The Nation: A Spoonful of Sugar - On the Affordable Care Act
From Bernard Avishai:
It is hard to read Remedy and Reaction, Paul Starrs remarkable chronicle of the hundred-year effort to legislate universal health insurance in the United States, without recalling Robert Gibbss tortured quip that Democrats whove denounced the Obama White House for having knuckled under to Republican principles or intimidation ought to be drug-tested. Nobody with a sense of historythat is, nobody who reads Starrs bookcould doubt how sensible and brave was the presidents effort to drive the Patient Protection and Affordable Care Act of 2010 through Congress. Nobody with a feel for the present moment should doubt how imminent is the threat to the act, how urgent it is for progressive Democrats to rally around Obamaand without all the condescending qualifications that independents, who flock away from allegedly weak or incompetent leaders, interpret as contempt.
...Obamas actions were cannier than Clintons, but they also amounted to a profile in courage. When Obama came into office, Starr explains, only 11 percent of Americans thought reform would have a negative personal impact, but by August 2009 this segment of the population was trending to 31 percent. Both Rahm Emanuel and Joe Biden were urging retreat. Starr writes, Obama not only resolved to go ahead; in September and again in the new year, the president took charge of the effort to steady the health-care initiative and prevent it from careening off the tracks. Nor was the final bill anything less than what might reasonably have been expected, filling as it did the negative space left by four generations of government programs and serial compromises. Starting with clean sheets of paper was never realistic when one-sixth of the economy was at stake.
Starrs great fear is repeal of the Affordable Care Act, which would not only deny healthcare to more than 30 million people but would cast doubt on whether Americans will ever be able to hold their fears in check and summon the elementary decency toward the sick that characterizes other democracies. Obamacare, in short, was healthcare reforms bestand lastshot, and it would be unconscionable for liberals to remain cavalier about its defense, or Obamas, for that matter. Its past time to discard the misguided assumption that in a better economy, or with more of a fighter in the White House, something like a Canadian-style single-payer system might have been (or might sometime fairly soon be) enacted.