AHA Roundtable

The Battle over Health Care Is Not Over

Alan Brinkley, July 2012

Having prepared comments on the demise of the health care bill, I am happily surprised that the Court has sustained it. Over the months of waiting, I had thought that the only conservative justice who might support the bill would be Kennedy. Roberts seemed to be a long shot. In many ways, Chief Justice John Roberts’s vote—so surprising at the time—is much like Justice Owen Roberts’s votes on U.S. v. Butler and West Coast Hotel v. Parrish in 1935 and 1936, which supported the commerce clause in much the same way John Roberts did this week. Perhaps what made the chief justice support the bill might have been that striking it down could not only end the health care law but many other efforts that could be struck down in many other laws—with the possibility of returning to something like Lochner

Obama’s bill is, I believe, good for the country. Millions of Americans who have had no reliable health care will now be more secure. At least eight presidents have tried to create universal health care, and it’s remarkable that the least experienced president in decades has achieved it.

But the battle over health care is not over. President Obama created this law to his great credit, but he then ignored it, allowing the conservative opposition to describe it as a socialist takeover of the medical world. The bill itself is vast and complicated, and it is not surprising that most Americans have very little idea about what the bill means. But for two years, the president and other supporters of the health care law did virtually nothing to help explain what the bill would do. Instead, they left the description of the bill to conservatives who oppose it. No wonder that a majority of Americans—most of whom have little understanding of the bill—want the bill to be struck down. And it is no surprise that the Republicans are committed to repeal it.

For most of modern American history, medical care has been unevenly provided. For many years, only Lyndon Johnson had been able to create universal health care—but only for the poor and the elderly. Other presidents, beginning with Bill Clinton, have worked to ensure that all children would receive health care, and that effort is mostly successful. What makes “Obamacare” so controversial is to a large degree the newness of universal health care and the fear of the unknown. But everyone knows that health care in the U.S. has been changing dramatically with or without the government, and this bill should at the least impose some fairness in the process.

The Obama administration has had a great victory. But this time, it should not let the right characterize the bill. Instead, it should do what it should have done in 2010—enthusiastically support the bill and explain it to a nation that wants and needs health care.

—Alan Brinkley is the Allan Nevins Professor of American History at Columbia University.