There's been a great deal of debate this cycle about the relative merits of the candidates' health care plans. The key point seems to be the issue of mandates - Obama would require that all children have health insurance, Hillary would extend that requirement to every American. Whatever the abstract merits of the competing proposals, one thing seems clear - Obama has yet again demonstrated his superior understanding of the American temperament, and that bodes well for the plan advanced by the presumptive nominee.
I would sum it up like this. Hillary may have abandoned the truly-sweeping changes she proposed during her husband's first term, but her plan remains ambitious. It is her aim to enact reforms that would, in one fell swoop, extend coverage to every American (that is, to every citizen and legal resident - she would still exclude millions of those in the country illegally). She and her advisers argue that only truly universal coverage can be economically feasible. Obama is proposing a plan that might, in any other year, seem ambitious - but stacked up against Hillary's seems relatively cautious. He would mandate that every child be covered, but not every adult. If it turns out that the numbers don't add up, he's said, he'll reconsider universal coverage. It's a relatively incremental approach. I'm not qualified to pass judgment on the economic merits of the proposals; smarter folks than I have already written thousands of column-inches on the subject. But I do think that there's another way to gauge the two plans, and that's to consider the visions of change that they embody.
For centuries, Americans have proven resistant to governmental provisions of welfare. The quintessentially American ethos of self-sufficiency and independence leads many voters to recoil from the very notion that the government should take a prominent role in their lives. Many Americans would prefer to shoulder greater risks and maintain their independence, than to surrender their freedom of choice and gain greater security. But there has always been an important exception to this general rule. Americans feel a collective obligation to care for the vulnerable and the defenseless. When proposals are advanced to care for those believed unable to care for themselves, they have almost always enjoyed tremendous support. Moreover, almost every major expansion of the welfare state has followed the same path - reforms initially proposed to benefit the most vulnerable are gradually expanded to benefit all Americans.
Let me offer a few examples. It was in the wake of the Civil War that the federal government first entered the welfare business; an enormous bureaucracy provided benefits for the wounded, and pensions for veterans and their widows and orphans. Governmental regulation of wages and of working hours was first held to be constitutional only insofar as the government acted to protect the vulnerable (women and children), and only much later extended to the workforce as a whole. Modern personal-injury law has its origins in the railroad accidents of the late nineteenth century; the courts initially moved to protect and compensate women, who were seen as dependent and vulnerable, but gradually expanded those protections to men, who were every bit as much at the mercy of machines. Modern product liability and consumer safety protections date to a series of accidents in the mid-1950s, in which poorly designed products led to the maiming or deaths of scores of small children, and were gradually expanded from that narrow base.
In other words, the courts, the legislatures, and the electorate have always been far more supportive of efforts to protect the vulnerable than they have of efforts to expand governmental authority over the able-bodied and the independent. But when those initial efforts have proven effective, they have often cleared the way for more sweeping programs that have followed in their wake.
There's a new NPR Survey out this morning that suggests this holds true for health care, as well. Let me quote Harvard Prof. Robert Blendon, a co-director of the survey:
There was extraordinary support in this poll among all groups — Democrats, Republicans and independents — for the idea of requiring that every child has a
health insurance policy and then provid[ing] help to parents that can't afford
it. And we don't have as wide a consensus for what to do about adults. So it's
the childrens' side of this which offers the possibility of a very quick breakthrough in the next Congress.
That's an important message. Obama has intuited where the American people stand on this issue, for better or for worse. His proposal is consonant with the long history of reform efforts in this nation, which extend help first to the most vulnerable. When the efficacy of those efforts is clear, the rest of the population has often come to support extending the protections. We've already seen this with S-CHIP, which succeeded where HillaryCare failed. It remains immensely popular, and has inexorably expanded in many states to cover increasingly broad segments of the population.
Obama's approach may not please economists, but in some sense, that's immaterial. He can unite the American people in support of his vision, and it's likely to lead to something approaching universal coverage in fairly short order. That ought to cheer critics of the proposal, and even dejected Clinton supports, concerned that her defeat will hamstring efforts at health care reform. If history is any guide, Obama's approach will prove far more politically feasible, and lead us to the same ultimate destination.
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