November 3, 2008


The Test (Steve Coll, November 10, 2008 , The New Yorker)

The next Presidency has within its reach at least two generation-spanning causes: the need to jump-start a new energy economy, and, in so doing, help to contain climate change; and the need to enact a plan to provide quality health care to all Americans, and, in so doing, complete the project of social insurance that Roosevelt described in 1935. Each of these projects is urgent, but it is health-care reform that speaks more directly to the economic and human dimensions of the present downturn.

The accumulating failures in the country’s health-care system are a cause of profound weakness in the American economy; unaddressed, this weakness will exacerbate the coming recession and crimp its aftermath. A large number of the country’s housing foreclosures in recent years appear to be related to medical problems and health-care expenses. American businesses often can’t afford to hire as many employees as they would like because of rising health-insurance costs; employees often can’t afford to quit to chase their better-mousetrap dreams because they can’t risk going without coverage. Add to this the system’s moral failings: about twenty-two thousand people die in this country annually because they lack health insurance. That is more than the number of Americans who are murdered in a year.

Presidents who help right a wrong of this character are generally immortalized in granite, but to succeed they require a transformation-minded Congress, too. The next Congress will likely be without the active leadership of its great lion of social reform, Ted Kennedy. There is only one senator with the wonky expertise, work habits, and political stature to fill Kennedy’s place: Hillary Clinton. The psychology she would bring to this inheritance would surely be complex, but no health-care-reform bill will pass without her. Lyndon Johnson, also a person of complex psychology, understood this politics of legacy well. At the Medicare signing ceremony, he invited Jimmy Roosevelt, F.D.R.’s eldest son, and the aging Harry Truman, who had pushed hard for health-care reform, to share the glory. Johnson, in his remarks, linked them (and himself, of course) to the Social Security Act and its “illustrious place in history,” and he carefully recited an “honor roll” of fifteen congressional leaders who contributed to the bill’s passage. It was, Johnson said, a “time for triumph.” It is, even more so, today.”

Irrespective of who wins on Tuesday, they should ask the Clintons and the Bush brothers to produce a proposal for universal health coverage based on HSAs. If nothing else, the haters from both parties would be so distracted the new president would have a free ride...

Posted by Orrin Judd at November 3, 2008 1:42 PM
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