Learning to Love the Healthcare Bill

Learning to Love the Healthcare Bill

Just as Americans came to appreciate Medicare and Social Security, so will they come to value publicly funded healthcare.


Will the passage of healthcare reform provide a boost to Obama’s popularity and the chances of holding on to a Democratic majority in the fall? The question preys on the minds of many progressives, even those who find the White House lacking in zeal for causes on the left. The alternative would mean polarization, at best. At worst, it could be a return to the dark days of Republican rule from which we have escaped all too recently. To be sure, the failure to pass the healthcare bill would have been a catastrophe. The measure was a significant test for the base of the Democratic Party. Could a leadership that stumbled badly on the banks, mortgage cramdowns and credit card regulation actually provide something of tangible benefit to the working people of this nation?

Before this victory, Obama’s position was not unlike that of Roosevelt as he approached his first midterm in 1934. FDR stabilized the banking system through a more conservative series of reforms (the banking holiday, the Emergency Banking Act and Glass-Steagall) than many had hoped for; he succeeded in passing legislation that was supposed to address the recession systematically (the Agricultural Adjustment Act and National Industrial Recovery Act roughly paralleling the stimulus bill in terms of what they were supposed to accomplish). But these policy victories notwithstanding, FDR hadn’t addressed the needs of the more than 10 million unemployed. His answer to this critique came in the fall of 1933 with the creation of the Civil Works Administration, which under the leadership of Harry Hopkins succeeded in directly employing 4.3 million people between Thanksgiving of 1933 and 1934. While the CWA was only a temporary program, it sent a message to workers who had voted for a New Deal in 1932 that the president was trying to make a difference for them.

Heading into the midterm elections of 2010, Obama has something concrete to show for his leadership, and that cannot be discounted. What matters more than anything at this juncture is how quickly the concrete benefits of healthcare reform start to flow to the millions of Americans in desperate need of help. Many of the bill’s most important provisions do not kick in for many years, but others—the elimination of pre-existing conditions, the ability to enroll dependent children up to the age of 26—will be in effect by September, and they speak to the needs of middle-class voters, who have to be kept in the political fold. Whether this will be enough is hard to say.

Social Security was passed in 1935, but the benefits it promised did not start to flow until 1940 for the small first group of retirees. It was not until the ’50s that something approximating universal coverage became a reality, and even today nonworkers are not covered in their own right. African-Americans were robbed of Social Security benefits, even if they had worked all their lives, because the exclusions that were built into the original legislation to placate Southern politicians who threatened to veto the whole package were not reversed for decades. As it happens, Social Security was fairly popular from its inception, largely because it was sold as a contributory insurance policy rather than a "handout" or act of charity toward the elderly poor and because it offered something for (almost) everyone. But it took time before it was fixed in the social policy firmament to the point where its opponents were silenced. Some of them are still with us, as the proposals for privatization demonstrated not long ago.

Once American families begin to depend on the safety net—whether for retirement, higher education or healthcare—the popularity of these provisions becomes very hard to diminish, even by those committed to unraveling them. This is, no doubt, why opponents of healthcare reform are so eager to snarl it up in the courts or rally the base for repeal. They too are students of history. They know that if American families start to rely on these new forms of health insurance, to factor them into their household ledgers, the reforms will become entrenched to the point of no return.

In the meantime, we can expect a high level of conflict, obfuscation, court challenges and tea parties designed to rally the conservative base and delay the implementation of healthcare reform. This too is a familiar story. Indeed, virtually every episode in the development of the American welfare state has been surrounded by contentious politics, and in many instances the opposition won the day. In the 1940s FDR and New Deal Democrats hoped to establish universal healthcare and a "cradle to grave" welfare state through the Wagner-Murray-Dingell bill. But they were torpedoed by Congressional opposition, as was the establishment of a "right to a job" when the Full Employment bill was gutted in committee. Harry Truman’s Fair Deal—which sought to build on the New Deal by including healthcare, public housing and a permanent Fair Employment Practices Commission to prevent racial discrimination—was largely blocked by a Republican Congress.

But it wasn’t just the political class that split over the New Deal. Ordinary middle-class citizens were deeply torn as well. Much as they wanted FDR to save them from the ravages of the Depression, those on the left saw him as tepid and too cozy with employers. They denounced Roosevelt for lowering wages, failing to nationalize the banks and edging away from his commitment to "the forgotten man."

On the "ordinary" right, farmers in the heartland who avoided the relief rolls decried their neighbors who accepted public benefits (other than Agricultural Adjustment Administration checks), while small shopkeepers and accountants bemoaned the loss of tax dollars from their paychecks to support the indolent even as they filled the grocery orders paid for by the Federal Emergency Relief Administration. Opinion polls from the 1930s make it clear that a majority of the country was sure that the unemployed could find work if they really wanted it. Most of all, the rejection of cash relief, of any policy that smacked of support for the able-bodied nonworker, was nearly universal. Public employment was more widely embraced and grew in popularity as the ravages of the Depression left fewer and fewer alternatives in the labor market.

As historians like Jason Scott Smith have noted, programs like the Works Progress Administration were often embraced by people who were otherwise hostile to government expenditures. Many moderate and conservative voters adopted the reverse NIMBY view that other New Deal projects might be wasteful boondoggles but the WPA project in their district was indispensable. We can see the modern echo of this attitude in conservative Republicans who voted against the stimulus bill as a spending orgy but were happy to hand out giant cardboard checks in their home districts for projects financed from stimulus funds.

Similar objections to social programs were raised during the Johnson years. Medicare was probably the most important innovation of the Great Society, but when Johnson worked overtime to pass the original legislation, public support for the idea waffled. In 1962, 70 percent of Democrats and 48 percent of Republicans surveyed in the National Election Studies thought that "government ought to help people get doctors and hospital care at low cost." By 1964, when a historic Medicare proposal passed in the Senate, Democratic support had declined to 60 percent and Republicans weighed in with 29 percent. The same survey asked respondents if they preferred providing health insurance for the elderly by allowing them to buy private plans or if they thought government should finance a program through Social Security. In 1962, 55 percent supported the idea of government-financed health plans; by 1965, that number had dropped to 46 percent. Eventually, however, as people began to rely on the program’s benefits, support began to build. Today, Medicare garners strong and steady backing from the public. Indeed, it is a "third rail" that politicians approach at their peril. Obama’s Republican opponents vowed to prevent even a single dollar in cuts to Medicare, and tea party protesters shouted, "Keep your government hands off my Medicare!"

For some time to come we can expect the firestorm of opposition to healthcare reform that is unfolding today to persist, even from people who stand to benefit from the provisions of the new law. The rose-colored glasses through which we sometimes view the legacy of the New Deal and the Great Society often obscure how contentious the debates were or how long they continued after the passage of key legislation. We should not be deterred by the noise coming out of the tea party. The weight of history is against them.

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