Tuesday, July 10, 2012

The Audacity of Change: Obama's Healthcare Gambit

Starting in the late 1980s and early 1990s, I began to hear an increasingly alarmed cry from certain political sectors about the fate of healthcare. As early as 1987, health care costs rose from #15 to #7 in the list of Americans' top worries about the future and  that only got worse. As the '90s wore on and into the '00s, I continued to hear two things:

  1. Because of the baby-boom, health care and retirement programs were going to run out of money.
  2. Because doing anything about it was complicated and fraught with risk, no politician was going to do anything about it until it was too late.
Pundit after pundit proclaimed this second point on the left and the right with all of the conviction of optimists slowly ground down into cynics by the repeated failure of their politicians to do anything challenging that would risk their political futures.
In 1993 and 1994 the Bill Clinton administration attempted to push the Health Security Act through congress. This was a true overhaul of health care in the United States, which provided for a set of regional health care alliances which managed the interaction between health insurance providers and consumers. It avoided the controversial "mandate" of Obama's plan by making health care premiums a tax which funded regional alliances.

Both Hilary Clinton and Obama proposed plans for health care reform in the 2008 election primary season. Interestingly, Clinton's was the plan which more closely resembled the one that the administration eventually offered as a compromise. This plan relied on an individual mandate to buy health insurance (if a plan was not provided by an employer) and was originally developed as an idea by conservatives in 1993 to combat the Clinton Health Security Act.
So, what Obama has done is what I listened to pundits say was impossible for the better part of two decades: he built a compromise between the extremes of the right and left and managed to get enough votes signed on to it to get it passed.
It's not that anyone is really thrilled with compromise. Vermont is likely to bypass the act entirely and enact their own single-payer health care system. Massachusetts already has a very similar plan which, then Governor, Mitt Romney oversaw the implementation of. Republicans across the country are unhappy with being required to pay for insurance.
So, what do we do in this election season? Punish effective compromise in the face of previously believed certain failure or reward the success? We all knew that this had to be done. We lamented the fact that our politicians were unwilling or unable to effect change, but now that change is upon us will we make the predictions true and make that change the reason that Obama is not re-elected?
Personally, I'm not Obama's biggest fan. He is, first and foremost, a moderate on most topics, and while I tend to be a moderate on many topics, there are some that I'm decidedly liberal about (mostly foreign policy). I don't want compromise on those issues, but I recognize that I have to at times, and the candidate that I have at hand has demonstrated the will and capacity to overcome extreme political challenges in order to change public policy for the better.
I think it's worth giving him a chance to make his second term just as effective.

Note: The Economist had an article with a very similar title in 2008. I didn't know this when I wrote this article's title, but I think our two articles are very different and am not concerned that anyone would mistake the one for the other.