WASHINGTON – As the final round of the battle over the health-care overhaul begins today, President Obama and the Democrats are in reach of a historic legislative achievement. The question is at what cost.
By almost any measure, enactment of a comprehensive health care law would rank as one of the most significant pieces of social welfare legislation in the country’s history. But unlike Social Security or Medicare, Obama’s health care bill would pass over the Republican Party’s unanimous opposition.
Even Republicans agree on the magnitude of what Obama could pull off, while disagreeing on the substance of the legislation.
Sen. Lamar Alexander, R-Tenn., said: “Obviously, he will have achieved as president something nobody else has done. So in that sense, it’s historic.” But he added, “It doesn’t end the health care debate – it just changes it. And if it does pass, it would be a historic mistake.”
The issue now is whether final passage of the legislation – Senate leaders say they will take up the reconciliation bill this week – will cause Democrats more harm or begin a turnaround in the party’s fortunes heading toward the November midterm elections.
Obama and Democratic congressional leaders are still struggling to find the final votes in the House to push the bill through, against united Republican opposition and a country sharply polarized over whether and how health-care coverage should be extended to virtually all Americans. Liberals say the bill should have created a government alternative to private insurance and conservatives decry an increase in taxes and expensive new government programs.
The political stakes are enormous. Obama’s approval ratings are below 50 percent in several recent polls, and more people disapprove of his handling of health care than approve. His presidency will be stamped by the outcome of the debate.
Democrats are afraid of failure and nervous about what success could bring. They fear substantial losses in November, with their majorities in the House and Senate possibly at risk if the country turns even more negative toward the administration and its policies. Republicans vow to continue challenging the program at the state and national levels.
Regardless of the political fallout, historians say health-care reform will take its place in the same category as the enactment of Social Security in 1935 and Medicare in 1965, and only a rung or two below passage of the major civil rights bills of the 1950s and 1960s. In addition to the bill’s providing coverage for more than 32 million uninsured Americans, people would no longer be denied coverage because of pre-existing conditions. The “doughnut hole” for Medicare prescriptions would eventually be eliminated and young people could stay on their parents’ insurance plan through age 26.
“I think this will be seen as a really major reform initiative,” presidential historian Robert Dallek said. “How it plays out remains to be seen. But if Social Security and Medicare and civil rights are any preludes to this initiative, then I think it will become a fixed part of the national political-social-economic culture.”
But there is a major difference between this health care battle and the debates that preceded passage of Social Security and Medicare. Although there was opposition to those measures in the end they passed with overwhelming, bipartisan majorities.
The House approved the Medicare bill on a vote of 313-115, including 65 Republicans – nearly half the GOP caucus at the time. The Senate approved the measure by 68-21, including 13 of the 27 Republicans.
Social Security passed the House in 1935 by 372-77. On that vote, 77 Republicans joined the majority and 18 Republicans opposed it. In the Senate, the vote was 77-6, with 5 of 19 Republicans in opposition.
At the time, President Franklin D. Roosevelt’s ambitions were even larger. Historian David Kennedy, a scholar of the New Deal era, said Roosevelt originally included universal health care as part of the Social Security legislation but pulled out those provisions before sending the bill to Capitol Hill.
“He thought it was such a significant political liability it could sink the whole bill,” Kennedy said.
Today, Republicans and Democrats agree on the potential significance of what happen over the next week in Washington. Where they disagree is on the question of whether it is necessary or wise to do it.
Former Democratic National Committee Chairman Howard Dean has often been at odds with the White House over the health care bill, but he said the current version is worthy of support as a significant first step toward real reform and because it could help Democrats politically. “Our team’s got to win this one, and if they do I think they’ll be rewarded. ...” he said. “A ‘yes’ vote hurts Democrats much less as a party than a ‘no’ vote.”
But former Republican House Speaker Newt Gingrich argued that Obama and the Democrats will regret their decision to push for comprehensive reform. Calling the bill “the most radical social experiment … in modern times,” Gingrich said, “They will have destroyed their party much as Lyndon Johnson shattered the Democratic Party for 40 years” with the enactment of civil rights legislation in the 1960s.
No one doubts that Johnson was right to push for those civil rights measures. And he was well aware of the potential damage that they would do to a Democratic Party that was then a coalition that included whites and blacks, liberals from the North and conservative segregationists from the South. Those battles over civil rights set off a political realignment that played out over decades and led eventually to Republican domination of the South that continues to this day.
