http://yglesias.thinkprogress.org/archives/2009/08/yesterdays-compromise-is-tomorrows-triumph.phpYesterday’s Compromise Is Tomorrow’s Triumph
Matthew Yglesias
Ed Kilgore makes the excellent point that what look today like the great progressive legislative triumphs of yesteryear look more like squalid and disappointing compromises at the time they were enacted:
As for Medicare and Medicaid, the idea that LBJ came up with a bold set of proposals and ram-rodded them through Congress is wrong by all sorts of measurements. It’s important to understand that however important these health care entitlements became, they were at the time clearly major compromises from the progressive commitment, first articulated by Harry Truman, to enact national health insurance. Medicare, obviously, was offered only to retirees, not all Americans–a distinction that is cherished as a matter of principle by those Medicare beneficiaries who today oppose universal health coverage. Medicaid was even more of a compromise, eschewing national health coverage for a crazy quilt system in which the states would largely determine eligibility and benefit levels, with coverage generally limited to low-income families with children.
Medicare and Medicaid also did not spring fully formed from LBJ’s head or his White House, and weren’t enacted via royal disdain for Congress and the petty fiefdoms of the committee system. Federal health insurance for retirees was narrowly defeated in the Senate in 1960 and in 1962. It finally passed the Senate in 1964, only to succumb in the House when Democratic Ways and Means Chairman Wilbur Mills refused to support it. It was finally enacted in 1965, but only after Mills shaped the legislation, and also added Medicaid, intended as a sop to Republicans and the AMA, which had long proposed health care subsidies for low-income families as an alternative to national health insurance.
One point here is that substantive policy outcomes are highly influenced by America’s political procedures. There was almost certainly enough progressive sentiment in public opinion and congress in the first half of the 1960s to have enacted a real national health plan if we had a system with fewer veto points. But thanks to the large number of veto points—sometimes you lose in the Senate, sometimes a powerful committee chairman beats you—the opportunity couldn’t be seized. Had we enacted universal health care in the 60s, Ronald Reagan would have no more undone it in the 1980s than he undid Medicare. But we didn’t. So you reach our present situation.
The other point for today is that
you need to judge legislative outcomes relative to the status quo, not relative to what you enact in utopia. Medicare & Medicaid (especially the very stingy version of Medicaid that was initially created) were really pretty pathetic compared to what Harry Truman proposed. But they’ve done enormous good for a lot of people over the decades.
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