Just when you thought it was safe to go back into the news, the dorsal fin of Obamacare has sliced the water’s surface. Diehard opponents vow to make next year’s midterm elections a referendum on a law they’ve disparaged as socialist claptrap. Meanwhile, conservative pundit David Brooks spies logistical icebergs ahead as the hellishly complex reforms are implemented.
Brooks’s concern, based on interviews with experts pro and con, is legitimate but manageable. As for the socialism charge, remember this if nothing else: Mandatory national health insurance was the brainchild of an anti-socialist reactionary.
Germany’s Otto von Bismarck enacted the world’s first compulsory health care system in 1883. Expanded in the 130 years since, it remains the scaffolding for German coverage today. Bismarck required certain low-income workers to get insurance through their workplaces from private, nonprofit carriers, financed by a payroll tax—just like our Social Security and Medicare. The Iron Chancellor didn’t get that nickname running daycare centers. In other words, he was no bleeding heart. He essentially outlawed socialists, banning their meetings and literature distribution. His insurance law and other reforms (he created social security half a century before ours) aimed to neuter socialism, not embrace it, by providing basic needs to the working class.
Amid cries of “socialism!” from the Reich Limbaughs of his day, Bismarck didn’t much give a damn. “Call it socialism or whatever you like,” he said.
“The actual complaint of the worker is the insecurity of his existence; he is unsure if he will always have work, he is unsure if he will always be healthy, and he can predict that he will reach old age and be unable to work,” Bismarck argued. All but libertarians would agree that addressing those concerns, by private mandates if not directly, is a legitimate job of even limited government. And even libertarians should agree on another government obligation that Obamacare will begin to address, one I summed up in an op-ed during the original debate over the bill: national security. Every year, thousands of uninsured Americans die after putting off preventive medical care. Others fall ill and require hospitalization. I believed then and still believe that a preventable terrorist attack with as many casualties would provoke a national security crisis and government action.
Bismarck’s reach was far less ambitious than President Obama’s; his law was a welfare program covering only a fifth of the German population. Now that the system covers everyone, health care costs have become a problem. But that’s true in all advanced countries, and the U.S. struggles less successfully with it than Germany, which has lower medical costs and where people generally like their system.
These logistical matters return us to Brooks. Many states are opting to foist on the feds the Obama-mandated task of setting up exchanges, online marketplaces to shop for health plans. Meanwhile, the Supreme Court, while upholding most of the law, allowed states to refuse a provision expanding Medicaid for the poor. Some analysts think younger, healthier Americans may elect to pay fines for shirking the coverage the law requires, reasoning that that’s cheaper than insurance. These and other issues will make implementing the law more daunting than the labors of Hercules, says Brooks. Elsewhere, his newspaper quoted George W. Bush’s health secretary as saying the infinitely simpler job of creating Medicare’s prescription drug benefit nearly crashed that program.
Even so, Brooks notes that most experts he talked to, including opponents of the reform law, expect that we’ll survive its chaotic first years. “Overall,” he concludes, “it seems likely that in some form or another, Obamacare is here to stay.”
The law’s supporters — the smart ones anyway — always admitted it was flawed. For example, it makes just small steps towards controlling medical costs. It was still wise to pass it, allowing for the possibility of needed future fixes. To have punted, yet again, on a reform that eluded presidents since FDR would have condemned the uninsured to another round of God-knows-how-long waiting. And as one writer argued while making “The Conservative Case for Obamacare,” the president’s plan got its architecture from what were originally Republican blueprints.
Other nations have pulled off universal insurance without crashing and burning (see Germany, above). There’s no cause to think that this big, capable country can’t match them.