If the health care legislation passed in Washington over the
weekend is a watershed, it is not for the reason you may think. It's not
because it is such a big piece of social legislation or because it represents
such a big victory for President Obama. Both conclusions come with
caveats -- either about what and who was not addressed by the legislation or about
the political fallout from the ugly process that created this important but
imperfect band-aid on America's broken health care system.
No, the reason the health care reform bill is important is
not because it was the first major such piece of social legislation in the U.S.
in decades, but rather because it represents the first in what will become by
necessity an on-going series of efforts to fix deep and serious defects in the
American economy. In a decade or two, this legislation is like to be seen by
Americans as the beginning of a lengthy, brutal and spasmodic process to cut
deficits and restore America's leadership prospects in the global economy.
Health care is 20 percent of the U.S. economy and growing. It
is linked to the part of the U.S. government's obligations that are expected to
explode in the next decade and create mountains of debt that make those
accumulated in the past few years look small by comparison. The inability to
pay the bills that will come due, the inefficiency in the system, the drag the
current system is placing on U.S. competitiveness -- all will demand that this is
bill number one in a long series of efforts.
The Republican Party, which has discredited itself more with
its stance on this bill than on any other of its signature initiatives since
the McCarthy era (and I include the wrong-headed Iraq War on that list), will
define whether it is relevant going forward by whether it moves from a
brainless position of "oppose" and now "repeal" to one of seriously seeking
meaningful solutions to this fire in the engine room of the U.S. economy. (Their
mendacity and mean-spiritedness, their deviousness and hypocrisy throughout
have been stunning. Do they really want to be known as a coalition of the
stupid, the greedy and the uncaring? That's the message being offered by the
Boehner-McConnell-Teabagger team.)
But let's look past the recent debate in Washington and
toward what the global implications of this are. If America doesn't fix the
health care problem as an aging, deficit burdened society, the country will
watch its financial resources dwindle and those we have be siphoned into essential
but costly social programs. This bill is a step in the direction of
acknowledging the problem, addressing some grotesque social wrongs perpetrated
by the current system and edging toward some slightly enhanced efficiency. Future
legislation will have to make real headway at cutting deficits by increasingly
cutting out the middlemen (insurance companies) we can't afford and by
enhancing savings through greater efficiency. Changing the retirement age,
limiting certain extremely expensive procedures and adding taxes will also be
among the unpopular essentials of this process... and you can guess which party
will take the lead with each.
The process is akin to reinvesting in infrastructure,
changing our energy paradigm and revitalizing our educational system in terms
of the basics of making America competitive again. Heck, these changes are
essential to making America viable for the long-run. So while it is tempting to
breathe a sigh of relief that with some luck the shouts of "baby killer" are
behind us, Americans and those interested in what will be preoccupying the U.S.
government for the next several decades ought to see this legislation not as
the end, nor as the beginning of the end but perhaps, in the words of
Churchill, as the end of the beginning -- although if the next stages of these
reforms don't ultimately come, then Churchill will be paraphrased and the
beginning of the end it will have been.
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