Source: The Hill
Every Democratic administration in the past century — no exceptions — came to Washington promising to rewire the healthcare system, mainly to protect Americans from the costs of illness. So did most Republican administrations (including President Trump’s). In the uproar of our times, few people noticed that the Affordable Care Act had already ended the long quest.
The program has flaws, of course — lots of them. But, for the first time, future administrations have the option to get to near universal coverage by building on what’s already there. That is a whole lot simpler than designing a new program from scratch, and it can be done through budget reconciliation, thus avoiding the dreaded Senate filibuster. The mix of Medicare, enhanced Medicaid, Affordable Care Act marketplaces and employer health plans make it possible to cover all Americans in incremental steps.
The Affordable Care Act, when it finally emerged from the fires of repeal efforts and court challenges, brought down the curtain on a long, political kabuki. Democrats kept proposing health reforms. Republicans would respond with shouts of “socialism” and offer more modest alternatives — less change and less government, more markets and more private sector.
Under the Obama administration, Democrats returned to power waving a variation of the old Republican alternative as their new plan, imagining that this time they might win bipartisan support. The Republicans again shouted “socialism,” and the wheel turned again. And again.
Now, the Republicans have run out of rope.
There have been few real proposals to counter the Affordable Care Act. For one thing, there is very little room for a government program to the right of the Heritage Foundation’s blueprint that inspired the reform (originally offered as a counter to the more ambitious Clinton plan back in 1993). More important, a new spirit was booming out of the conservative grass roots. It demanded all-out war on Democrats and their healthcare fandangos. Republican officials joined the chorus. But perhaps all that no longer matters.
The quiet collaboration between the parties throughout the years has been hard to see because each episode set off a ferocious debate. Theodore Roosevelt, running as a third-party candidate, first proposed the reform in 1912. Over the next decade, the fight broke out in the states; opponents challenged government health insurance in California (where it was routed by referendum) and New York (buried in committee).
The debate hit Washington thanks to the Franklin Roosevelt administration. As victory loomed in World War II, Roosevelt cast about for a new crusade to lead and alighted on national health insurance. But he died before his plan was ready, and it landed, completely unexpectedly, on Harry Truman’s desk — a liberal message from Roosevelt’s grave. Truman made it the cause of his life.
The battle that followed helped define the modern political parties. Liberals proudly supported a right to healthcare; conservatives opposed the government overreach. The arguments, metaphors, memes and insults — on both sides — have barely changed over the decades.
Now, for the first time, the foundations for a healthcare program are in place.
Perhaps the ACA’s curious design obscures the end of the 100-year war. Barack Obama himself ruefully described his program to us as “Jerry-rigged” and a “Rube Goldberg.” Comedian Jon Stewart turned the point into a punchline when he threw up his hands in comic exasperation as Katherine Sibelius described the plan’s intricacies. “Let me ask you this,” responded Stewart. “Am I a stupid man?”
The program needs more work. The Affordable Care Act is not very affordable. Good healthcare coverage costs a lot. And private insurance markets need steady oversight or, in the race to return profits to investors, they will cut access to care. The system’s administrative costs are out of control.
But here, finally, stands a foundation. A full century after the debate began, the health insurance basics are in place. The Biden administration used them to bring national uninsurance levels down to just over 7 percent, an historic low. And many individual states continue to achieve uninsurance levels in the low single digits.
Perhaps future leaders will toss it aside and try another fundamental rethink. Every administration eventually faces demands for healthcare reform. But now, for the first time, leaders — Democrats as well as Republicans — have the option to come into power and tinker their way to universal coverage.
