But maybe it's not quite so big.
In terms of magnitude, cost, and novelty, the health care law is a large domestic policy achievement but not as revolutionary as the creation of Social Security or Medicare and Medicaid. At first glance, this bill looks big for two reasons: it affects virtually 300 million people and costs just shy of $1 trillion. But breadth shouldn't be mistaken for depth.
The law's deepest impact is on 32 million people who don't have health insurance, or less than 10 percent of the population. In other words, there's little change for the other 90 percent who have insurance and can keep it if they so choose.
If you have insurance now, your premiums will still rise, but maybe the rate of increase will be a little slower than it has been recently. Your plan will cover more procedures after "pre-existing conditions" are moot. You may lose several thousand dollars - at most - to a penalty for not buying insurance or to new taxes. For those people, the financial effect will be similar to any number of tax cuts or hikes have been made in recent history and not been labeled "historic." (Yes, it's still a lot of money.)
The bill is projected to cost $940 billion over the next decade, or a little more than the stimulus package that now costs $862 billion, up from the original price tag of $787 billion. While the programs spend their money at different annual rates, for the sake of illustration, the spending difference between them is a paltry $7.8 billion per year. That hardly puts health care reform in a league of its own when it comes to spending.
Virtually lost in the year's worth of health care reform arguments is the fact that this reform is rather conservative. The law didn't create a new health care system from whole cloth -- single-payer, government-run, free-market, or otherwise -- but rather stretches the existing patchwork of private and government insurance across the gaps in coverage to cover nearly everyone.
The majority of the uninsured will soon do what tens of millions of other Americans do: buy private insurance plans. The only difference between these 24 million and the rest who have private insurance is that they will buy the plans with the help of tax credits. (If you buy insurance through your employer, it's tax-free anyway. And starting in 2018, that begins to change for richer insurance plans.) The practice of Americans paying for private goods and services with government money is not new: millions send their kids to school with vouchers, pay for medical procedures with insurance from Medicare/Medicaid, buy hybrid cars with rebates, and so on.
The remaining 16 million will be insured through a program that's anything but new: Medicaid, created in 1965.
By contrast, Social Security and Medicare/Medicaid were revolutionary. Neither old-age pensions nor insurance for the elderly and poor from the government existed before the Roosevelt and Johnson. The efforts of both men dramatically changed how Washington interacted with the average citizen. In 1932, maybe that citizen interacted with the feds though the Post Office, the military, or the penitentiary. Some time after 1965, the same citizen probably started drawing a monthly check from Washington's pockets and paying for health care with insurance with tax dollars.
Obama's health care success doesn't move the federal government into our lives nearly as much as FDR and LBJ's successes did.
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