Obama's bold agenda takes shape
The Editor, Sir:
After a year of riotous argument, decades of failure and a century of spoiled hopes, the United States is reaching for a system of medical care that extends coverage nearly to all citizens. The change that's coming will reshape a sixth of the economy and shatter the status quo.
To the ardent liberal, President Barack Obama's health-care plan, passed by the House of Representatives on Sunday night, is a shadow of what it should have been, sapped by dispiriting downsizing and trade-offs.
To the loud foe on the right, it is a dreadful expansion of the nanny state.
To history, it is likely to be judged alongside the boldest acts of presidents and Congress in the pantheon of domestic affairs. Think of the guaranteed federal pensions of Social Security, socialised medicine for the old and poor, the civil rights remedies to inequality.
Change is coming, but in steps, not overnight. The major expansion of coverage to 32 million people - powered by subsidies, employer obligations, a mandate for most Americans to carry insurance, new places to buy it and rules barring insurance companies from turning sick people away - is four years out.
'Medicare begins tomorrow'
In contrast, on June 30, 1966, after a titanic struggle capped by the bill signing a year earlier, President Lyndon Johnson launched government health insurance for the elderly with three simple words, as if flicking a switch: "Medicare begins tomorrow."
Obama practically needs a spreadsheet to tell people what's going on and when with the law he will sign after the Senate takes final action this week.
Yet, he and LBJ share a distinction: They are the only two presidents to succeed with a transcendent health-care law.
"We rose above the weight of our politics," Obama said late Sunday night in relishing the House victory on a 219-212 vote. "We proved that we are still a people capable of doing big things."
You can be sure Obama, a student of history, is aware of how LBJ captured the moment when Medicare became law with his pen. That happened in Independence, Missouri, in the presence of the very first American to sign up for the programme, Harry Truman. The ex-president had ended a world war but could not achieve national health insurance in his time.
"Care for the sick, serenity for the fearful," Johnson promised that day. "In this town, and a thousand other towns like it, there are men and women in pain who will now find ease."
Said Truman: "I am glad to have lived this long."
Ted Kennedy lived long enough to see a goal of his lifetime take shape but not long enough for it to happen. His death last summer was almost the death of the whole plan because a Republican won his Senate seat, changed the voting balance and left despondent Democrats in search of a second wind, which they found.
This historic bill will mark the presidency of Barack Obama.
I am, etc.,