If I might break away from my typical cynical grumbling for a moment, I'd like to say something nice: The first four months of the Obama Era have been extraordinary. The change has been as radical as expected, and while our new president isn't doing everything right, the most serious change has been doing anything at all.
Yesterday's pro-active capitulation of the Health Care-Industrial Complex is case in point. Leaders of America's largest health care corporations and associations stepped up and said, "We're going to try to rein in cost increases." While some on the left are decrying this as mere PR by a private industry trying to maintain its profitability, this move by Big Healthcare is utterly striking. You couldn't imagine anything like it occurring in any industry under the asleep-at-the-wheel stewardship of the Bush-Cheney years.
For the first time in 15 years, health care is hot again. (It was still only lukewarm during the Medicare drug benefit debate a few years ago.) Which is, of course, reminding us of "HillaryCare," perhaps the most frustrating public policy debate since the Reagan years.
This is how I remember it: After Bubba wins the election, he puts Hillary in charge of health care policy. She convenes a panel of experts, hold a few hearings, and then go behind closed doors to pound out a plan. They emerge with nothing short of a real healthcare system, which America has always lacked. Republicans attack it sight unseen, which turned out to be their exact strategy. Creating a healthcare system means creating a management structure, which also looks like a giant government bureaucracy. The plan fails.
In desperation, Senate Dems try to get symbolic targets like "90% coverage" into bills. Those fail, too. It all fails. A few months later, Democrats are swept from office in the GOP revolution.
With Dems running the policy-making branches of government for the first time since '94, healthcare is back. And so are our memories of the last time that we tried to fix this horrifying non-system of ours.
Since '94, things have only gotten worse. Healthcare is now more than 1/6 of our total economy. The rest of the advanced world gets 100% coverage, no insurance burden on employers, no medical bankruptcy, higher life expectancy, and lower infant mortality, all for about half of what we spend here. We oddly support an expansive Medicare system (a giant medical bureaucracy) while we fear creating any sort of real system for everyone else. We prefer skyrocketing premiums and hidden costs to anything that smells like "taxes." Or so they tell us.
And then we have our friends Harry and Louise.
Harry and Louise are one of America's great political myths. They were the stars of a paid campaign by the Coaltion for Health Insurance Choices, itself a front group for the insurance industry. In a series of ads, Harry and Louise moped around their kitchen fretting about the government assigning them a new doctor, and a faceless idiot Washington bureaucrat deciding which procedures are covered. (As opposed to their employers' insurance companies telling them which doctors they could go to, and which procedures would be covered.) Harry and Louise turned American opinion against the Clinton plan, and health care reform was dead forever.
Or so I've heard. I never saw a Harry and Louise commercial, and neither did anyone else I talked to back then. In fact, few people saw the ads at all, except in the TV news reports that covered the debate. The campaign targeted deeply anti-government audiences like Rush Limbaugh's, and saturated markets where national media opinions were formed (primarily two cities on the eastern seaboard).
In the past two weeks, as health care reform has heated up again, the media has rediscovered its own myths about Harry and Louise. Their role in the HillaryCare debate of '94 has been elevated to that of Archduke Ferdinand's in starting World War I.
Will we see another anti-reform campaign? Undoubtedly. Obama's plan is to create a public insurance option to cover the uncovered, while preserving the current employer-based system. (The New Yorker had an excellent analysis of how we reach universal coverage given our current conditions and traditions.) The long-term hope -- or fear, depending on your perspective -- is that the public system will effectively control costs and ration care. What does that mean for private insurers down the road? It's scary for them -- and for Dittoheads, teabaggers, and other anti-government types -- to contemplate.
And they'll try to scare us, too. But doing nothing since '94 has only pushed our healthcare non-system deeper into decline. The cost issue is undeniable -- even right-wingers admit that health care may not be an unalienable right, but it's definitely too expensive.
This time, the "nothing" option isn't really an option at all.