Back in 1883, the authoritarian and imperial government of Prince Otto von Bismarck--he whose most famous sentence is "It is not by speeches and majority votes that the great issues of our time will be decided, but by blood and iron--the Chancellor of the German Empire, established universal and national health insurance for Germany.
The reasons to have national health insurance are as clear now as to Prince Otto more than a century ago: The success of a nation--whether that success is measured by the glory of its Kaiser, by the expansion of its territory, by the security of its borders, or the well-being of its population rests on the health of its population. Serious illness can strike anyone. Seriously ill people, as a rule, don't make very much money. The longer the seriously ill are untreated the more costly does their treatment and maintenance become. Private savings, as a rule, can pay the costs of treatment only for the thrifty and previously well-off. Unless, therefore we adopt the view that the seriously-ill without ample savings should quickly die and so decrease the surplus population, a country with national health insurance will be a wealthier and more successful country. These arguments were entirely 1sza`convincing to Prince Otto. They are equally convincing today.
On January 1, 2014, the popular and democratic government of the United States will establish not national health insurance but rather partially implement a law--the Affordable Care Act--and so, the Congressional Budget Office projects, reduce the number of people in the United States without health insurance by roughly one-half. Back in 2009 President Barack Obama could have proposed a program as comprehensive as Prince Otto: allow and encourage and make it affordable for uninsured Americans to get the health insurance that the members of congress have, the FEHBP; or simply expand Medicare to cover all. Instead, he put his weight behind the--complicated--ACA. Why? Because, it was then explained to me back in 2009, the core of the ACA was identical to the plan that mid-2000s Massachusetts Governor Mitt Romney had proposed and signed: ObamaCare was RomneyCare with a new coat of paint and with the VIN number filed off. Since Mitt Romney was in 2009 the heir-presumptive to the Republican Party's presidential nomination, few Republicans would be able to vote against what was their next presidential candidate's signature initiative, the ACA would pass congress by acclamation with very healthy and bipartisan majorities, and President Obama would thus show that he could transcend Washington's partisan gridlock.
We know how that worked out.
Not a single Republican vote for the Affordable Care Act in the House of Representatives. One Republican Senator--Susan Collins--voting for it in committee, but then switching sides and not just voting against it but going beyond and trying to kill it via filibuster on the floor. Mitt Romney refusing to recognize his bill then and refusing to recognize his program now, just like he would refuse to recognize his horse Rafalca when it competed in Dressage in the 2012 Olympics.
But now, come January 1, 2014, the Affordable Care Act gets implemented. Or, rather, it gets implemented from the Potomac River up north to Campobello Island and the Great Lakes, over to the Strait of St. Juan de Fuca, and down to the Gulf of California, plus some other places--New Mexico, Colorado. Elsewhere, in the south, along the prairie, Republican legislators refuse to answer constituents' questions as to how to negotiate the new, changed bureaucracy; refuse the federal dollars earmarked to expand their state-level Medicaid programs; and refuse to lift a finger to implement the "marketplaces" that are supposed to give individuals and small businesses the same access to health insurance at competitive prices that employees of large businesses get via their companies' benefits departments. In the "blue states"--where 60% of the country's population making 70% of the nation's income and owning 80% of the nation's wealth live--the implementation of the Affordable Care Act is likely to be like the implementation of RomneyCare was in Massachusetts: a somewhat bumpy ride, but a clear success that nobody wishes to repeal after the fact. In the "red states" where the Republican political infrastructure digs in its heels? Who knows?
What will the doctors and hospital administrators of Phoenix, Kansas City, Houston, Atlanta, and Miami do after they talk to their colleagues in places--Los Angeles, Seattle, Minneapolis, Chicago, Baltimore, New York--where the state government and political structure did try to make ACA implementation a success, compare and contrast, and think? What candidates will they contribute to and vote for in the elections of 2014 and 2016? What will the nurses and the patients do?
The partisan heat in America is about to be turned up from 9 to 11 over the next several election cycles, as the blame game begins.