This is when change begins

It’s no panacea. The process of redirecting the oceanliner of our bureaucracy vis-à-vis health care will take time; the sausage-making process common to American legislation has not been repealed; the full effects won’t trickle down to everyday bedrock for another four years. But today at the White House, President Obama did what at least eight presidents in the modern era before him could not:

With his signing of the 2,409-page Patient Protection and Affordable Care Act, the biggest shift in health insurance coverage for American citizens since Medicare in 1966, about 32 million uninsured Americans are poised to reap the benefits of the closest thing to universal health insurance in the nation’s history.

A change in the social contract between government and governed has been laid upon the table, signed, sealed and delivered.

“Today, health insurance becomes law in the United States of America,” Obama said in the East Room of the White House.

“The bill I’m signing will set in motion reforms that generations of Americans have fought for and marched for and hungered to see,” said the president. “Today we are affirming that essential truth, a truth every generation is called to rediscover for itself, that we are not a nation that scales back its aspirations.”

Up to now, much of the talking on the issue has been about politics and policy. With health-care reform now health-care law, you make the pivot to perception — of the president and his party. Obama’s too polite to throw it out there, but he’s entitled to ask: How ya like me now?

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People forget it was in his special joint session address to Congress, on Sept. 9, 2009, when he made his daring gauntlet throw-down on health care: “I am not the first president to take up this cause but I am determined to be the last.”

Six months and change later, it’s reality. That’s a potent message to put before the voters between now and November, an actualization of his campaign slogan: not Yes He Can but Yes He Did. It’s the kind of big win Obama needed to buttress the Democratic base of supporters tired of congressional gridlock, hungry for the kind of transformational event that Obama’s election showed them was possible in the first place.

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Certainly, some of the disillusioned independent voters who drifted away from the Democrats in the past year will come back into the fold, galvanized by a refreshingly new Democratic focus on getting things done, and the Dems’ apparent willingness to leave the circular-firing-squad behavior to the Republicans.

And that perception of Democrats as winners will resonate further on the president’s behalf. With passage of a health-care law he pledged the American people, Barack Obama already steps into the ranks of the most socially transformational presidents of the last 100 years.

And we’re not even halfway through his first term.

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This is when change begins. But let's give credit where it’s overdue. If we want a shorter, less cumbersome name for the Patient Protection and Affordable Care Act, we might try calling it what it really is: the Dingle-Kennedy Act.

Their legislative contributions form the DNA of the new health-care law. No two members of Congress worked harder for what Obama signed into law than Democratic Rep. John Dingle, the congressional champion of health-care reform going back more than 50 years, and Edward Moore Kennedy, the late Democratic senator from Massachusetts who for 40 years made health-care reform not just his job in the Senate but his mission, his calling, to the day he died last year.

Dingle and Kennedy’s work for the healthcare reform that President Obama signed into law was, among other things, an attempt to level the playing field between haves and have-nots.

The New York Times’ David Leonhard gets that. Writing in the Times today about the economic impact of the Obama health care law, he notes how the law begins to change, or at least challenge, the economic disparities of American life — disparities that had their origins in the Reagan administration.

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“The bill that President Obama signed on Tuesday is the federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago,” Leonhard wrote.

“Over most of that period, government policy and market forces have been moving in the same direction, both increasing inequality. The pretax incomes of the wealthy have soared since the late 1970s, while their tax rates have fallen more than rates for the middle class and poor.

"Nearly every major aspect of the health bill pushes in the other direction. … Beyond the health reform’s effect on the medical system, it is the centerpiece of his deliberate effort to end what historians have called the age of Reagan.”

And Leonhard, recounting a story told to him by White House economic adviser Lawrence Summers, reported Tuesday on how Summers, helping his daughter prepare for a college exam, “realized that the federal government had not passed major social legislation in decades. There was the frenzy of the New Deal, followed by the G.I. Bill, the Interstate Highway System, civil rights and Medicare — and then nothing worth its own section in the history books.

“Now there is.”

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Image credits: Health-care bill signing: Pete Souza/The White House. Signature: President Obama. Ted Kennedy: via The Huffington Post.

‘This is what change looks like’

“I am not the first President to take up this cause, but I am determined to be the last.”

President Obama

Yesterday’s date rendered strictly in numerical form — 3.21.10 — looks a lot like what the day turned out to be: a countdown clock on ruinous past practices, the arrival of time’s-up on a national legacy that’s been a national embarrassment before the world. It might have been just another official first full day of spring if not for the fact that lawmakers on Capitol Hill were busy changing the arc of the national future.

With the initiative and energy of President Obama and the negotiating skill of House Speaker Nancy Pelosi and the Democratic leadership, a courageous Democratic Congress voted last night to enact the Patient Protection and Affordable Care Act, the most panoramic change in health insurance coverage for American citizens since Medicare in 1966.



In two dramatic votes last night the Democratic led House passed the Senate bill 219-212, passed the reconciliation bill 220-211. The Senate bill, passed last Christmas Eve, now goes to President Obama to be signed into law in a ceremony on Tuesday morning. The reconciliation bill makes corrections to the Senate bill; it goes to the Senate for a final vote. A motion to recommit was also defeated by the Democrats.

The vote last night and the president’s expected signature in the morning usher in the most sweeping realignment of the terms of the social contract between the federal government and the American people in generations, and the closest thing to universal health care this nation has ever seen.

MSNBC’s Ed Schultz got the gravity of the occasion: “This is a defining moment in our history when it comes to what our priorities are. We have chosen people over profit.”

Talk-radio velociraptor and former recreational pharmaceutical enthusiast Rush Limbaugh might want to have his Costa Rican real estate agent on speed-dial right about now.

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“Tonight, after nearly 100 years of talk and frustration, after decades of trying, and a year of sustained effort and debate, the United States Congress finally declared that America’s workers and America's families and America's small businesses deserve the security of knowing that here, in this country, neither illness nor accident should endanger the dreams they’ve worked a lifetime to achieve,” Obama said in the East Room of the White House last night, after the deal went down.

“Tonight, at a time when the pundits said it was no longer possible, we rose above the weight of our politics. We pushed back on the undue influence of special interests. We didn't give in to mistrust or to cynicism or to fear. Instead, we proved that we are still a people capable of doing big things and tackling our biggest challenges. We proved that this government -- a government of the people and by the people -- still works for the people. ...

“This isn’t radical reform. But it is major reform. This legislation will not fix everything that ails our health care system. But it moves us decisively in the right direction. This is what change looks like.”

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For days now, the Democrats on the Hill have quietly betrayed a growing sense of optimism about passage of the bill, even as they engaged in a variation of Lyndon Johnson-style arm-twisting. And deal-making wioth one noted holdout: Rep. Bart Stupak of Michigan, a conservative Democrat who'd opposed the bill since November because of what he said were loopholes through which elective abortion could be paid for with public funds.

Stupak insisted on and yesterday received a way to make clear his objection to public funds used for abortion: A pending executive order announced by President Obama, meant to shore up his already-stated commitment to maintaining the Hyde Amendment's policy and language restricting federal funds for abortion in the current health-care legislation. Executive Order 13535 was signed after an agreement with Stupak, who’d threatened a no vote against the bill unless such an agreement were obtained.

“We’ve all stood on principle,” Stupak said at a news conference announcing the deal. “We expect the current Hyde language to apply throughout this health-care bill. “[The president] said there will be no federal dollars for abortion. The president has put his commitment in writing. This is a very extensive order, he does not plan on rescinding it.” ...

“We've always said ... that we were for health-care reform, but there was a principle that meant more to us than anything, and that was the sanctity of life.”

There’s some illogic in Stupak’s argument, though: How do you uphold the sanctity of life as an absolute and oppose health-care reform when opposing it likely means dismissing the sanctity of the lives of millions of Americans here already?

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The great thing about the Stupak-brokered agreement — besides the fact that its very existence validates the best deliberative possibilities of American government — is something that burnishes the president’s negotiating bona fides: the agreement that led to Obama’s executive order reflects no compromise of Obama’s own principles on the matter of elective abortion. He’s been on the record as saying that under his health plan, no federal funds would be used or siphoned off, directly or indirectly, to fund non-medically necessary abortions.

Health-care reform: Navigating the tunnel's end

The health-care debate that’s on the verge of becoming American history has hundreds of thousands of personal stories that distill the nation’s perilous situation on health care for its citizens into something accessible. The lofty, procedural, partisan rhetoric of the issue comes down to everyday scenarios. Like the one for Natoma Canfield, a small-businesswoman recently diagnosed with leukemia, a woman whose story typifies the bureaucratic farrago facing those millions of Americans with pre-existing conditions.

Or Michael Brooks’ story. The 12-year-old Omaha boy, faced with a myofibroblastic tumor, a rare form of cancer that was unresponsive to chemotherapy, found that his family’s insurance wouldn’t cover an experimental procedure, according to KETV of Omaha. He faced a grim future until his community — from neighbors, friends and classmates to strangers wandering in off the street — rallied to gather the money for the experimental procedure. Health care by crowdsourcing: a sad sign of the times if there ever was.

It’s that kind of heart-wrenching financial improvisation that may be near an end in the United States. Sometime this week, maybe next at the very latest, President Obama expects to sign into law the most sweeping health-care legislation since Medicare, more than two generations ago, and the realization of an objective that has eluded this nation since Theodore Roosevelt first proposed it in 1912.

The caged death match Republicans have now with House Democrats hinges on so-called deeming resolutions, a procedure under which the yearlong saga of the health-care reform may finally be just about over. The resolution, shorthanded as “deem and pass,” was suggested by Rep. Louise Slaughter, chair of the House Rules Committee, and has been adopted and championed as a strategy by House Speaker Nancy Pelosi.



It's the latest skirmish in the health-care warfare between the House and the Senate, the bruising and confusing legislative choreography that all these months has looked like gridlock to the American people.

The intricacies of this entirely parliamentary procedure will provoke a headache you don’t need, but Jason Linkins of The Huffington Post, breaks it down nicely:

The House is stuck having to basically pass the Senate health care bill, because the bill cannot be reconciled in conference committee. Why? Because it will be filibustered. However, House members are averse to doing anything that looks like they approve of the various side-deals that were made in the Senate -- like the so-called "Cornhusker Kickback." The House intends to remove those unpopular features in budget reconciliation, but if they pursue budget reconciliation on a standard legislative timeline -- where they pass the Senate bill outright first and then go back to pass a reconciliation package of fixes -- they'd still appear to be endorsing the sketchy side deals, and then the GOP would jump up and down on their heads.

Enter deem and pass. Under this process, the House will simply skip to approving the reconciliation fixes, and "deem" the Senate bill to be passed. By doing it this way, the Democrats get the Senate bill passed while simultaneously coming out against the unpopular features of the same.

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The conservatives won’t roll over. In recent days, the National Republican Congressional Committee took out a new sky-is-falling ad, a countdown clock in ominous blacks, whites and red counting down the time before the expected vote.

And the conservative press is up in arms. The Wall Street Journal, mouthpiece of media buccaneer Rupert Murdoch, condemned “deem and pass” as an “amazing procedural ruse,” a “two-votes-in-one gambit” and “a brazen affront” to the Constitution. The Journal mentions in passing that the procedure has been used in the past, only going back to 1998 to put it in a shallow historical context.

The non-starter-over in chief

If you had any doubt that President Obama means to, uh, stay the course in his pursuit of health care reform this year, you can rest a little easier. Today in an address from the East Room of the White House, flanked by doctors, nurses and other health-care professionals, the president threw the gauntlet upside the heads of the gradualists on Capitol Hill, the tabula rasa crowd who insist on starting the health-care reform process all over again on the proverbial Clean Sheet of Paper.

Obama’s message couldn’t be simpler: No do-overs. Two weeks, give or take. “Let’s get it done.”

“The insurance companies aren’t starting over. They’re continuing to raise premiums and deny coverage as we speak.

“For us to start over now could simply lead to delay that could last for another decade, or even more,. The American people and the U.S. economy just can’t wait that long.”

“I believe the United States Congress owes the American people a final vote on health care reform. We have debated this issue thoroughly, not just for a year, but for decades. Reform has already passed the House with a majority. It has already passed the Senate with a supermajority of sixty votes. And now it deserves the same kind of up-or-down vote that was cast on welfare reform, the Children’s Health Insurance Program [S-CHIP], COBRA health coverage for the unemployed, and both Bush tax cuts – all of which had to pass Congress with nothing more than a simple majority.”



In a speech that exhibited a pitch-perfect balance of rhetorical loft and rhetorical heft, the president indicated he’s had enough of the congressional kabuki do-si-do bullshit that has characterized this debate in the halls of Congress for the past 13 months (to say nothing of the prolonged debate among street activists, netroots organizers, and the blogosphere in general).

And just as important, Obama gave the speech the necessary sense of mission, of purpose. It might be fair to say health-care reform could be to Obama what the Interstate highway system was to Eisenhower, what the moon shot was to JFK: an opportunity to apply national principles to the pressing and immediate task at hand.

“In the end, that’s what this debate is about: It’s about what kind of country we want to be. It’s about the millions of lives that would be touched — and in some cases, saved—by making private health insurance more secure and more affordable.”

“What’s at stake right now is not just our ability to solve this problem, but our ability to solve any problem.”

“The American people want to know if it’s still possible for Washington to look out for their interests and their future,” Mr. Obama said. “They are waiting for us to act. They are waiting for us to lead. And as long as I hold this office, I intend to provide that leadership. I don’t know how this plays politically, but I know it’s right.”

“And so I ask Congress to finish its work, and I look forward to signing this reform into law. Thank you. Let’s get it done.”



The Republican response was swift and utterly predictable. House Minority Leader John Boehner of Ohio said “well, it’s pretty clear that the Obama administration and my colleagues in Congress are going to continue on their march to shove this government-run health care plan down the throats of the American people,” Boehner said, using the word “shove,” one of the GOP’s hot verbs of the moment (others invoked recently by the Republican leadership include “ram” and “jam”).

Rep. Marsha Blackburn, of Tennessee, condemning Democratic attempts to “push through” health care, said, “This is a bill that is too expensive to afford. It is something that will restrict access to health care, and it will cause us to continue to lose jobs in this country.”

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So much of the health care debate has centered on its estimated out-of-pocket cost; the president’s plan has been estimated at $900 billion over 10 years. Hardly chump change by any estimation.

But look at it another way:

According to a Harvard Medical School analysis released on Sept. 17, almost 45,000 Americans die every year as a result of having inadequate medical care and/or no health insurance. Extrapolating from that estimate, then: if those 45,000 Americans’ lives could be saved, what would be the cumulative annual effect on the economy?

It’s fair to assume that not all of those 45,000 Americans are of or past retirement age, or facing end-of-life issues like terminal diseases that would prevent them from making an extended contribution to the work force. Many, maybe even most of them, could be expected to return to some productive work once their health issues were resolved.

For the sake of a workable scenario, let’s assume that 70 percent of those 45,000 Americans — 31,500 of them — had been ordinary working people.

According to the Statistical Abstract of the United States 2010, wage earners of all races and both genders earn an average of $27,059 a year. Multiplied across the 31,500 people saved from early death in our hypothetical, that puts $852.3 million into their pockets, which, ultimately, means putting most of that money into the national economy.

Add to that the vast financial benefit that arises because hundreds of thousands of other Americans aren't forced into bankruptcy by ruinous medical bills — Americans who are able to route that money into various sectors of the wider economy, such as construction, small businesses and consumer products. The benefit would be billions more.

And there’s the other unknown unknown: just how big a financial impact their incomes would have on other businesses whose income depends on their income ... and on and on, the ripple effect of American capitalism at work.

Admittedly, such gains would be a drop in the bucket compared to the conservatively estimated $90 billion a year the Obama plan is expected to cost, to insure another 31 million Americans. But surely, there’s an obvious financial benefit to bringin’ em’ back alive. Any money is good money when the alternative is no money. A live contributor to the American workforce beats a dead statistic any day.

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We don’t know if anything like that entered the president’s consideration, and since it’s just a back-of-the napkin conjecture, maybe it doesn’t matter.

What does matter is the fact that in May 2002, the Institute of Medicine estimated that 18,314 Americans died every year because they lacked health insurance coverage.

In less than eight years, that number’s more than doubled.

"The report documents the immense consequence of having 40 million uninsured people out there," said Ray Werntz, a consumer health expert with the Employee Benefit Research Institute, to USA Today in 2002. "We need to elevate the problem in the national conscience."

The president’s throwdown to Congress does just that. Finally.

It’s still to be seen if Congress can meet his admittedly ambitious two-week deadline. Congress is as unwieldy an institution as there ever was, and the Republicans on Capitol Hill and their cheerleaders in talk radio and the punditburo will do everything they can to slow down a process that’s already taken too long.

But more and more, there’s a sense that we’re near the endgame, maybe closer to this goal line than ever before. And when you’re on the 10-yard line, or even the 20, you damn well don’t start the game over.

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Image credits: Obama: Pete Souza/The White House. Operating room: Detail of photo by Piotr Bodzek, MD, republished under GNU Free Documentation License version 1.2 or later.