Obama's Bill of Health

President Barack Obama reads letters he has been sent during his visit to Capitol Hill to meet with House Democrats, in Washington, Saturday, March 20, 2010. (AP Photo/Pablo Martinez Monsivais)
AP Photo/Pablo Martinez Monsivais

The health bill that the House is expected to vote on today isn't exactly a "clean" bill of health. Not even its backers are happy with everything in it. Not ONE Republican is expected to vote for it. Still, if it does become law it will, for better or worse, transform the way millions of us get health care. Our Cover Story is reported now by Tracy Smith:

Is this the single most important issue, asked President Obama? "Absolutely," he answered.

After months of rancor in the streets, and histrionics in the halls of Congress . . .

"Do you have the courage?"

"The only way this bill should be passed is if it's eaten first!"

. . . The vote takes place in just a few hours.

"Is this a vast improvement over the status quo?" Mr. Obama asked. " Absolutely!"

If there's so much controversy, it's because there's so much at stake: Coverage for 31 million uninsured Americans; lower health care costs for many . . . more taxes for many others; bigger government, to be sure, but also a boon to private insurers and small businesses; and, most dramatically … the presidency.

"Don't do it for me, don't do it for the Democratic Party - do it for the American people," said Mr. Obama.

"Barack Obama's presidency is on the line with this vote,' said David Gergen, a professor at Harvard's Kennedy School and CNN's senior political analyst.

"If he fails, it will, it could be almost catastrophic for his presidency. If he wins, he will definitely get a place in the history books.

Over the past week, hold-out Democrats were whipped into ine.

And on Thursday, the Congressional Budget Office gave a badly-needed boost to the bill, estimating its cost as "on-target" at $940 billion - even predicting a deficit reduction of more than $1.3 trillion over the next 20 years.

But opponents aren't going down without a fight . . .

And if it feels like this long, angry and divisive debate over American health care has gone on practically forever - the fact is, it has.

"The founding fathers didn't want to make it easy. And they succeeded beyond their wildest dreams," said Brown University professor James Morone, who has chronicled the attempts of presidents past to make national health care a reality.

Theodore Roosevelt made the opening salvo: He campaigned on healthcare-for-all in his 1912 attempt to return to office.

The idea was revived two decades later by yet another Roosevelt, Franklin. But even after getting Social Security approved by his own divided Congress, FDR found that universal health care was simply a "bill" too far.

"Why don't we have it? One word: Congress," said Morone. "We've organized Congress in a way to make it very, very difficult."

Roosevelt's successor, Harry Truman, learned that lesson the hard way . . .

"Truman believed in his bones, in his guts, that national health insurance was the most important thing for America," Morone said. "He took it to Congress. They had hearings, four weeks of hearings. So many groups lined up to scream against 'socialized medicine' that they extended the hearing two more weeks. Six weeks of hearings.

"And, after that, they didn't even take a vote."

Not until the 1960s would a savvy veteran of Congress finally make some headway. President Lyndon Johnson, formerly known as 'the Master of the Senate' - had the political muscle to break the logjam.

"Johnson knew how to play Congress like perhaps no other president in history," Morone said. "The Johnson treatment of how he would grab a Congressman, and he'd pluck their jacket, and he'd put his arm around him - and he's a big man, 250 pounds. And when you got the Johnson treatment you just wanted to get out there and take a breath of air."

With his Medicare and Medicaid legislation, LBJ brought a form of universal health care to the elderly and the poor.

His successor - Republican Richard Nixon - wanted to extend coverage to everyone else.

"Throughout his career he had a soft spot for health care; he was a liberal on health care," said Morone said. "He came up with the great national health insurance proposal: We're going to leave employers in place, we're going to leave Medicare and Medicaid, and we'll just try to cover everybody else using competitive mechanisms. It was the most creative new national health insurance bill maybe in the entire story. And, at the last minute, in spring of 1973, as Nixon is going down, the Republicans in Congress balked.

"And health care reform was dead once again. But the Nixon plan is one Democrats would embrace," said Morone.

Indeed, with the 1992 election of Bill Clinton, reform was back at the top of the agenda.

"This health care system is badly broken and it's time to fix it," President Clinton told Congress in September 1993.

First lady Hillary Clinton presided over the closed-door drafting of legislation.

"It was written at the White House and then presented to Congress almost as a fait accompli," said Gergen. "And then Congress said, 'Not invented here? Throw it away,' and then started over again."

That, plus opposition from special interest groups (exemplified by the "Harry & Louise" advocacy ads), proved fatal to the plan.

In the years that followed, health care grew from a concern, to what many describe today as a full-blown crisis.

"More than 50 percent of all the foreclosures in this country, more than 50 percent of all the bankruptcies are because people can't pay their medical bills," said reform advocate Ralph Neas of the non-partisan National Coalition on Health Care.
"A lot of people don't realize right now, every one of us is paying $1,000 a year because uninsured people are going to the emergency room because they don't have health insurance to go to a doctor."

"And those are just a few of the reasons why Neas says that, after a hundred years of trying, the time for change is now.

"What good is it to have a job or to go to school, or to do anything unless you have your health?" he said. "It's almost a prerequisite to happiness and success in life."

So, just what might the health care bill mean to you?

Those currently getting insurance from an employer will keep the same plan - "Same doctors, same everything," said Neas. "If they want to change jobs, they can't be denied in their future jobs, or on the job now, because they have preexisting conditions."

If you're buying insurance as a small business or are self-employed, "Your costs are going to go way down," Neas laughed. "The estimates are they'll be ten to 15 to 20 percent lower than they are now."

And - perhaps most important -- if you've got no insurance, "In one fell sweep, we're going to have 31 million Americans who currently do not have health insurance will get it. If they can't afford it, there will be Medicaid expansion, or tax credits."

Of course, that last point has a very controversial flip side: the new bill requires almost everyone to go out and get insurance, or pay a penalty: either several hundred dollars or a percentage of annual income.

Advocates say that's the only way to spread out risk and bring down costs.

But opponents say it's throwing good money after bad.

"What you're doing in this plan is you're spending a lot of money to subsidize an inefficient system," said Dr. Scott Gottlieb, a fellow with the conservative American Enterprise Institute. He opposes the health care bill because of that mandate, and the fact that some upper-middle class Americans may see overall health insurance costs go up.

"You'll see insurers pull out of certain markets," Dr. Gottlieb said. "You'll see insurers try to aggressively hike premiums in certain markets ahead of implementation of the bill."

And what about those Tea Party protesters against the bill?

Their public enemy #1 - the public option, a government-run alternative to private insurers - is long gone.

In fact, today's bill is a far cry from what many liberals once hoped for. President Obama described it as a "middle-of-the-road bill."

Why? Some critics say, just follow the money . . .

Bill Buzenberg runs the Center for Public Integrity which advocates for transparency in politics. They see the "color of corporate money" all over today's bill.

"This is the most heavily-lobbied bill that we have ever seen - 4,525 lobbyists have been working on this," said Buzenberg. "That's eight for every Member of Congress.

"It was across the board. I mean, you would expect insurance companies. You wouldn't expect Dunkin Donuts, for example, to be in there lobbying. They were working against a sugar tax. And they succeeded. There's not a sugar tax. The Cigar Association was lobbying. Why? They didn't want tobacco taxes to pay for this."

But President Obama vowed he "wouldn't let the perfect be the enemy of the good," deeming the proposal to be the most significant legislation since Social Security.

Earlier this year, the president said, "We are close to the summit of the mountain." Whether or not he reaches that goal will be decided in today's vote.

"If they get it through Obama's done something that Roosevelt couldn't do, that Kennedy couldn't do, Clinton, Nixon," said Morone. "Obama becomes, in history, a quite major figure, whatever else happens in the rest of his administration - or he becomes a minor figure. All in one day."