The struggle for healthcare reform is not going to end this year. By saying that, I am not breaking any news about Harry Reid or the Senate, or even about the chances for passage of any particular bill or healthcare reform scheme before New Year's Eve -- rather, I am urging people to take a step back and view healthcare reform from a much bigger-picture point of view. Because whatever passes is not going to be the final word on the subject. As with almost any sweeping social legislation, it's going to take a few revisions before we get it right. Perfect bills almost never pass. The more normal course of events in Washington is that compromises pass, and then are strengthened later on. Healthcare reform should be viewed in the same way.
As an example of what I'm talking about, consider the fact that Republicans have been fighting to dismantle Social Security for over seventy years. Even if President Obama signs a healthcare bill next week, the larger healthcare reform battle will not be over by any stretch of the imagination. But there's another side to this coin, as well. Because while Republicans can be expected to keep coming back to the new legislation in an attempt to dismantle it, Democrats may also have the opportunity to revisit the issue in order to strengthen whatever initial legislation passes.
A quick read of the history of Social Security is instructive here. The very first Social Security law was passed in 1935, fully two-and-a-half years after Franklin Delano Roosevelt took office. While F.D.R. managed to quickly pass much of his New Deal schemes, Social Security took a while longer. And, at first, it was nowhere near the system we have today. It had racism and misogyny buried in it. Huge swaths of workers (such as agricultural workers) were not covered at all. Many of these job categories not covered were jobs held mostly by women and minorities. At the time, the N.A.A.C.P. called the bill "a sieve with holes just big enough for the majority of Negroes to fall through." Southern Democrats sat on the Senate Finance Committee (now chaired by Max Baucus), and were instrumental in designing the bill in such a fashion. Particularly egregious disparities happened under Aid to Dependent Children, since the funds were administered by the states -- some of whom rampantly discriminated against anyone they chose (illegitimate children, for instance, weren't covered in some states, and black families were paid a fraction of what white families were paid). Women were shortchanged as well, which was also deliberately designed into the system. The first push to revamp Social Security started the year after it passed, and in 1939 Social Security was amended for the first time in the name of "family protection." This also moved up the date monthly benefits would be paid out from 1942 to 1940.
Social Security would be amended over and over again throughout the following decades. As a result, it broadened its coverage far beyond the groups the original legislation covered. But it took some time -- it wasn't until the 1950s that agricultural workers and service employees were covered. Medicare and Medicaid were added to the system in the biggest expansion to date, in Lyndon B. Johnson's Social Security Act of 1965 (the biggest achievement he would see in his "Great Society" agenda).
Since then, most of the adjustments to Social Security have been actuarial tweaking of benefits paid out, taxes collected, and retirement ages. President Reagan signed the last big tax increase (yes, you read that correctly) in the system, back in 1983. Congress had opted itself out of the system until the 1983 revision was passed, which also covered presidents and other federal employees left out.
By the 1980s, and ever since, Social Security itself was being called "the third rail" of American politics (touch it, and you die). Ronald Reagan began his political career demagoguing Medicare and Medicaid as "socialized medicine" (I have previously written about the album the A.M.A. put out in 1961 in a fake-grassroots lobbying attempt with the catchy title "Ronald Reagan speaks out against Socialized Medicine"), but during his two terms in office he never succeeded in getting rid of them.
But some conservatives have never given up trying to dismantle the social safety net Social Security provides. Their latest attempt, which peaked in the last two decades, was to try to "privatize" the Social Security system. Republicans have been fighting such battles since 1935, all while Social Security has grown more and more inclusive to the public -- far beyond where it initially started. But some of the inequities built into the Social Security system remain even today -- like the regressive nature of the payroll tax which funds it (where the rich pay far, far less as a percentage of income than the middle class or poor). So even now, it's not perfect by any stretch of the imagination.
What lessons does this history have for today's struggle for healthcare reform? Well, the biggest lesson is that President Obama signing a bill in the next few months is not going to be the end of it. Not by a long shot.
Let's just say for the sake of argument here that your favorite healthcare scheme passes. Whichever flavor of legislation you prefer, assume that Obama signs it into law before the State of the Union speech next January. Yes, that's a fairly large assumption, but that is my point here -- even if it happens, Republicans simply are not going to shrug their shoulders and say: "Well, we lost that one, let's move on to other things."
Pretty much all of the bills making their way through Congress agree on one thing -- they won't go into effect until 2013. But that is two congressional elections hence. So what do you think will happen if Republicans take over one or both houses in either of those elections? Since the benefits of healthcare reform won't have materialized yet, their first order of business will be to attempt to dismantle as much of it as they possibly can.
Progressives will also have to continue fighting, and not merely on the defense against such conservative attacks on the new system. A large portion of Democrats are virtually guaranteed to be seriously disappointed by anything that passes, because of the compromises made along the way. This should not be seen by progressives as a defeat, however, but rather a call for further action. Because no matter what is in any bill Obama signs, it is a sure bet that it will not be the last word on the subject.
It's going to change over time, just as Social Security has changed. Hopefully, it will change for the better, as limitations and restrictions are overturned in the future. The possibility also exists, of course, of the whole scheme changing for the worse (if Republicans come back to power in either Congress or the White House, for instance). The danger of dismantling the system will be highest during the first years, before the 2013 "trigger" date. It's easier to take something away that hasn't even begun to be handed out yet.
But eventually, assuming some sort of bill passes, and assuming it survives relatively unscathed in 2013, average people are going to see improvements in the system and they will resist dismantling the new system as fiercely as they now resist any sort of dismantling of Social Security. Those are some rather large assumptions, and an optimistic read of the next few years, I realize. But, remaining optimistic here, what all supporters of healthcare reform should realize is that while whatever bill emerges from Congress is doubtlessly going to fall short of a lot of people's expectations -- it will not be the end of the story.
I am not making apologies in advance for Congress, I should mention. It would obviously be better to pass the strongest possible framework for healthcare reform now, so that building upon such a foundation later will be an easier job. In other words, this is no excuse for watering things down even further before the bill passes. The stronger and more inclusive a system we can come up with from the beginning will mean a quicker road to a truly impressive healthcare system.
But it is meant as an early consolation to those whose ideas have been shot down already, or will be shot down before the bill gets to Obama's desk. Just because you think you've lost the fight for your particular issue doesn't mean it won't be possible later on. Take a look at where Social Security started in 1935 -- a tiny system intentionally geared towards white males -- and where it stands today.
No matter what healthcare bill passes, it is not going to remain static. It is going to be revisited again and again over the next few decades. Everyone may remember the initial passage years from now as the big historic "turning point," but there will still be a lot of work left to make it a truly historic change. That's the way of lawmaking. Rather than bitterly denouncing whatever emerges from Congress as being far short of what you expected, see it instead as merely the beginning of the long road towards making the system work the way you want it to. See it as a call to action, and not a defeat, if you really want to make it better. And don't get discouraged, because these things always take more time to get right than anyone expects.
Chris Weigant blogs at: ChrisWeigant.com
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www.ssa.gov/history
-- an incredible resource that I use in my government classes.
For those who say single-payer or nothing, they will get nothing. And more people will go without health care, and more people will go bankrupt, and more people will die. With nothing.
Of course I do not like the current legislation, of course I believe there will be attempts at watering it down further, and of course there will be attacks by conservatives on a continual basis. But we do need something to work with as soon as possible. Something to fix, something to revise, something to strengthen. Re-read this post -- something IS better than nothing. We can continue the pressure, continue the hard work, and get at least some people the health care they deserve.
Don't be such an ideologue that you can't see the very important message of Chris Weigant's post. Thank you.
No, no, thank YOU for your comment. Most excellent. I guess they've done away with the "HuffPost Pick" thing, but if it still existed I would so honor your comment.
-CW
This is all true about the importance of getting something done, and feeling good about it when it does. However, that doesn’t make it any less necessary to fight tooth and nail for the best possible starting point, right now.
Oh, I quite agree. We're not out of the woods yet, even for this year. I was just trying (to stretch the metaphor a bit) to get people to see the whole woods, instead of this tree or that. But that's not to say fighting for each tree isn't important now, as you point out.
-CW
It seems distinctly possible that we could end up with 'reform' which actually propels us backwards. Not just with Stupak, which effectively obliterates the ability for people to buy private abortion coverage using private monies. Tort reform has been an failed experiment in several states. Malpractice insurance rates dropped only 1.5-10.5%. Costs rose. Meanwhile, QUALITY dropped precitiously. The risk of a suit is an incentive for quality and accountability.
Even more importantly, it seems this Congress and Administration might attempt to MANDATE enrollment in a for-profit insurance system - a model which all other sane, industrialized countries (and Minnesota) have illegalized. This would further empower that broken system while disempowering consumers, during a time they are already experiencing financial hardships due to the lack of regulation in this and other corporate institutions.
There has to be a bottom line. No public option equals no mandated enrollment, unless single payer or banning profit is back on the table. I wish I could trust that the Democrats would pull the plug if it is not authentic reform instead of attempt to spin a 'win' at all costs.
Together are creating unprecedented legislation
With Citizens indentured to a private corporate interst
From 18 to 65
Pay them, we must for being alive on American soil.
They hand us and our children, and our children's children over to Big Insurance
And call it HealthCare Reform
Perhaps we should rewrite the Pledge of Allegiance:
I Pledge Allegiance to the Flag
Of the United States of America
And to the Private Profits for which it stands
One Nation, under Big Insurance
For Posterity
With Penalties and Mandates for All.
But didn't CFR actually start back in the 1970s? McCain/Feingold was the most recent action on it, but I believe (I could be wrong) that it capped a decades-long push that involved more than one piece of legislation.
And if you were really gung-ho, you could go back to the original Populists and Progressives from the early 20th century, who must have been behind the original campaign finance law, which restricted corporations from donating directly to political campaigns (which, I believe, is before the Supreme Court right now). So you could draw a line from the 1900s all the way through McCain/Feingold if you had a wide definition of the term.
But I do agree with you about the link between weak CFR and where we find ourselves today on HCR.
-CW
I distinctly remember Ronald Reagan's "Cadillac-driving welfare queens" line that he used in campaigns (I believe it may have even started when he ran for governor back in the 1960s), but I had forgotten that he actually did something about it while in office.
-CW
Yeah... sigh...
To paraphrase Rummy, "you go to legislate with the Congress you have, not with the Congress you'd like to have."
-CW
Good article, Chris - but I disagree about this bill.
Actually the comment from John and response from Chris below covered some of my objections well - this bill is an apples and hamsters comparison to Social Security.
Let's take one of Chris's assumptions - that the bill remains unscathed thru 2013 and people don't want the Public Option dismantled. First problem - the Public Option that will pass is going to suck. It will be more expensive. It won't be open to many. If there's an opt-out (the best case at this point) - it will be open to less. So - it's not like social security at all.
What is sure to happen is that the private insurance industry will become entrenched by this bill - and THAT'S what people are going to be resistant to And that is exactly why this bill needs to be seen for what it is - the death by back stab of universal health care, brought to you by the Democratic Party.
Ah, but I counter thusly (and, by the way, I have a lot of respect for your own columns here, just wanted to say that in mutual admiration):
In 1935, the Social Security that managed to pass Congress sucked. It wasn't open to many. There was an opt-out, and many localities and professions took it (until later, that is). So it is indeed a close parallel. When SS started to become overwhelmingly popular among its beneficiaries, it was vastly expanded. So why couldn't this path be the same for healthcare reform?
-CW
Of course you want to "kill the bill" until something perfect can be written -- allowing millions of Americans to be devoured by the system in the meantime. In all of your posts about killing healthcare reform, you have yet to lay out a realistic path to passing a bill that satisfies your qualifications. Chris is.
This bill is a first step towards single-payer. This is the path. Waiting another generation (which is the historical precedent) won't strengthen reform or bring about a climate favorable to single-payer. The next time around, reform will be weaker.
Whoops! Forgot you were on here... I just used your name up there with Bob Cesca, hope you don't mind.
-CW
Two debilitating character flaws on which the Republican Party has no monopoly, however, are greed and the lust for power and celebrity that facilitate greed at the expense of the average citizen. So, a critical question now is whether the handful of personally ambitious Blue Dog Democrats, who have not-particularly well-educated or well-informed constituencies, will continue to accept pay-offs from the Merchants of Death--the obscenely overpaid, highest ranking executives of America's private, for-profit, bait-and-switch health insurance corporations--to do their bidding and so, work with and for the Republicans against the best interests of the average American.
Forty thousand lives a year hang in the balance.
For every single Bill that the author can name, I can name an area of Legislation that Congress has refused to revisit, even though the needs might be obvious. For starters, I'll name the Health Care Bill itself -- it has been SEVENTY YEARS COMING. Tha'ts not timely or incremental in anybody's dictionary.
After closely watching Congress all year, can ANYone on ANY side of the health care debate honestly say that we have sane, honest, careful representation in the House or Senate Leadership who can protect all of us from the mischief that would ensue?
The current health care Bill is the only shot we can count on. Period.
Our Representatives should vote against the Bill if it is a weak compromise -- literally to force Congress to continue the debate. We need to treat this as our last chance.
tt77
That said, there's no rule of physics or politics that prevents Congress from amending existing laws; it does that all the time. One reason it took Congress so long to address universal health care is that the costs of care (and so, of insurance) didn't start to become as high as today's until about 20 years ago. Then, the sheer arrogance and ineptitude of a certain poitician (whose name I won't use, but whose initials are Hillary Rodham Clinton) so completely screwed matters up, it required a new Democratic president--and Democratic majorities in Congress--before the matter could even be raised again.
This is NOT our only chance and it IS, as Chris notes, an on-going fight, not a one-shot deal. It would be cleaner and simpler if Congress always worked as you say, but it's not inevitable. The lesson having Obama as President has taught us anew is that NO leader will protect us from mischief. Citizens have to take an active role inbetween elections--or accept atrocious legislation and unmet vital needs.
The reasons to accept too little reform now are the forty thousand lives lost every year there's no reform. (There's also reason to start getting ready to replace Obama on the national ticket in 2012 if he doesn't better deliver on his core campagn promises.)
Well, it's stretching the analogy a bit, but here goes: the stock market, in the case of SS, is a for-profit venture (if you get lucky), and SS is the safety net.
If a public option (which is supposed to be a non-profit) becomes a true safety net, then the analogy would work.
But I realize, it's kind of apples and oranges. I was commenting more on the history of SS, and the incremental way it came into being, more than trying to draw a direct parallel.
-CW
(Granted it makes an even heftier profit off healthy people, which is why it likes preexisting conditions.)