The draft Democratic Party platform sent out last week puts health care reform front and center. “If one thing came through in the platform hearings,” says the document, “it was that Democrats are united around a commitment to provide every American access to affordable, comprehensive health care.”
Can Democrats deliver on that commitment? In principle, it should be easy. In practice, supporters of health care reform, myself included, will be hanging on by their fingernails until legislation is actually passed.
What's easy about it? For one thing, we know it's economically feasible: Every wealthy country except the United States already has some form of guaranteed health care. The hazards Americans treat as facts of life – the risk of losing your insurance, the risk that you won't be able to afford necessary care or will be financially ruined by medical costs – would be considered unthinkable in any other advanced nation.
The nation would love it
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The politics of guaranteed care are also easy, at least in one sense: If the Democrats do manage to establish a system of universal coverage, the nation will love it.
I know that's not what everyone says. Some pundits claim that the United States has a uniquely individualistic culture, and that Americans won't accept any system that makes health care a collective responsibility. Those who say this, however, seem to forget we already have a program – you may have heard of it – called Medicare. It collects money from every worker's paycheck and uses it to pay the medical bills of everyone 65 and older, and it's immensely popular.
There's every reason to believe that a program that extends universal coverage to the nonelderly would soon become equally popular.
Three big hurdles
There are, I'd argue, three big hurdles to universal health care.
First, the Democrats have to win the election – and win it by enough to face down Republicans, who are still, 42 years after Medicare went into operation, denouncing “socialized medicine.”
Second, they have to overcome the public's fear of change.
Some health care reformers wanted the Democrats to endorse a single-payer, Medicare-type system for all. On the sheer economic merits, they're right: Single-payer would be more efficient than a system that preserves a role for private insurance companies.
But it's better to have an imperfect universal health care plan than none at all, and the only way to get one passed soon is to inoculate it against Harry-and-Louise-type claims that people will be forced into plans “designed by government bureaucrats.” So the Democratic platform declares that Americans “should have the option of keeping the coverage they have or choosing from a wide array of health insurance plans, including many private health insurance options and a public plan.”
The final hurdle is the risk that the next president and Congress will lose focus. There will be many problems crying out for solutions. It will be tempting to put health care on the back burner.
So I'm nervous. The history of the pursuit of universal health care in America is one of missed chances, of political opportunities frittered away. Let's hope that this time is different.
Give Edwards some credit
One more thing: If we do get real health care reform, a lot of people will owe a debt of gratitude to none other than John Edwards. When Edwards dropped out of the presidential race, I credited him with making universal health care a “possible dream for the next administration.” Edwards' political career is over, but perhaps he and his family can take some solace from the fact that his party is still trying to make that dream come true.