From The Archives: Healthcare Reform Struggle Will Not End This Year

[ Posted Thursday, March 25th, 2010 – 17:25 UTC ]

[Program Note: This is a repeat of a column I wrote last November (originally published on November 16, 2009). I felt it needed another look, no matter where you stand on the healthcare reform debate. Because the job is simply not over yet, no matter what perspective you're coming from. We may be on a new path, but we have in no way reached the end of the road on this particular debate. While getting to this point has been politically exhausting for just about everyone concerned, always keep in mind that the journey's not over yet. In any case, I thought this would be a good time to remind everyone that this will likely be a hot-button issue for years to come in American politics.]


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

Follow Chris on Twitter: @ChrisWeigant


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