1935, 1965, 2010 — a nation accepts its responsibilities

The Social Security Act was passed in 1935; Medicare in 1965. Today we celebrate the signing of the next step that will greatly improve the quality of life for all Americans.

Click on the picture to watch the ceremony.

Although Frances Perkins and FDR wanted to include national health care in the Social Security Act, it has taken 75 years to get some form of health care for all enacted in the U.S. Medicare transformed life for America’s seniors but didn’t cover those not in that category. While some may be unhappy with the limits of the new legislation–it’s not “Medicare for All”–it is an important step forward, for several reasons.

Robert Reich, in his essay, How healthcare reform makes history, says it very well:

This isn’t a return to the New Deal or the Great Society. It’s an incremental step forward, with big implications.

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The significance of Obama’s health legislation is more political than substantive. For the first time since Ronald Reagan told America government is the problem, Obama’s health bill reasserts that government can provide a major solution. In political terms, that’s a very big deal.

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For the first time since Ronald Reagan told America government is the problem, Obama’s health bill reasserts that government can provide a major solution. In political terms, that’s a very big deal.

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We will not return to the New Deal or the Great Society, but nor will we continue to wallow in the increasingly obsolete Reagan view that we don’t need a strong and competent government. Yesterday’s vote confirms our hope that we can have both strength and competence in Washington. It is an audacious hope, but we have no choice.

Here is a great quote from Obama’s speech: “We are not a nation that scales back its aspirations… We are a nation that faces its challenges and accepts its responsibilities.”

Frances Perkins would applaud that sentiment.

Imperfect healthcare bill compared to 1935 Social Security Act

In a blog post today at the New Yorker, Henrik Hertzberg pointed to a Politico article by Bruce Schulman, “House should grit teeth, pass Senate bill” in which Schulman describes how far short of its original goals the 1935 Social Security Act fell, yet how influential its impact since then has been.

Of course, the final product scaled down all FDR’s original ambitions. It excluded agriculture, domestics and small shops with fewer than 10 workers — a decision ensuring that African-Americans, large numbers of whom toiled as farm workers and domestics, would be without protection. It took three decades of gradual expansion before Social Security covered every worker — a long, hard slog.

[…]

By the time the last compromise was made, Perkins expressed the disillusionment of many reformers. The thing,” she lamented, had been “chiseled down to a conservative pattern.”

[…]

Even with the compromises present at its creation, FDR, Perkins remembered, considered Social Security “the cornerstone” of his legacy. President Barack Obama and the Congress might well remember that model.

Thanks to Bruce Schulman for putting political compromise–particularly as it relates to major reform efforts–into perspective, and thanks to Henrik Hertzberg for bringing Schulman’s article to our attention.

Real Principles for Healthcare Reform

I recently received an email from a friend asking me to sign a petition listing the following principles for health care reform as set out by President Obama:

The PRINCIPLES

REDUCE COSTS — Rising health care costs are crushing the budgets of governments, businesses, individuals and families and they must be brought under control

GUARANTEE CHOICE — Americans must have the freedom to keep whatever doctor and health care plan they have, or to select a new doctor or health care plan if they choose

ENSURE AFFORDABLE CARE FOR ALL — All Americans must have quality and affordable health care

These principles, though pithy, are much too general. Who defines “quality” and “affordable”? Here’s what I propose as the real principles for health care that we should be following:

The REAL PRINCIPLES

HEALTH IS A HUMAN RIGHTS ISSUE Access to health care is a human right and recipients should not be subject to market pressures or personal financial considerations in their pursuit of good health.

MEDICAL EXPERTS AND THEIR PATIENTS SHOULD HAVE CONTROL OVER MEDICAL DECISIONS Doctors, nurses, and patients together — not insurance companies — should determine medical treatment.

WE SHOULD BE WORKING TOWARD A PATIENT-CENTERED — NOT PROFIT-CENTERED — SYSTEM A majority of Americans (a NY Times poll from June 20, 2009 reports 72%) are in favor of a public option. Our current system lags far behind those of other developed countries, in terms of health outcomes, convenience, and cost. (Check out our dismal ranking here.)

OUR POPULATION’S HEALTH IS A COMMUNITY RESPONSIBILITY We pay for public education with taxes because we believe that an educated citizenry is a benefit to all. We pay for our judicial system, our military, the Environmental Protection Agency, the Food & Drug Administration, our airports, roads, and bridges — and many other critical items — in the same way, because they make all of us stronger. Is health care less important than these other essential services?

A BAD BILL IS WORSE THAN NO BILL We need major reform, not a re-jiggering of the current system. We must not settle for less. A complicated incremental bill will not help anyone, except the industry lobbyists who are working so hard toward that goal.

And I like to think that Frances Perkins would agree.