Health Care Reform

Jordan Awan

In recent months, more ink has been spilled over health care reform than any other topic currently in the news. It is unusual to see such a violent and prolonged debate over social legislation, with maybe the exception of abortion rights or immigration, both of which played a significant role in the health care debate. Loaded statements, empty rhetoric, dog-whistle terminology and outright lies became de rigueur, as the "death panel" rumors and talk of a "socialist takeover" reached a surreal climax during President Obama's September 9th address to Congress, when Republican Rep. Joe Wilson interrupted him by shouting, audibly on live t.v., the now infamous accusation: "You lie!"

It often seemed as if America's political landscape was veering from absurdity into outright lunacy, due to the fact that the arguments against reform were concerned neither with civility nor reality. Recycling Reagan's old false dichotomy of big versus small government, opponents claimed that their main goal was to reduce the size of the federal government; however, they did not want to do away with the government programs they had come to rely on, such as Medicare and Social Security. This strange contradiction lay at the heart of the argument against health care reform, further muddling the debate: opponents liked government programs but not the government itself. Yet despite the vitriol and confusion of the right and some self-sabotaging behavior on the left (most publicly by Joe Lieberman and Bart Stupak), the reform bill narrowly passed.

The United States was the only advanced industrial nation that did not guarantee health care coverage to it's citizens; the new law almost completely corrects that, sadly stopping just short of universal coverage due to the lack of a government-run public option. Still, by 2019, almost 95 percent of American citizens and legal residents below Medicare age will have coverage. On a recent talk at Columbia University, the right wing French President Nicolas Sarkozy expressed bewilderment at the divisiveness over the issue of health care in America. "When we look at the American debate on reforming health care, it’s difficult to believe. The very fact that there should have been such a violent debate simply on the fact that the poorest of Americans should not be left out in the streets without a cent to look after them … is something astonishing to us. If you come to France and something happens to you, you won’t be asked for your credit card before you’re rushed to the hospital.”

The new law represents a national resolution to undo and reform the worst elements of the existing system, which was exceptional in its cruelty. For example, a few weeks after President Obama signed the bill into law, Reuters reported that the insurance company WellPoint had created a computer algorithm that would target all policyholders recently diagnosed with breast cancer and then automatically launch an investigation in search of a pretext to drop their policies. Once the women were identified by the program, WellPoint would cancel their policies based on either false or insubstantial information. Another company, Fortis (now called Assurant Health) had a similar longstanding protocol to drop all policyholders who had recently contracted HIV. "Rescission," the practice of dropping policyholders as soon as they are diagnosed with a life-threatening illness, is just one example of the many abuses carried out by insurance companies. The new law has the power put an end to these unchecked abuses.

However, it is worth reflecting on the passing of the most substantial and consequential social legislation in decades not just for the vital changes it makes, but also the larger meaning of the new law. It is a recognition of the moral obligation to end the inexcusable neglect of the well-being of all Americans. As President Obama declared, "After a century of striving, after a year of debate, after a historic vote, health care reform is no longer an unmet promise. It is the law of the land." In many ways, the health care law is the logical (if overdue) next step in a line of necessary social reforms that began after the Great Depression and continued until the late 20th century, when it was interrupted by the sudden and fanatical anti-government fervor of the Republican Party. (Eisenhower was the last Republican in favor of social reform and proactive government; he defended the New Deal and enlarged the Social Security program.) The Republican anti-government standpoint began with Nixon but was given an articulated voice by Regan.

Regan brought both focus and theatrical flair to the Republican stance against government involvement in the well-being of all Americans; for instance, he once declared that Medicare would bring an end to freedom. His thinking equated "less government" with independence and efficiency, a rhetorical trick that obscured the contradiction of an anti-government government. Regan's ideology reached its high water mark during the second Bush administration's disastrous eight year attempt at undoing the federal government through a combination of illegal operations and basic inactivity (perhaps "ungoverning" is an apropos term); it has a swansong in the current session of Congress, where Republicans resolutely attempt to use their minority to sidetrack or block any and all social and economic legislation.

For decades, the Republican Party has capitalized on fear and ignorance to create the greatest economic inequality since the Gilded Age and an almost total collapse of the economy. Since the late 1960s, the government has moved perceptibly to the right, in step with market forces, causing an increase in inequality; the tax rates of the wealthy have fallen much more than the tax rates for the middle class and the poor, while at the same time the pretax incomes of the wealthy have skyrocketed. Every aspect of the health care law charges in the opposite direction. The law does not just reform and correct our broken health care system and ensure every American a vital safety net; it is arguably the federal government's largest and most concerted assault on economic inequality since Lyndon Johnson passed the Civil Rights Act in 1964. It is a dramatic and deliberate end to what many historians call "the Age of Reagan."

Watching the actual vote, as each "aye" was tallied, there was a tangible sense that history was being made; that after decades of Republican misguidance and the corporate malevolence of a deeply corrupt insurance industry, our country was finally heading in the proper direction again. Yes, the health care law has problems and is not nearly as progressive as it should be (ridiculously, it's slightly less assertive than the one Bismark passed in Germany in the 1880s), and there is clearly much more that needs to be done; but in the end, who on the left did not feel a swelling of pride at being an American the day the bill passed? Yet this went further than just being a political victory for President Obama or the Democratic Party or the left; it was a resounding victory for America's character. It was the triumph of what Lincoln called "the better angels of our nature" over fear, ignorance, greed and cynicism. As the Vice President opined moments before President Obama signed the historic bill into law, "This is a big fucking deal."