Preface to the Post-ACA Edition of Seeking Justice in Health Care
The 2010 Historical Context
Not all moments in history are equally ripe for change. The devastations of war and economic depression historically have led to the most significant changes in how societies see themselves and how they operate.
The recession that began in December 2007 has been the most severe economic downturn since the 1930s. Our national leaders implemented rescue plans and stimulus packages of a scope and size unimaginable even a few years ago.
In the 1930s, health care spending was approximately 1/30th of the national economy. Now it is one-sixth. On a sustained basis, it is impossible to fix the economy without fixing health care.
While health insurance had been initiated in Europe as early as the late 19th century, it took the Great Depression for it to take root in the United States. The current recession offered an opportunity to take additional major steps towards creating a health care system that is efficient, effective and equitable – one that provides everyone in America needed health services at a cost that can be afforded individually and collectively. The 2008 election was a mandate for change, not only in particular policies, but in our national culture and in how we see ourselves as a people.
The 2009-2010 battle over health care was a monumental political, policy and financial struggle. President Obama learned the lessons of President Clinton’s failed effort and insisted that the legislation be crafted in Congress. The Republicans sought to repeat their political success of 1994 through a “just say no” strategy. The financial crisis and budget deficits presented obstacles to major new public spending on health care.
What emerged was an omnibus bill, a complex package consisting of hundreds of separate yet often interlocking pieces. The signal accomplishment was health insurance reform – a reduction in the number of uninsured to less than 5% of the population. Health care delivery reform to improve value and constrain the growth of costs, was handled more indirectly and is less assured of success. Deliberation in health care over its nature and purpose, over the distribution of costs and benefits, and over its size in the economy will be ongoing.
The complex health insurance and health care reform law that passed in March 2010 was an important step that provides major opportunities to make progress. But the ongoing opposition to reform, the widespread misunderstandings about the law, and the movement of the law through legal challenges, demonstrate that there still are many challenges and obstacles in the path.
This Guide is offered as a resource to help answer the difficult questions and to help us make the best decisions as we move forward with the implementation of the Affordable Care Act ad continue to seek justice in health care in the United States.