Kathleen Sebelius, Secretary of Health and Human Services. (U.S. Mission Geneva Photo/Eric Bridiers)
Now that the Patient Protection and Affordable Care Act is law, the Obama administration has to translate the law's requirements into specific rules, particularly for the health-insurance industry. The act requires insurers to do a lot of things they haven't done before, like making sure all plans cover at least a basic array of services and limit out-of-pocket expenses. But under a so-called grandfather clause, plans already in existence are exempt from many of the new requirements. How the administration has interpreted "grandfathering" -- one of its first rule-making decisions -- may be an indication of things to come.
When Lyndon Johnson signed the law creating Medicare in 1965, he promised that it would transform the lives of America's senior citizens. "No longer will older Americans be denied the healing miracle of modern medicine," Johnson proclaimed. "No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years." As ambitious as those goals were, some of Medicare's architects had even loftier hopes. Many were veterans of Harry Truman's crusade to provide insurance to every single American; it was only after that effort failed that they decided to concentrate on covering the elderly, whom they knew to be a politically sympathetic group.
Protecting America's Health: The FDA, Business, and One Hundred Years of Regulation
By Philip J. Hilts, Alfred A. Knopf, 352 pages, $26.95
In the 1990s, attorney Daniel Troy made a name for himself defending pharmaceutical manufacturers and tobacco companies in their frequent fights with the Food and Drug Administration. But in 2001, Troy got an opportunity to champion the interests of those same clients from a far more advantageous position -- inside the FDA itself -- when President Bush appointed him to be the agency's chief counsel.
The debris of Reaganism is scattered across Bill Clinton's domestic agenda: Environmentalism may be slow to take hold at the Interior Department because friends of industry have "burrowed in" to the bureaucracy. Sound industrial policy will call for better information than the Commerce Department and Federal Trade Commission have to offer. Crafting welfare reform may be more difficult because the Department of Health and Human Services keeps insufficient data to evaluate its own experimental programs. And invigorating the Environmental Protection Agency could take years because an orgy of contracting out and budget cutting has left the agency with insufficient staff to keep the private contractors honest.