The Future of Health Care

The health care bill that President Obama signed into law on March 23, 2010 is the signature achievement of his administration to date, and the legislation’s policy aftermath and political fallout will have much to do with defining his legacy. Just days after the bill became law, congressional Democrats began to realize for themselves what the great majority of the country had been trying to convey in town-hall meetings, in letters and phone calls, in rallies and marches: that the bill does not do what it promises to do, that it is irresponsibly expensive, and that it harms much of what’s best about American health care.

Conservatives aim to unravel Obamacare. New Atlantis senior editor Yuval Levin has made the case in the pages of the Weekly Standard for repealing the legislation before it fully kicks in, as has our contributing editor James Capretta in National Review. And elsewhere in this issue of The New Atlantis, David Gratzer argues that, even before it becomes possible to undo the new law in its entirety, conservatives should attempt to pick away at its worst policy mistakes.

The long fight over health care has already transformed American politics. Conservatives and libertarians are reenergized; droves of self-declared independents have fled the Democratic Party; and Republican policymakers are becoming reacquainted with the moral and fiscal arguments for small government and free markets. If the pollsters and prognosticators are right, the prospects for this November’s midterm elections look grim for the Democrats, with the loss of at least one chamber of Congress a very real possibility.

But if Obamacare is left intact, its effects on American political life will extend far beyond this election season and the one after. In a speech about health care before Congress in September 2009, President Obama said that “I am not the first president to take up this cause, but I am determined to be the last.” That is unlikely. The experience of other countries makes clear that the more involved government becomes in citizens’ health care, the more the issue becomes a fixture in political life. In some countries it has become the dominant issue in domestic politics — as in the United Kingdom, where the National Health Service is forever in need of reform, where Members of Parliament can win or lose elections because of the number of hospital beds in their constituencies, and where the quality and cost of medical treatment are perennial matters of national debate.

The new legislation does not socialize American medicine as thoroughly as British medicine has been, but it does set in motion a series of changes that will undermine the U.S. private health insurance industry, making almost inevitable the eventual rise of a fully public system. It endangers not just the strength of American health care but also the health of the body politic — unless it can be dismantled before it takes effect.