Learning From History On Health Care Reform

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.

Comments

[PlaceboStudman]

The question here is, what exactly are they/we trying to reform? Are we trying to reform ie improve actual CARE, or are we simply trying to find ways to make what we're paying for now cheaper? Because if we are simply trying to find ways to make what we are paying for now cheaper, then we will end up having WORSE health care, as more people become sick and die from the abuse and neglect that come from the care we receive.

I have asked this question before, without an answer, and I will ask it again and again until I get an answer.: what is the point of paying $10 after reform, vs the $100 we are paying now, if nothing is done to improve the quality of care we are receiving? And don't tell me it has to do with insurance overhead, because it doesn't. It has to do with the fact that the FDA and BigPharma are in cahoots together to give us substandard dangerous medication and treatments, even before they are made available to insurance to be accepted or denied

[MagnusAvarus]

Here is how I see it coming down. The corporate Dems and the Administration appease the private insurance parasites by taking single payer off the table and propose something like the failed Mass. reform plan.
See the presentation of David Himmilstein M.D. before a congressional committee.
http://www.pnhp.org/news/2009/february/national_lessons_fro.php
The Rs then work hard to water the Dem plan down further and the Dems cave supposedly seeking bipartisanship. When the vote comes no or nearly no Rs vote for it. The Dems are left with an worse than worthless mess hung around their necks but still get big contributions from insurance and pharma lobbyists their real constituency.
The US Citizens get the shaft once again while Congress and the administration get the best socialized medicine that the US can provide and don't have to deal with this problem for at least another 10 to 15 years... in the mean time tax payer dollars go to subsidize private insurance which continues to delay, deny, cancel, put up red tape barriers and pay their CEOs hundreds of millions of those dollars rather than spending them on health care.
HR 676 and SB 703 are what we who want real reform should be supporting let the corporate Ds and obstructionist Rs know! Call, e-mail, Fax, sit-in they won't do the right thing unless we make them.

[Sudipta Bhawmik]

Whatever happened to HR 626?
Is that bill dead? It had lot of promise for a single payer system.

[RoloTomassi]

It's HR 676, Medicare for All.

[FearlessFreep]

I remember in the '90s when Washington talking heads favored Clinton's "managed competition" over single-payer because it was "relatively fail-safe."