Some 50 years have passed since Yogi Berra uttered his deathless phrase, "It's déjà vu all over again," and yet that fractured bit of folklore still elicits a knowing, and often patronizing, smile whenever it is heard. But condescension aside, the much-abused architect of this and so many other malapropisms may have been on to something -- a subtle something for which the seemingly buffoonish mind of the Hall of Fame ballplayer has never been credited.
Déjà vu refers, after all, to a single event or image that leaves the impression of having been previously experienced. To be logically consistent, the term "deja vu all over again" must therefore refer to a specific feeling that is sensed not once but repeatedly over time -- which is exactly what Berra meant in his allusion to the sight of Mickey Mantle and Roger Maris hitting back-to-back home runs in game after game. And it is also exactly what we are witnessing today, in the ongoing debate over the future of the Patient Protection and Affordable Care Act (PPACA) signed into law by President Obama on March 23, 2010.
Castigated by its opponents as "Obamacare" and most recently attacked by the Republican attempt to repeal it as "The Job-Killing Health Care Law," the legislation causing the current commotion is only the latest iteration of a déjà vu that I have been reliving throughout my adult life.
I have been following the attempt to initiate or revamp federal involvement in the health of Americans since it was a major topic for my high school debating team in 1947. That was the year of the third version since 1944 of the so-called Wagner-Murray-Dingell Bill, intended to provide government-sponsored universal national health insurance. Fought vigorously by several major politicized organizations -- chief among which was the American Medical Association -- the fourth try at passing the bill in 1949 went down to a final crushing defeat.
The next significant attempt at federally-based coverage occurred during the Great Society efforts of President Lyndon Johnson, as an outgrowth of which amendments to the Social Security Act resulted in the birth of Medicare and Medicaid. Not surprisingly, the AMA again opposed the legislation, though it later cooperated in its implementation once passage had occurred. It is not at all cynical to point out that physicians' realization of the potential boon to their incomes was a major factor in this about-face. The debates around the medical aspects of Johnson's package of proposals brought on my first major sensation of déjà vu.
Though the concept of a national health system never lost its power to stir up emotions, campaign promises and Congressional debate during several succeeding administrations, its next full-blown outburst did not occur until early in the administration of President Bill Clinton. A combination of ineptness, unexplained secrecy and inadequate consultation doomed the plan from its inception, but there was also by then a considerable increase in powerful and moneyed opposition, including the hardly disinterested insurance and pharmaceutical industries. Herewith my second déjà vu.
Though President George W. Bush made some small noises about his intention to present some form of improved health coverage, nothing grew out of them. Still, determined efforts by Democrats continued through both of his terms, as well as assurances of the party's firm resolve not to let the crusade -- for that is what it had become by then -- wither and die.
Prominent legislators, among whom Senator Ted Kennedy was appropriately considered to hold the leadership position, made the goal of universal health care the centerpiece of their political agendas.
Whether wisely or not, one of the first priorities of the incoming Obama administration was to present a package of healthcare benefits, which, to no one's surprise, produced an uproar in Congress and an assortment of polls declaring that the majority of Americans were opposed to it. Several of the proposals of what has been for me déjà vu number three -- including the potentially game-changing one of the public option to enroll in a government-administered insurance plan -- had to be dropped as a result of the considerable horse-swapping that took place in order to pass the more than 2,400 pages of what most moderates and all liberals consider to be a much-diluted and inadequate bill.
It is this compromise, the PPACA, that the Republican Congressional majority is determined to overthrow via the Repealing the Job-Killing Health Care Law Act Bill, was uniquely loaded title if ever there was one. Among the stated Republican objections was the fear of "creeping Socialism."
A specific aspect of the pre-PPACA discussions has continuously been hotly debated since Senators Wagner and Murray, joined by Congressman Dingell (the father, incidentally of the present 84 year old Congressman John Dingell of Michigan -- which says a great deal about how long Americans have been getting hot under the collar about this issue) introduced the concept of government-sponsored universal health insurance.
The final bill of 1947 provided only for employer-employee contributions to a national care and hospitalization fund, but did not help those without jobs. This being a disappointing weakness of the proposed legislation, liberals continued to urge not only the creation of a truly universal system, but that all health insurance be federally administered. Such futurists wanted to go beyond what we nowadays call the "public option" -- in that day when the health insurance industry was embryonic -- and on to a universal government-run health insurance system.
Needless to say, conservatives and many middle-of-the-road Republicans called such notions socialistic, even as they do today. In addition, they protested that a government-administered plan would lead to loss of physician autonomy, as bureaucrats in Washington determined what kinds of treatment were to be given as well as those which should be withheld, very much as indignant current-day voices have invented such fictions as the much-feared "death panels" of Sarah Palin and others. Plus ca change, plus cela meme chose. "The more things change, the more they remain the same."
The risibility of the title "Repealing the Job-Killing Health Care Law Act Bill" is roughly equivalent to the risibility of any similar legislation's chances of being signed into law in the future, regardless of which party is in power. And in my view, current rulings by federal judges that parts or all of PPACA are unconstitutional will ultimately also be shown to be mere tactical delays in the rolling out of the Act's provisions, and even in further extension of benefits -- including the "public option."
This is because opponents of broadening the government's role are pursuing a strategy that never succeeds, no matter the situation in which it is invoked: they cannot hold back the tide of history. Not only throughout Western Europe but in America as well, the expectation of the citizenry has increasingly been that a progressive society will accept responsibility for the social welfare of its members.
To be convinced of this indubitable truth, one need only survey the trajectory of social legislation in our nation and in other democratic states since the inauguration of President Roosevelt in 1933, and much earlier in parts of Europe. Though often slow and marked by hesitation and rabid opposition, the forward motion of this type of change is ultimately relentless.
With respect to the assurance of universal health care, even conservative presidents like Nixon and Bush recognized the need; even self-interested organizations like the AMA and the rank and file of American physicians (both of which support PPACA) now recognize the need. It is primarily those interests standing to suffer huge financial losses -- such as the insurance industry -- that remain immovable, and perhaps gradually less so as they imagine new ways to cooperate with government.
There will always be plenty of self-proclaimed individualists who resist the inexorable nature of social evolution (while refusing to recognize that they are among its beneficiaries) but their number will become fewer.
Making this prediction is hardly a pie-in-the sky fantasy, as evidenced by the number of staunch opponents of such benefits as Social Security, unemployment insurance and Medicare who changed their minds after realizing how these measures benefitted the stability of the nation, and of themselves.
Universal health insurance is an idea whose time came long ago; we have finally embarked on the next of the several stages that will be necessary to implement it. Attempts to stop the tide can only result in slowing an inevitability. Our national history tells us as much.