Learning from History on Health Care Reform

by Lesley Politi on April 29, 2009

President Obama is preparing to execute a major health care overhaul. After decades of a crumbling system, this is long overdue. Americans are hurting more than ever before and are eager for a change. But the many failed attempts at reform during the last century attest to how complicated and challenging this issue is. Although Obama seems poised to make it happen this time, Democrats must keep in mind some key lessons from history if they are to succeed.

Fortunately, Obama faces a more conducive political climate than Bill Clinton did during the ’90s. Public support for national health care has risen dramatically. Democrats, with a popular president and robust majorities in Congress, are in a more commanding position to enact reforms. Unlike the divided effort on Clinton’s health plan, current Democratic leaders are cohesively working toward a solution. The Red Scare has dissolved and the Reagan era is long gone, which means Americans are less likely to be bamboozled when the right wing equates universal health care with “big government,” “socialism,” “communism,” “fascism” and my personal favorite, “totalitarianism.”

Progressives are better organized and more determined than ever before. The support for liberal ideas and the “Health Care For America NOW” campaign will help counterbalance the inevitable backlash from special interest lobbies like the AMA, HIAA and PhRMA. The AARP and AFL-CIO, with copious besieged members, are prepared to fight the good fight. Moreover, the conservative movement is a wretched mess, harboring less legitimacy and support than perhaps ever in our lifetimes.

Despite better conditions, however, success will be far from a cakewalk. Unlike the ’90s, America faces a major economic crisis and an extraordinarily fiscal deficit, which will restrict Obama’s playing field. Congressional Republicans, without any ideas or alternatives, will cry foul no matter what Obama proposes, especially if there’s money involved. With nothing left to lose, they’ll fight as dirty as they can. (It won’t matter that they have no credibility on fiscal responsibility.) The medical lobbies that have partnered with the GOP to block reforms for a century will once again wage war to preserve their power. And they’ve only grown stronger over time.

Obama can still fail if he doesn’t learn the lessons of history. Bill Clinton and Harry Truman, despite their noble and thoughtful attempts to implement universal health care, both flopped. Neither would settle for anything less than complete coverage, which was admirable, but also politically fatal as it required the radical changes many feared. Medical lobbies crushed the movements with malicious anti-reform campaigns worth millions, and both times the GOP capitalized to regain control of Congress.

While a complete transformation may be substantively ideal, proposing to tear apart existing structures has historically been a deal-breaking poison pill. Democrats might be wise to play this one cautiously and pragmatically, because if they falter, Republicans could reclaim the levers of power sooner than we can afford.

To the country’s benefit, Obama knows his history. Unlike Clinton and Truman, he isn’t trying to demolish the system and rebuild it. Obama seeks to invest in present structures while also creating a supplementary public program that is more affordable and accessible to the tens of millions struggling. This would accomplish two things: 1) It would allow Americans to hold on to their existing plans if they choose to, quelling another potential Harry and Louse-style backlash; and 2) It would liberate the middle class from the augmenting costs and ineffectiveness of HMOs and private care.

Some progressives have criticized Obama for not pushing full-force on a single-payer plan. While single-payer would be the ideal system in the long-term (such programs have the best track record worldwide), another failure to make any amends will be catastrophic. A big advantage of Obama’s strategy, along with the relief it’ll bring to millions of families, is that it’s relatively fail-safe. Lest we forget, the most transformative health care overhauls that succeeded in the last century were Medicare and Medicaid, both of which employed the same strategy: build on what we’ve got and let the changes happen organically.

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