It’s about time
Court’s ruling caps a century of reform struggle and policy twists
If you find yourself near Oyster Bay in New York and hear a sound like the purring of a contented grizzly bear, it’s probably the ghost of Theodore Roosevelt. Exactly 100 years ago, Roosevelt broke from the Republican Party, which he thought had abandoned his reforms. He ran for president on the Progressive Party ticket and endorsed a national healthcare plan. Since then, more than half a dozen presidents have tried, with limited success, to expand coverage (See chronology, pp. 14-19).
Now, the U.S. Supreme Court has upheld President Barack Obama’s reform law in a convoluted decision authored by the chief justice and clearly aimed at defusing allegations of extreme partisanship against the court. And it’s worth reflecting on how we arrived at this place in history.
Decades after Roosevelt’s campaign, dissatisfaction with the nation’s crazy-quilt healthcare “system” grew. In the 1990s, conservative analysts devised their own reform plans. That thinking coalesced around a system of private insurance plans. It’s outlined in a 1991 Health Affairs article titled “A Plan for Responsible National Health Insurance.” Here are two key points from that paper: “(3) All citizens should be required to obtain a basic level of health insurance,” and “(4) The obligation to obtain basic health insurance should be placed on the individual, not the employer.”
More than 20 prominent Republican lawmakers sponsored insurance-market legislation with an individual mandate. It was an alternative to President Bill Clinton’s proposal.
But after Obama won in 2008, Republicans and conservatives rejected any Democratic proposal, and the Democrats eventually passed the Patient Protection and Affordable Care Act out of political desperation. Republicans denounced the conservative plan as unconstitutional socialism.
Most legal experts dismissed the constitutional objections as dubious at best. One of them, Charles Fried, solicitor general under President Ronald Reagan, vowed to eat his kangaroo-skin hat if the Supreme Court struck down the law. Nonetheless, conservative legal groups pushed to have the law scrapped (June 25, p. 8).
During the Supreme Court’s March oral arguments, Fried in a Washington Post interview lamented what he saw as the reason for the conservative antipathy to the ACA: “Politics, politics, politics … I don’t understand what’s gotten into people. Well, I do I’m afraid, but it’s politics, not anything else.”
Indeed. Today, public policy no longer matters, even if it’s your own policy. If your political opponent endorses a measure, it must be rejected.
Here are other things to chew on besides hats: About the time of the Clinton plan debate, decidedly capitalistic Switzerland contemplated an overhaul of its malfunctioning healthcare system. It adopted a plan similar to the conservative proposals in its reliance on private insurance and a requirement that everyone buy insurance.
Switzerland and other countries that have adopted health insurance have viewed their moves as moral and practical imperatives. On the practical side, as healthcare experts have noted, a country that covers everyone has a powerful incentive to keep people healthy and not waste resources. The moral debate is usually avoided in the U.S. in favor of economic considerations. Nonetheless, a country that guarantees its people the means to life’s necessities embraces human decency and national unity. In her ACA opinion, Justice Ruth Bader Ginsburg quoted from a 1785 letter from George Washington to James Madison: “We are either a united people, or we are not. If the former, let us, in all matters of general concern act as a nation, which have national objects to promote, and a national character to support …”
And at this moment in history, we could use more national unity and less political gamesmanship.