Whither the Health Care Reform Bill

Lincoln Mitchell – Harriman Institute, Columbia University Posted: 04/01/2011 01:21 PM ET

March 23rd was the one year anniversary of the passage of the health care reform bill. This date came and went with very little fanfare or media attention. The anniversary was overlooked partially because of the import of today’s issues including the no fly zone in Libya, the aftermath of the tsunami in Japan and the ongoing budget fights in Washington, but it was also overlooked because a year after its passage, it is increasingly clear that the health care bill may not have been as significant as it seemed, and was presented, at the time. The text messages sent from the Obama political operation celebrating the anniversary of this bill, and suggesting its historic significance, largely served to underscore that a year after passage, the health care reform bill is not really historic at all.

Although not all of the components of the health care bill have come into effect yet, it is clear that bill will neither push the US down the road not socialism, nor make affordable and decent health care available to all Americans. The bill may have a modestly positive effect by encouraging a few more Americans to buy health insurance, or by keeping some Americans from losing their health care due to preexisting conditions. It will also likely have some consequences that were not foreseen a year ago. Health care companies may become more politically powerful as they gain more clients; or legal challenges may continue to reshape the bill. In general, a year after its passage, it is apparent that this bill will not radically reshape life in America, but will be part of the ever changing and increasingly complex legal framework in which health care is delivered in the US.

As the health care debate of 2009-2010 recedes into history, we can see that the debate was important primarily for political reasons. Passage of the health care bill did not revolutionize health care the way, for example, the Civil Rights and Voting Rights Acts in the 1960s revolutionized race relations. Instead, the health care debate energized the Tea Party movement and changed the face of American politics, contributing heavily to the major Republican victory in the 2010 election. To some extent, the passage of the health care bill also revived a struggling Obama administration as they demonstrated that they were able to get something done.

The notion that a year after its passage the primary impact of the health care bill has been political rather than substantive is indicative of broader problems with the American political system and is further evidence that the American political elite is now much more comfortable with, and better at, politics than governance. The health care debate featured name-calling, doomsday scenarios, dramatic overstatement on both sides, and descriptions of the bill that overstated its import to an extraordinary degree. Both sides played the politics very well and were very comfortable doing that. However, the result was that a deep problem in American society, rather than being addressed concretely was papered over by a bill that may not change very much.

Unfortunately, the triumph of politics over governance is not limited to the health care debate. On the contrary, it is now the norm for most domestic