For many decades it was America’s political “Rubik’s Cube.”
“It” being the effort to establish a national health service.
President Theodore Roosevelt tried and failed. As did Presidents Truman and Clinton (although, in a piecemeal approach Medicare for seniors and Medicaid for the poor became the law during the Lyndon Johnson administration.)
So, in 2009 President Barack Obama’s top advisors strongly advised against his spending vital political capital on creating a comprehensive federal health insurance program. Although the cost of healthcare was a great concern for many Americans, the Administration had other urgent priorities as well – not the least of which was managing the recovery from the disastrous 2008 financial crisis.
All politics aside (if that’s possible on such a far-reaching issue), the complexity of the two-year effort earned it the appellation, the Administration’s “most enduring and most contested achievement.” But that endurance is about to be tested in the Supreme Court. If the Affordable Care Act is struck down, in whole or in substantial part, many millions of Americans could lose their health insurance. This at a time when the COVID-19 pandemic is ravaging many parts of the nation and millions of Americans are struggling in a seriously wounded economy to pay rents, buy enough food and acquire other essentials.
And if the A.C. A. was ” most contested” during its two-year development, then today, in the nation even more divided, agreement on a replacement or revision would likely also be a multi-year effort .
To appreciate how challenging it would be to win broad support across the American political spectrum rooted in public opinion it’s instructive to read President Obama’s narrative of the passage of the A. C. A. as he has presented it in a detailed article in the current (November 2nd) edition of THE NEW YORKER – an excerpt from his new book, “A Promised Land”.
As an introduction to the article, The New Yorker editor David Remnick stresses both its specifics and its timeliness:
It is “about the ferocious battle over his most transformative piece of legislation … [The] President grapples with the ongoing American debate over health care: the root of the problem, the countervailing interests, the ambitions, the setbacks, the politics – ‘the art of the possible’… His subject could not be more relevant: as the election approaches … health care is at the center of everyone’s attention. Meanwhile, Donald Trump, having failed repeatedly to kill the A.C.A. … continues to promise that he will replace it with something far better. Soon. Very soon.”
It is, of course, President Obama himself who best identifies the essence of the challenge: “I was convinced that the logic of heath-care reform was so obvious that even in the face of well-organized opposition, I could rally the American people’s support.”