- By David RothkopfDavid Rothkopf is visiting professor at Columbia University's School of International and Public Affairs and visiting scholar at the Carnegie Endowment for International Peace. His latest book is The Great Questions of Tomorrow. He has been a longtime contributor to Foreign Policy and was CEO and editor of the FP Group from 2012 to May 2017.
If the health care legislation passed in Washington over the weekend is a watershed, it is not for the reason you may think. It’s not because it is such a big piece of social legislation or because it represents such a big victory for President Obama. Both conclusions come with caveats — either about what and who was not addressed by the legislation or about the political fallout from the ugly process that created this important but imperfect band-aid on America’s broken health care system.
No, the reason the health care reform bill is important is not because it was the first major such piece of social legislation in the U.S. in decades, but rather because it represents the first in what will become by necessity an on-going series of efforts to fix deep and serious defects in the American economy. In a decade or two, this legislation is like to be seen by Americans as the beginning of a lengthy, brutal and spasmodic process to cut deficits and restore America’s leadership prospects in the global economy.
Health care is 20 percent of the U.S. economy and growing. It is linked to the part of the U.S. government’s obligations that are expected to explode in the next decade and create mountains of debt that make those accumulated in the past few years look small by comparison. The inability to pay the bills that will come due, the inefficiency in the system, the drag the current system is placing on U.S. competitiveness — all will demand that this is bill number one in a long series of efforts.
The Republican Party, which has discredited itself more with its stance on this bill than on any other of its signature initiatives since the McCarthy era (and I include the wrong-headed Iraq War on that list), will define whether it is relevant going forward by whether it moves from a brainless position of "oppose" and now "repeal" to one of seriously seeking meaningful solutions to this fire in the engine room of the U.S. economy. (Their mendacity and mean-spiritedness, their deviousness and hypocrisy throughout have been stunning. Do they really want to be known as a coalition of the stupid, the greedy and the uncaring? That’s the message being offered by the Boehner-McConnell-Teabagger team.)
But let’s look past the recent debate in Washington and toward what the global implications of this are. If America doesn’t fix the health care problem as an aging, deficit burdened society, the country will watch its financial resources dwindle and those we have be siphoned into essential but costly social programs. This bill is a step in the direction of acknowledging the problem, addressing some grotesque social wrongs perpetrated by the current system and edging toward some slightly enhanced efficiency. Future legislation will have to make real headway at cutting deficits by increasingly cutting out the middlemen (insurance companies) we can’t afford and by enhancing savings through greater efficiency. Changing the retirement age, limiting certain extremely expensive procedures and adding taxes will also be among the unpopular essentials of this process… and you can guess which party will take the lead with each.
The process is akin to reinvesting in infrastructure, changing our energy paradigm and revitalizing our educational system in terms of the basics of making America competitive again. Heck, these changes are essential to making America viable for the long-run. So while it is tempting to breathe a sigh of relief that with some luck the shouts of "baby killer" are behind us, Americans and those interested in what will be preoccupying the U.S. government for the next several decades ought to see this legislation not as the end, nor as the beginning of the end but perhaps, in the words of Churchill, as the end of the beginning — although if the next stages of these reforms don’t ultimately come, then Churchill will be paraphrased and the beginning of the end it will have been.