(Stipulation No. 1: Obamacare’s opponents say it’s really the road to serfdom.)
(Stipulation No 2: While offering health insurance to more Americans, Obamacare falls far short of universal coverage.)
But we are getting ahead of ourselves with all this stipulating.
Our journey begins in the middle of the last century.
Industrialized nations emerging from World War II began ushering in health-care policies that ensured coverage for all citizens, basically accepting it as a fundamental right and a hedge against the damage that for-profit medicine can make on a national economy. Over the following decades, these universal systems would emerge in Britain, Germany, France, Japan, Spain, Italy, Canada and other developed democracies.
In 1947, President Harry Truman attempted to do the same in the United States. In 1945, Truman said, “The health of American children, like their education, should be recognized as a definite public responsibility.”
Truman’s plans, however, were doomed by vigorous opposition by the American Medical Association, which coined the term “socialized medicine” to stir public opposition.
Thanks to that defeat and the development of IRS rules that (a.) didn’t treat health benefits as taxable income and (b.) allowed businesses to write off those expenses, an employer-based health-care system sprang up in the United States.
As a 2008 Wall Street Journal column by bioethicist Ezekiel J. Emanuel and U.S. Sen. Ron Wyden noted, “The system worked at first, but a lot has changed in 60 years. Back then, the average soldier returning from World War II took a job with a local company where he would work for decades until he got a gold watch at a big retirement party. Today, lifetime employment is dead. By 42, the average American will change jobs 11 times.”
Continuing on our tour, let’s move ahead 15 years, to July 30, 1965, when President Lyndon B. Johnson signed bills that created Medicare and Medicaid. In the most basic terms, one (Medicare) established a health-care system that provided for elderly Americans, while the other (Medicaid) created government health insurance for the poorest Americans.
In the early 1960s, when Medicare was being debated, Ronald Reagan, the future governor of California and president of the United States, offered a dire prediction that if such legislation became law, “We are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.”
Physician and author Atul Gawande reminds us of the rocky early days of Medicare: “In public memory, what ensued was the smooth establishment of a popular program, but in fact Medicare faced a year of nearly crippling rearguard attacks.” The AMA was initially resistant, as were Southern governors opposed to integrating hospitals.
By the early 1970s, President Richard Nixon promoted his own version of health-care reform, one that promised to provide basic coverage to all Americans. “Comprehensive health insurance is an idea whose time has come in America,” Nixon said. Congress and the special interests supporting the status quo disagreed.
Next up came Bill Clinton, whose 1992 campaign for president promised to do something about a U.S. health-care system that left many Americans in deep debt or without coverage at all.
Enter a key memo by William Kristol, a well-connected Republican, who wrote, “passage of the Clinton health-care plan in any form would be disastrous. It would guarantee an unprecedented federal intrusion into the American economy.”
Exit Clinton’s health-care reform plans.
Clinton’s big-picture reform did bring something significant to the forefront — a conservative alternative, one created in the late 1980s and early 1990s. The Heritage Foundation’s version of universal coverage would require all Americans to carry health insurance. This “individual mandate” (sound familiar?) would weed out the freeloaders who didn’t carry insurance but depended on emergency rooms (and ultimately those with insurance) to pay for treatment.
The mandate came to life on April 12, 2006, when Massachusetts Gov. Mitt Romney signed a health-care bill that required Bay Staters to purchase insurance.
“It’s a Republican way of reforming the market,” Romney announced on signing day. “Because, let me tell you, having 30 million people in this country without health insurance and having those people show up when they get sick, and expect someone else to pay, that’s a Democratic approach. That’s the wrong way. The Republican approach is to say, ‘You know what? Everybody should have insurance. They should pay what they can afford to pay. If they need help, we will be there to help them, but no more free ride.’ ”
In 2008, Barack Obama ran for president, vowing to make health insurance “affordable and available to every single American.”
After a tortuous journey through the legislative process and with complete Republican opposition, on March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act.
Almost immediately, Obamacare (as it became known) was challenged in federal court. By a 5-4 vote in 2012, the Supreme Court upheld the law as constitutional.
Five months later, Obama won a second term as president. This, along with a Senate controlled by Democrats, guaranteed that Obamacare would survive all repeal attempts before its full implementation in the middle of the decade. Ironically, Obama defeated the man credited for creating Romneycare.
On Tuesday, Obamacare’s health insurance marketplaces open to the public. Republican opposition to the law is as intense as it was when it was debated four years ago.
However, if history is our guide, there will likely come a day when Obamacare — as flawed as it is, as in need of tweaking as it is —will become as much a fixture of American life as Medicare, Medicaid and Social Security.
Bob Davis is associate publisher/editor of The Anniston Star. Contact him at 256-235-3540 or firstname.lastname@example.org. Twitter: EditorBobDavis.