Dr. Gratzer, a physician, is a senior fellow at the Manhattan Institute. Most recently, he is the author of Why Obama’s Government Takeover of Health Care Will Be a Disaster, part of the Encounter Books Broadsides series.
In the coming hours, the U.S. House of Representatives will vote to repeal the Patient Protection and Affordable Care Act, commonly referred to as ObamaCare. With a large Republican majority, that vote is likely to succeed. But the Senate will not even consider the motion, and it will thus be more symbolic than practical.
Today, ConservativeHome launches an exclusive five-part series by Dr. David Gratzer. In the series, he will explain why the debate over Obamacare is just beginning, what a Republican strategy for the next two years should look like, and what real health care reform in American should consist of.
What a difference 10 months has made. In March, President Obama signed the Patient Protection and Affordable Care Act into law, and it seemed like the accomplishment of a generation. Presidential historian Robert Dallek wrote in the Wall Street Journal that it was a “minor miracle.” Now, less than a year later, it seems like a millstone hanging around the electoral prospects of Democrats.
Back in the spring, the mood was, of course, very different. “We are a nation that faces its challenges and accepts its responsibilities. We are a nation that does what is hard. What is necessary. What is right. Here, in this country, we shape our destiny.” President Obama spoke those sweeping words at the East Room signing ceremony that would end the legislative drive that had begun before Inauguration. Moments before, he had signed the bill into law, using 22 pens.
If his words seemed august but solemn, the mood in the White House was unusually festive. After the ceremony, staffers opened bottles of champagne and partied into the night.
ObamaCare, as his package of reforms became known, had a challenging birth, with a near death experience when a little known Massachusetts state representative won an unlikely special election, depriving the Democrats of their filibuster-proof majority in the Senate. With resolve, clever legislative tactics, and a bit of luck, President Obama signed into law health-care reforms that would be compared to the Great Society programs of Medicare and Medicaid. In some ways, that comparison underrates the Patient Protection and Affordable Care Act. Remember: Medicare sought only to cover the elderly and Medicaid was a narrow add-on at its creation.
This legislation would redefine Medicaid, expanding its rolls by potentially tens of millions of people in a decade; it would change the type and cost of coverage of millions with its highly regulated (but well subsidized) health-insurance exchanges; and, perhaps most significantly, with regulations covering medical loss ratios, it would literally change the way all health-insurance companies conduct business.
On March 23, the President evoked the memory of Theodore Roosevelt and the first promise of universal coverage in 1912. But the President’s plan was far greater, seeking a re-engineering of a sixth of the national economy. The March conventional wisdom that most – if not all – of the reforms would be implemented. President Clinton said at the time: “The minute the president signs the health care reform bill, approval will go up, because Americans are inherently optimistic.” Medicare, Medicaid, S-CHIP – all these gigantic health-care programs offered good precedent.
For the record, I agreed. On March 24, I sounded practically Clintonian in a short blog: “Let’s be clear, for all the hot talk about repeal and sweeping Republican victories in the fall, much of this legislation is here to stay. Sunday was a game changer.”
Ten months have now passed and that verdict seems far from clear. Even before the ballots were counted in the Congressional elections, President Clinton himself changed his mind and said back in September with unusual brevity: “I was wrong.”
With implementation phased in over the next decade, with so many decisions on regulations and interpretations to be made in the coming years, full implementation seems unrealistic. Yet, despite the strong Republican showing in early November and the promises of repeal, the legislation was passed into law and GOP votes in Congress would fall far short of the numbers needed to overturn a presidential veto. 2010 marks simply the end of the beginning, not the beginning of the end.
In the series of posts that will follow this one, I will consider three reasons why the full implementation of ObamaCare is far from inevitable. Then, I’ll describe ideas for bettering the legislation, and ultimately reforming American health care. And I’ll keep an eye on the prize: improving our health, not just our health care.