A giant step toward universal health care

What happened

With his signature this week on landmark legislation, President Obama launched the first major expansion of social welfare since Medicare was enacted in 1965, initiating a multiyear overhaul of the health-insurance industry that by 2018 will extend coverage to nearly all American citizens. The law, which passed the House of Representatives Sunday night, will require Americans to purchase health insurance. It will extend coverage to 32 million uninsured people by expanding Medicaid rolls, establishing new health-insurance exchanges to provide more competitive rates, and providing subsidies to poor and middle-class families to buy into private plans. “We have now just enshrined the core principle that everybody should have some basic security when it comes to their health care,” an ebullient Obama said at Tuesday’s signing ceremony.

The legislation will cost $940 billion over 10 years. The Congressional Budget Office projects that through a combination of higher taxes on the wealthy, industry fees, and reduced spending on Medicare, the bill will actually reduce the deficit by $130 billion in its first decade and another $1.2 trillion in the following decade. Republicans, who unanimously opposed the legislation, said it will actually wind up adding hundreds of billions in deficit spending. They vowed to challenge the law in court while attacking Democratic “fixes” to the legislation currently working their way through the Senate. “There is bitter disappointment that this thing actually passed,” said GOP strategist John Feehery.

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What the editorials said

Access to health care has now joined “that short list of fundamental rights for all Americans,” said the Chicago Sun-Times. This is a nation based on individual liberty and self-determination—“our abiding metaphor is the self-sufficient pioneer mending his own fences”—but to make capitalism “more fair and humane,” we guarantee our fellow citizens public education, a roof over their heads, and a secure old age. Now we properly add “affordable health care” to that list. The chief beneficiaries are “the working poor,” said The Philadelphia Inquirer. But this plan provides “a path to more affordable, accessible health care” for everyone.

“The ticker tape media parade” is under way, said The Wall Street Journal. But what comes next will be far less fun. Liberal Democrats are now “the rulers of American medicine,” and will be held accountable for “insurance premiums, government spending, doctor shortages, and the quality of care.” They took over the system, so now they own it.

What the columnists said

“What the hell do we Republicans do now?” said David Frum in CNN.com. We could have negotiated with Democrats, shaping this legislation to be more market-friendly. Instead, lawmakers took their marching orders from the “overheated” Rush Limbaugh and Glenn Beck, and waged war with “hysterical accusations and pseudo-information.” The result? A massive new entitlement—never to be repealed. The GOP thought this would be Obama’s “Waterloo.” Instead “it turns out to be our own.”

The Reagan Revolution is officially over, said David Leonhardt in The New York Times. By beginning an era of tax cuts for the wealthy and deregulation, Reagan opened a widening gap between the rich and everyone else. Since 1980, the incomes for the very richest Americans have risen 300 percent, while incomes for the middle class and poor stagnated and their health-care costs soared. In essence, the Democrats’ health-care plan taxes families making more than $250,000 a year to help subsidize health insurance for all families making less than $88,200. It is “the biggest attack on economic inequality” since the 1960s.

The price for that attack will be monstrous, said Douglas Holtz-Eakin, former director of the Congressional Budget Office, also in The New York Times. Claims that this bill reduces the deficit are pure “fantasy.” By backloading costs and frontloading revenue, the bill produces an illusion of savings over the first decade. It also falsely assumes cuts of $463 billion in Medicare, with no reforms to cut costs, and counts future increases in Social Security revenue without accounting for payouts to beneficiaries. “If you strip out all the gimmicks and budgetary games” in this bill, you’re left with a law that will “raise, not lower, federal deficits by $562 billion.”