The superlatives are justified. The passage of comprehensive health care reform is this country's most momentous social reform since the creation of Medicare more than 40 years ago. And in my view the new law is at least that long overdue. It beggars belief that a nation as rich as the United States could have tolerated for years a health care system which every other advanced economy would reject out of hand, one which left tens of millions without health insurance, and under which serious illness could very well mean financial ruin. The new law finally confronts the problem, and takes bold steps towards fixing it.
Sunday's vote is also a political triumph. Scott Brown's unexpected win in Massachusetts--a Republican in a liberal state, running against this bill--stunned the Democrats and caused many to think the effort was dead. Barack Obama bravely chose not to back down. Without that commitment, the bill would have failed. The same goes for Harry Reid and Nancy Pelosi: they did not deviate. In parliamentary terms, the Democrats made the whole venture more dramatic than it needed to be. It is absurd that getting the Senate bill through the House should have been such a struggle. But the main thing is that they succeeded. It is a success that eluded all their predecessors. They are entitled to celebrate. They have their places in history.
Remarkable as it may be--and welcome, too, as I believe--it is nonetheless a tainted victory. Brown won in Massachusetts for a reason. The Democrats had failed to make their case for this reform to the American public. They pressed the case for some sort of reform, but that was easy: the country was already there. What the country dislikes is this particular bill, and the Democrats, intent on arguing among themselves, barely even tried to change its mind.
People struggle to understand how extending health insurance to 32 million Americans, at a cost of a trillion dollars over ten years, can be a deficit-reducing measure. If cuts in Medicare will pay for half of that outlay, as the plan intends, they struggle to see how the quality of Medicare's services can be maintained--let alone improved, as Pelosi said again in her speech on Sunday. The CBO notwithstanding, the public is right not to believe these claims.
Whether you agree with that or not, the law the Democrats just passed is unpopular. It is a far-reaching, transformative measure that in the end will affect almost everyone; it is opposed by most of the country; and it is now law. I would never have believed this possible in the United States.
I am used to explaining to foreigners that the US political system is, by design, exquisitely sensitive to public opinion, with its lower house up for election every two years. American governments cannot ignore their people, as Europe's governments can and frequently do, I used to argue. And I would cite my favorite example. Germany's government abolished its currency and forced the euro on a country that was opposed to monetary union throughout, saying, "You are wrong. We know better. We will do this regardless, and you will come to like it." Can you imagine such a thing happening in the US, I used to ask? Could anything be more un-American? The usual response would be laughter.