Distortion, cultural bias and a complex legal path delayed the Bill until now, writes LARA MARLOWEin Washington
AS HEALTHCARE legislation moved towards a final vote in the US House of Representatives at the weekend, congresswoman Louise Slaughter, the 80-year-old chair of the House Rules Committee, found words for her frustration over the amount of time it has taken. “We feel like we’ve been pregnant for 17 months,” Slaughter said, referring to President Barack Obama’s election in November 2008 as the starting point. “Let’s get on with it already.”
When he spoke at the 125th annual Gridiron dinner, a gathering of journalists and politicians, here on Saturday night, former president Bill Clinton poked fun at the longevity of the healthcare debate, and at his own history of cardiac problems. Healthcare reform “may not happen in my lifetime, or Dick Cheney’s,” Clinton said. “But hopefully by Easter.”
Obama originally planned to pass healthcare reform last summer. House Democrats introduced their Bill on July 14th, 2009. The debate turned nasty in August, when the growing right-wing Tea Party movement seized upon it to exploit discontent at Town Hall meetings.
It remained nasty this weekend. Several thousand “tea-partiers” gathered on Capitol Hill on Saturday, as lawmakers met to lay down the rules for yesterday’s vote. “Born in the USA not the USSR” and “Buck Ofamacare” said their placards. A protester called representative Barney Frank, who is gay, a “faggot”. Another spat on representative Emanuel Cleaver, who is black. Two other African-American congressmen, John Lewis and André Carson, were jeered as “niggers”. “It was like a page out of a time machine,” said Carson.
The right-wing disinformation campaign, all about “death panels” and “government takeovers” reached fever pitch during the August recess. Obama addressed a joint session of Congress on September 9th to set the record straight.
The complexity of the US system, in which at least five House committees and three Senate committees helped to shape two sets of draft legislation, which had to be voted in both chambers, then merged into a single text, revoted and signed by the president, slowed the process, all the more so because Republicans seized every opportunity to thwart progress.
Deadlines were established and broken, for Thanksgiving, Christmas and Obama’s “state of the union” address on January 27th. But on January 19th, Scott Brown, a Republican, won the late Ted Kennedy’s Senate seat in a byelection, depriving the Democrats of their filibuster-proof 60-strong majority. All momentum fizzled out of healthcare reform.
Obama was going to concentrate on jobs and the economy instead. His chief of staff, Rahm Emanuel, argued for a “skinny Bill” concentrating on one or two issues, for example forbidding insurance companies from refusing customers with pre-existing conditions.
House speaker Nancy Pelosi, Emanuel's former boss, held out for the big Bill, telling Obama he would never again enjoy as strong a majority. In late January, according to the New York Times, Obama told his closest advisers, "We need to try one more time." The alternative, he said, was to put healthcare reform in a "time capsule" that would not be re-opened during his presidency.
But it wasn’t until the third week of February, when he published his own healthcare plan, that Obama became actively engaged. The February 25th televised healthcare summit, when the president argued the merits of the healthcare plan for seven hours with Republican opponents, was a turning point. A few days later, Obama demanded a Yes or No vote in Congress.
At public rallies, he excoriated insurance companies for exhorbitant rate increases, and told the healthcare nightmare stories of Americans who wrote to him.
Why has it taken so long for the US to join the ranks of every other industrialised country in offering near-universal health coverage? As Obama pointed out often in the 54 speeches he’s delivered on the subject, US presidents have attempted to do so since Teddy Roosevelt, just over 100 years ago. Franklin D Roosevelt wanted to include universal healthcare in the 1935 Social Security Act, but he feared it would sink the entire Bill. The arguments used by Republicans against social security (America’s government-run pension scheme) were the same arguments used in 2009-2010 against healthcare reform, namely that it was unaffordable, wasteful and constituted a form of socialism.
President Harry Truman resumed the long and winding road towards healthcare reform in the late 1940s and early 1950s. The Clinton administration’s plan was defeated in 1993, with devastating effect for the Democratic party. One of the reasons Obama remained aloof from the debate for so long was that he did not want to be seen to be dictating to Congress, as the Clintons had been.
Americans’ deep-seated distrust of government and belief in self-reliance partially explain why it has taken so long. A Tea Party protester on Capitol Hill this weekend summed up her objection as: “Healthcare is something each person has to earn.”
In an 11th hour speech to the Democratic caucus, Obama addressed these traits, and drove home the difference between Republicans and Democrats: “We are proud of our individualism, we are proud of our liberty, but we also have a sense of neighbourliness and a sense of community,” he said to applause. “We are willing to look out for one another and help people who are vulnerable and help people who are down on their luck and give them a pathway to success and give them a ladder into the middle class.”
His failed quest for bipartisan support is another reason why a year has been lost debating healthcare. In terms of US social history, the healthcare Bill is of a magnitude comparable to the advent of social security in 1935 and Medicare (for over-65s) in 1965. Both Bills were approved by substantial numbers of Republicans. Not a single Republican was expected to vote for the healthcare Bill last night.
This means that subsequent challenges to the reform will be fierce. Republicans intend to make healthcare theissue in November 2010 and 2012 congressional elections, promising to repeal legislation if and when they regain a majority. Even before its passage, a number of states began preparing lawsuits on constitutional grounds against the Bill.