November 22, 2008
Is the time right for universal health care?
Barack Obama has one overriding task: he must restore the strength and confidence of the American economy, and the sooner the better. But keep your eye on health care.
When FDR came into office in March 1933 after an even longer and even more unnerving transition period than this one, he had one overriding task and he set about it with great energy and creativity. He proved that America could cope with the Great Depression, even though it took years and World War II to find great prosperity.
But the real story of the New Deal was one signature program—Social Security. Passed in 1935 it reframed the crisis of the economy by focusing on the long-term security of the elderly. It has been America’s most successful and popular social program. And retirement security for the elderly helped keep the economy on an even keel through good times and bad.
In 1965, Lyndon Johnson signed the second great pillar of American social policy and created the Medicare program. But the third pillar, universal health care, has languished. Democratic presidents from Harry Truman to Bill Clinton tried and failed to pull the sword from the stone. These three programs are really the heart and soul of the Democratic Party, to turn principles into reality or to defend them once created.
Obama seems to be inclined to get to health care now and not later, although his timing is different than FDR. The economic crisis is so bad now that constraints on spending are likely to be suspended. Only a huge economic stimulus can help the economy now. If Obama can make the connection between the economy and health care, the momentum may become irresistible. I think the most powerful argument, though, is one he made on the campaign trail in talking about his mother’s final days, that she spent her time not coping with her situation but on the phone arguing with health insurance companies. This really hits close to home.
With the appointment of Tom Daeschle as Secretary of Health and Human Services, Obama has a long time advocate of health care reform. While Sen. Ted Kennedy’s support is to be expected, the entry of Sen. Max Baucus of Montana with a progressive health care plan shows that the politics of health care has expanded the electoral map in the same way that Obama’s campaign did. In fact, Hillary Clinton’s willingness to consider the position of Secretary of State may reflect that there are so many potential parents of a new health care system that her own pioneering efforts ih 1993 may not give her a seat at the head table when the new Senate convenes.
Some Republicans are very worried —- not that Obama will be successful in dealing with the economic crisis—but rather that he will go farther and complete the Democratic grail of social programs. A similar fear led Congressional Republicans to block Clinton’s plan in 1993, a strategy that paid off handsomely in the 1994 congressional elections when they blamed Clinton for the failure of health care. But Obama’s victory was much more imposing than Clinton’s in 1992 ; and he also has the mistakes of the Clinton approach to study.
Finally, the Republican party is much weaker today than then. After Clinton won, conservatives could say that Bush, Sr. messed things up for conservatives by raising taxes. This year, the collapse of the Bush regime has been so total, and the Bush regime was so conservative that the Republicans are at a loss for direction. The logic for moving quickly on health care is also to act before the Republicans get themselves together again.
And so we may be seeing history made again following an historic presidential election—perhaps the most significant change in American social policy since Medicare. The key to its success will be to remember that the best programs are simple and have a clear justification not just for the numbers crunchers but in terms of what is fair and who is deserving. That is one reason that FDR insisted that Social Security be a contributory program, a recognition of the work performed in one’s lifetime. I do not know what the equivalent values are in health care (maybe a mandate that everyone must have coverage) but we do know that it is important to find what they are.