Paul Starr

Paul Starr is co-editor of the The American Prospect. His most recent book is Remedy and Reaction: The Peculiar American Struggle over Health Care ReformClick here to read more about Starr.

Recent Articles

The Republicans' Senior Moment

Seniors depend more on federal spending than any other group, but that did not deter a majority of them from voting for candidates who deplored "big government" and "socialized medicine."

Fred Linsenmeyer of Phoenix at a health-care town hall meeting held by Sen. John McCain (AP Photo/Ross D. Franklin)

One reason the electoral map turned red in November was that the electorate turned gray. Older Americans went to the polls in droves to vote Republican, while young people stayed home. And one big question about 2012 is whether the elderly will still vote Republican if the GOP can be forced to spell out the implications of its political agenda for Medicare and Social Security.

Back to Deadlock

Come next January, the great American impasse will be back in all its toxic splendor.

President Obama calls on Senate Republicans to stop filibustering campaign-finance legislation, July 2010 (AP/J. Scott Applewhite)

The voters often surprise us, but this fall's midterm election seems nearly certain to have at least one consequence. For the next two years, Congress will be unable to make any significant headway on the great challenges facing our country. The Republicans may win one or both houses, or they may fall a bit short, but their gains will be enough to stymie substantial legislation to deal with climate, immigration, the economy, and long-term fiscal challenges. A majority of the electorate may think those problems need urgent attention, but when the votes are tallied, they will likely add up to paralysis.

La Próxima Campaña de Reforma de Salud

Los partidarios de la reforma sabían que tenían que luchar para lograr su aprobación. Ahora necesitan llevar a cabo otra lucha para cumplir las promesas de la ley.

La Campaña de implementación

Las perspectivas de una nueva campaña para la reforma de salud -- en esta ocasión para llevarla a cabo-- pueden sorprender a algunos que pensaban que la batalla había terminado cuando el Congreso votó. Lo imperativo, sin embargo, es claro para los líderes de las organizaciones que lucharon por la promulgación de la ley y a los funcionarios claves en la administración del Presidente Obama. Ellos se están preparando para defender las reformas y ayudar a hacer realidad su promesa en los 50 estados.

The Preventive Turn in Health-Care Reform

Promoting preventive care and public health carries both promise and risk.

When health insurance developed in the United States in the 1930s, it covered hospital and later major medical bills, not preventive services. Insurance also had nothing to do with public health. And when Medicare was enacted in 1965, it too made no provision for preventive and public-health services.

The Affordable Care Act is different. Culminating a long shift in thinking, it incorporates preventive care into health insurance and seeks to promote public health through provisions aimed at reducing obesity and smoking and encouraging participation in wellness programs.

The Next Health-Reform Campaign

Supporters of reform knew they had to battle to get it passed. Now they need to wage another campaign to implement it.

Ron Pollack, Founding Executive Director of Families USA. (Flickr/House Committee on Education and Labor)

(Por la versión en español, haga clic aquí)

Carrying out health-care reform presents challenges far beyond those of ordinary legislation or even such landmarks as Social Security and Medicare. After a law establishes a new program, the next steps are usually a bureaucratic process of policy implementation. But the legislation passed by Congress last March, the Patient Protection and Affordable Care Act, will need to run a gauntlet of treacherous hurdles and be politically implemented.

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