Article   |   Volume 159, Issue 6

Convicts and Convictions: Some Lessons From Transportation for Health Reform

David A. Hyman

June 2011

It wasn’t supposed to go this way. The Democrats had taken both houses of Congress in 2006 and the presidency in 2008. With a
filibuster-proof majority in the Senate and a sizeable majority in the House, the decades-long road to Democratic delivery of comprehensive health reform had finally come to an end (along with conservatism and the Republican party). President Obama had promised to deliver health reform—although he allowed that if you liked your existing arrangements, you could keep them. Polls indicated that Democrats had maintained their traditional edge over Republicans in public trust to handle health care. Pharmaceutical companies and insurers had been bought off or intimidated into silence, ensuring there would not be a repeat of the “Harry and Louise” commercials that helped sink the Clinton health reform effort. The path to success was clear, as long as the Administration let Congress write the bill. Once Congress enacted the Patient Protection and Affordable Care Act (PPACA), Democrats would receive the thanks of a grateful nation, and their electoral dominance would be assured. The only real question was whether to include a public option to placate the left; everything else appeared to be a done deal.

Reality intruded, as it always does. The enactment of PPACA was an excruciating and extended process, with twists and turns that a novelist would have been embarrassed to include in a work of fiction. Former Senate Majority Leader Tom Daschle, the President’s first choice to lead the Department of Health and Human Services and run the health reform effort, was forced to withdraw his nomination after it emerged that he had underpaid his taxes by more than $100,000. Opposition to PPACA led to loud and rancorous public meetings between legislators and their constituents during the summer of 2009. Opponents accused proponents of lying about whether people could keep their health care coverage and whether PPACA would cut Medicare; proponents accused opponents of lying about “death panels” and the “government takeover” of health care. The “public option” was in, then out, then (maybe) back in again. Medicare for the near-elderly was in, then out. Convicts and Convictions: Some Lessons From Transportation for Health Reform -