Security has been. We have a platform to build on; we just need to keep building.