Care for the sick. Serenity for the fearful.
Those are the simple, elegant terms Lyndon Johnson used to describe Medicare on July 30, 1965, the day he signed it into law.
He said it at the side of Harry Truman, who was nearly 80 then. They were at the Truman Library in Independence, Missouri, where Johnson had come to pay homage. It was Truman who had waged the first serious campaign for national health insurance. Truman didn't succeed, but he'd launched a crusade that liberals would spend the next decade-and-a-half pursuing:
Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection.
Medicare would not fully realize Truman’s vision, of course. Truman had wanted to insure all Americans, while Medicare would insure only the elderly. But Medicare was a landmark piece of legislation, as much for the principle it established--that government had responsibility to protect at least some citizens against the crushing cost of illness--as for the actual lives it saved.
On Tuesday, President Obama will sign the Patient Protection and Affordable Care Act into law. And the same spirit will be in the air.
The compromises that went into this legislation are, by now, well-known. It won’t be fully effective for several years and, even then, several million people will likely lack health insurance. People won’t have the option of enrolling in a new public plan; the private plans many carry will still have substantial deductibles. Government accounts predict the plan will reduce the rate of growth in medical spending only modestly. The full realization of Harry Truman’s dream, of affordable health insurance for every American, will remain elusive.
But, like Medicare, this bill represents a monumental step forward. The numbers are impossible to ignore. More than 30 million additional people will have insurance; even those with sizable deductibles will have protection from the kind of ruinous financial liabilities they face now. There is no public plan--for now!--but there is extensive regulation, including requirements that insurers spend more money on actual patient care. What we spend on medical care isn’t going to plummet. But it won’t rise as fast as it might otherwise. And, over the long run, that can save a lot of money--particularly if we are smart enough to learn and adapt as we go.
And, as with Medicare, this bill is every bit as important for the statement it makes. Medicare affirms the principle that the elderly have a right to affordable medical care, even if it requires government help. Medicaid does the same for the poor. The Patient Protection and Affordable Care Act extends the promise of affordable care to the rest of the country--a promise that will be fulfilled, one way or another, by the government.
It will not happen today, tomorrow, or even in 2014, the first year of full implementation. And you can expect plenty of problems along the way. But history tells us that first we we agree to an obligation--and then we spend some time, maybe a long time, meeting it. Medicare grew to cover more and more benefits; Medicaid grew to cover more and more people. The same will happen with this act, I am sure.
In the meantime, life will get a little better for most people and a lot better for a few. The sick will get some care. The fearful will know some serenity.
And somewhere LBJ will be smiling. Harry Truman, too.