I woke up New Year’s morning with a nervous stomach. It was finally 2012, the year that I’d been talking about casually since people started asking me, “will the Affordable Care Act survive?” As I wrote in the epilogue to my new book, Fighting for Our Health: The Epic Battle to Make Health Care a Right in the United States, health reform has to jump two big hurdles in 2012 to survive. The first is the Supreme Court ruling on its constitutionality, with three days of oral arguments in March now just a few weeks away. The second, of course, is the election for President.
On the campaign trail in Iowa, Rick Santorum baldly revealed why the right is so intent on killing the promise of good health care for all: Santorum said it would make people “dependent” on the government. As I write in my book: “The right understands that if the Affordable Care Act is implemented, it will create a bond between the American people and government, just as Social Security and Medicare have done. The last thing that the corporate and ideological right want is for a new health care pillar to be added to the foundations of government social insurance.”
The battle over the Affordable Care Act needs to be understood in its historic context. While the legislation that passed was certainly compromised from an ideal law, it will for the first time – when its key measures are implemented in 2014 -establish a government responsibility to make decent health care affordable to almost everyone. Following a century of failure, during which the United States emerged as the only developed nation to guarantee health care, the passage of the ACA needs to be understood as a remarkable accomplishment.
That history weighed over the battle that began in 2008, when I helped found Health Care for America Now (HCAN), a coalition that as health care historian Paul Starr told me, was the first time that there was a major grassroots, field campaign to pass reform. Fighting for Our Health is the story of that campaign, starting from its early roots in 2003, when Yale professor Jacob Hacker (pdf) and I (pdf) separately developed a new policy approach, the public option. We each envisioned the public option as a way to bridge the gap between those who championed single-payer government health insurance and reforms based on expanding private health coverage. As I write: “It is impossible to overstate how important the idea of the public option was to creating the powerful unified coalition that became HCAN.”