The Final Health-Care Vote and What it Really Means.

It’s not nearly as momentous as the passage of Medicare in 1965 and won’t fundamentally alter how Americans think about social safety nets. But the likely passage of Obama’s health-care reform bill is the biggest thing Congress has done in decades and has enormous political significance for the future.

Medicare directly changed the life of every senior in America, giving them health security and dramatically reducing their rates of poverty. By contrast, most Americans won’t be affected by Obama’s health-care legislation. Most of us will continue to receive health insurance through our employers. (Only a comparatively small minority will be required to buy insurance who don’t want it, or be subsidized in order to afford it. Only a relatively few companies will be required to provide it who don’t now.)

Medicare built on Franklin D. Roosevelt’s New Deal notion of government as insurer, with citizens making payments to government, and government paying out benefits. That was the central idea of Social Security, and Medicare piggybacked on Social Security.

Obama’s legislation comes from an alternative idea, begun under the Eisenhower administration and developed under Nixon, of a market for health care based on private insurers and employers. Eisenhower locked in the tax break for employee health benefits; Nixon pushed prepaid, competing health plans and urged a requirement that employers cover their employees. Obama applies Nixon’s idea and takes it a step further by requiring all Americans to carry health insurance, and giving subsidies to those who need it.

More after the jump.

--Robert Reich

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