•    HOME   
•    NEWS   
•    BUSINESS   
•    INTERNATIONAL   
•    TECH   
•    SPORTS   
•    LIFE & TIMES   
•    OPINION   
•    MY JAKARTA   
•    BLOGS   

Washington. Rarely does government, that big, clumsy, poorly regarded oaf, pull off anything short of war that touches all lives with one act, one stroke of a president’s pen. In the United States, such a moment has come. 

After a year of riotous argument, decades of failure and a century of spoiled hopes, the United States is reaching for a system of medical care that extends coverage to nearly all of its citizens. The change that’s coming will reshape a sixth of the economy and shatter the status quo. 

To the ardent liberal, President Barack Obama’s health care plan, passed by the House on Sunday night, is a shadow of what should have been, sapped by dispiriting downsizing and trade-offs. 

To the loud foe on the right, it is a dreadful expansion of the nanny state. 

To history, it is likely to be judged alongside the boldest acts of presidents and Congress in the pantheon of domestic affairs. 

Change is coming, but in steps, not overnight. The major expansion of coverage to 32 million people — powered by subsidies, employer obligations, a mandate for most Americans to carry insurance, new places to buy it and rules barring insurance companies from turning sick people away — is four years out. 

In contrast, on June 30, 1966, after a titanic struggle capped by the bill signing a year earlier, President Lyndon Johnson launched government health insurance for the elderly with three simple words, as if flicking a switch: “Medicare begins tomorrow.” 

Obama practically needs a spreadsheet to tell people what’s going on and when. Yet he and Johnson share a distinction: They are the only two presidents to succeed with a transcendent health care law. 

“We rose above the weight of our politics,” Obama said late on Sunday night after the House’s 219-212 vote. “We proved that we are still a people capable of doing big things.” 

Ted Kennedy lived long enough to see a goal of his lifetime take shape but not long enough for it to finally happen. His death last summer was almost the death of the whole plan because a Republican won his Senate seat, changed the voting balance and left despondent Democrats in search of a second wind, which they eventually found. 

Why is this so hard? In part, because self-reliance and suspicion of a strong central government intruding into people’s lives are rooted in the founding of the republic, and still strong. 

In 1854, President Franklin Pierce vetoed a national mental health bill on the basis that it would be unconstitutional to treat health as anything but a private matter that is none of the government’s business. 

Seventy-five years later, the American Medical Association denounced proposals for organized medical services as an “incitement to revolution” at the hands of “Medical Soviets.” 

And that wasn’t even about government-run health care. The AMA’s fierce opposition to collectivism included objections to private health insurance, the norm today, and the pooling of doctors into what became health maintenance organizations decades later. 

No wonder would-be health reformers were thwarted one generation after another even as they made deep imprints on the nation in other ways. 

Teddy Roosevelt couldn’t do it — and he’s one of the four US presidents whose faces are carved into the monument Mount Rushmore. 

Franklin D. Roosevelt rewrote the social compact with his job and retirement security and regulatory expansion, all in the jagged teeth of the 1930s Depression, then took the nation to war. He made national health insurance a second-tier priority and it eluded him. 

Even so, social responsibility for medicine grew. 

In 1930, citizens paid nearly 80 percent of the nation’s medical costs from their own pocket. Government at all levels covered a mere 14 percent, with industry and philanthropy picking up the few remaining crumbs. Insurance was barely in the picture. 

Federal and state programs now cover half the cost of health care purchased in the country and were expected to go over 50 percent in the next year or two, even without Obama’s plan. By that measure, the government takeover of health care that opponents warn about is happening regardless of congressional action. 

Why the creep of government in health care? In part, because individualism isn’t the entire American story. The idea of watching out for each other is also firmly in the nation’s fabric. 

Besides, as much as Americans hate overbearing government and higher taxes, give them a federal benefit and then just try to take it away. Today’s hot potato becomes tomorrow’s cherished check. 

That’s one reason government programs grow — and why Democrats dared to push for a less than popular package mere months from congressional elections, when people were telling their leaders to create jobs instead. 

Former President Bill Clinton no doubt drew on his own health plan failure when, in December, he advised Democrats to pass what they could manage and not make it an all-or-nothing fight. “America,” he said, “can’t afford to let the perfect be the enemy of the good.” 

Obama absorbed these lessons. For him, a system with government as the sole or principal payer of everyone’s medical bills was a nonstarter, nice for the ideologues and other countries but not the American way. 

He would have liked the option of a government-run plan competing in the marketplace, but didn’t need it. 

For months he stood so far back from the legislative nitty-gritty that it was hard to tell what he stood for. 

In the end, he stood for more than the incremental steps that succeeded in the past, and for less than the towering ideas that failed. 

 

Associated Press