Democratic claims that the health care reform marked a major milestone in domestic policy were closer to the truth. But billing the legislation as comparable to the advent of Social Security in the 1930s or Medicare and Medicaid in the 1960s simply isn’t accurate.
Why do I say that?
- For the 85 percent of Americans with coverage, either through their employers or government programs, not much changes except having the reassurance that one can get Medicaid or buy subsidized insurance if you lose your job.
- Social Security and Medicare are social benefits guaranteed to everyone. They are paid for by universally-imposed taxes. This legislation’s only universal requirement is that individuals and families pay a tax if they don’t buy private insurance. Somewhere between 6 and 7 percent of the population will not have health insurance in 2019, according to the Congressional Budget Office.
- National regulation of the insurance industry was long overdue. Banning discrimination for pre-existing medical conditions and ending denials of coverage after someone gets sick are big wins for the American people. But these regulatory reforms are aimed at abusive practices. They do not fundamentally alter the employer-based insurance system. Compare those changes to the systemic shifts in industrial practices required to comply with the Clean Air Act, the Clean Water Act or the creation of the Occupational Safety and Health Administration. We are still very much in the era of small-bore reforms.
It’s important to remember how we got here. The employer-based system is unraveling. The number of working-age adults who get private insurance through their place of employment shrank from 69 percent to 63 percent between 2000 and 2008. That was before this devastating recession.
The upward creep in the number of uninsured — now 50 million — would have been much worse without previous expansions in government programs like the Children’s Health Insurance Program and Medicaid. This reform, by expanding government programs and subsidizing the private insurance system, attempts to shore up the existing system, not fundamentally alter it.
The biggest change from the bill will be political. Unlike welfare reform during the Clinton administration or No Child Left Behind from the Bush years, this legislation’s first principles are progressive in orientation. It seeks to expand the social guarantees of U.S. citizenship, not penalize or impose requirements on people who participate in public programs.
After 30 years of conservative rule, that is a major change. It is worth celebrating.
Merrill Goozner has been writing about economics and health care for many years. The former chief economics correspondent for the Chicago Tribune, Merrill has written for a long list of publications including the New York Times, The American Prospect and The Washington Post. His most recent book, “The $800 Million Dollar Pill – The Truth Behind the Cost of New Drugs ” (University of California Press, 2004) has won acclaim from critics for its treatment of the issues facing the health care system and the pharmaceutical industry in particular. You can read more pieces by Merrill at Gooznews.com, where this post first appeared.