Despite some flaws, health care reform is a sign that we can still enact reforms that improve Americans' lives.
With all the continued controversy around the Affordable Care Act, its easy to forget that it's very passage was something of a miracle. A year later, the notion that Congress could enact comprehensive legislation on anything -- let alone a major expansion of the role of government in providing economic security to Americans -- is laughable. But the Act's passage was not just a remarkable achievement at this moment in our history; it defied a century of defeat by the same forces that are working to repeal it now. On its first birthday, it's important to appreciate the miracle in itself and as a reminder that things again could change very fast in these volatile times.
For some 100 years, the American political system failed to do what every other developed nation had done: make affordable health care a publicly guaranteed right. Our uniqueness was not a glitch; it was emblematic of a society that remains dominated by an individual ethos as opposed to an ethic of collective good, of caring for each other. And it was evidence of what every political scientist knows and every lobbyist counts on: our system is designed to kill major reforms. As Jacob Hacker and Paul Pierson summarized in "Winner-Take-All Politics", "In America, it is hard to get things done and easy to block them. With its multiple branches and hurdles, the institutional structure of American government allows organized and intense interests -- even quite narrow ones -- to create gridlock and stalemate."
The mountain that President Obama sought to climb was every bit as steep as the slopes that defeated presidents from Roosevelt to Truman to Nixon and Clinton in their quests to make health care a right. The nation's biggest lobbying group in 2009, the U.S. Chamber of Commerce, pulled out all stops to kill the bill, fueled by at least $86 million laundered from the health insurance industry. An army of other lobbyists stood in the way: the health insurance industry alone employed 2,049, almost four for every member of Congress. An angry, right-wing, grassroots rebellion aimed its ire at the most vulnerable Democrats in the nation, funded by corporate front groups like Freedom Works and Americans for Prosperity and fueled by the largest and most sophisticated propaganda machine in our history, Fox News. The reactionary forces made politics as partisan as we have ever seen, requiring agreement from every Democrat in the Senate -- no matter how deep their reliance and allegiance to corporate power.
Yet somehow, this baby was born. How? What was different? As hard as it is remember now, the time was right. The revulsion at the excesses of the Bush administration created the opportunity for the election of a president who campaigned on the promises of "hope" and "change." But only if he gave it his all. And on health care, President Obama did. On the night of his election, Obama told himself that the biggest single thing he could do to help average Americans was fulfill his campaign promise to "provide affordable, accessible health insurance for every American." And at at least three crucial times during the first thirteen months of his presidency, Obama refused the entreaties of his senior staff to abandon the quest and insisted on pushing for comprehensive reform.
The President also learned much from the lessons of past failures. And while he made his own mistakes -- particularly in the failure to relentlessly make health care a personal issue and to define the opposition -- he and his team got many important things right. He made it his top priority and kept it there, he let Congress take the lead on legislation, and he appeased just enough potentially powerful industry opponents. And -- with his back to the wall after Scott Brown's Senate election in January 2010 seemed to doom the enterprise -- he rescued the effort by finally attacking the insurance industry and clearly defining Republicans as obstructionists who were defending the status quo and corporate America.
But the Affordable Care Act had much more than one parent. Nancy Pelosi brilliantly organized and rallied Democrats in the House and made it clear to supporters and detractors in Washington and around the country that she would not be denied. Much more quietly, but with the harder task of garnering the votes of each and every senator who caucused with the Democrats -- including Ben Nelson, a former insurance company CEO, and Joe Lieberman, who wanted to wreak revenge on the progressives who had defeated him in his 2006 primary -- Harry Reid found a way to do what Harry Truman never could: get health reform through the Senate. A host of other Democrats in both houses deeply felt the historical call to justice that health care represented. And some of them did that rare thing in politics: put their convictions ahead of their careers.
There was one more big difference between 2010 and every other past failure: for the first time ever, supporters of reform were well-organized and well-funded. That campaign, which I helped lead as the National Campaign Manager of Health Care for America Now, was rooted outside the Beltway. We defeated the tea partiers in August of 2009 where it counted: at home, at town hall meetings held by targeted Democrats around the country, where we turned out more people than the tea partiers. At thousands of meetings with members of Congress when they were home from Washington, we introduced them to people who were victims of our health care system, prompting gut-checks of why they ran for office. On the morning that the bill became law, a member of the House Democratic leadership told me that they would have never got the votes of first and second term Democrats without our effort. And a White House political aide told me simply, "We could have never done it without you."
The right gets that the passage of the Affordable Care Act was a miracle -- they thought they'd killed it in the August tea parties and again in the Massachusetts election. Now they are pulling out every stop to prevent a government promise to make health care a right from ever taking hold, knowing that it would be a major setback in their march to destroy any positive role for government in providing security and opportunity to average Americans
The left makes a huge mistake if we denigrate the accomplishment. Yes it's far from our ideal. But far better to celebrate the 32,000 lives that the ACA will save a year or the foundation it provides for states with the political will to take the next step, like Vermont's Governor, who wants use ACA funding for a single-payer plan.
At this bleak time, let's make the ACA's birthday a reminder that we can create other miracles. We see the signs: the uprising in Wisconsin, the hundreds of thousands of new supporters of Planned Parenthood, the boycott of Arizona that defeated more draconian immigration laws. Together, we can do our part to prove that the moral arc of the universe does indeed bend toward justice, as it did just one year ago today.
Richard Kirsch is a Senior Fellow at the Roosevelt Institute and is writing a book on the progressive campaign to enact health reform.