[Mb-civic] Can Mass. health plan go national? - Edwin Amenta - Boston Globe Op-Ed

[William Swiggard]

  Can Mass. health plan go national?

By Edwin Amenta  |  April 8, 2006  |  The Boston Globe

NOW THAT the Massachusetts Legislature has passed a law requiring health 
insurance, is this possible for the United States? It is worth asking, 
because innovative state action was the harbinger for America's most 
successful social reform -- Social Security, which passed in 1935 and 
covered almost all workers by 1950. Proponents of insuring the 45 
million Americans that remain uncovered can learn lessons from that 
earlier struggle.

It never happens that contentious reforms, once an innovator or two take 
the plunge, are simply seen as such good ideas that state after state 
will gladly adopt them. New York and California, as well as 
Massachusetts, passed innovative old-age programs in the early 1930s 
that compelled counties to participate, but many Southern and Midwestern 
states continued to drag their heels. If there is going to be health 
coverage for all Americans, the federal government will have to get 
involved.

But state-level action does matter in providing models and leaders. 
Franklin Roosevelt was governor when New York's landmark old-age 
legislation was passed, and he was committed to the issue when he was 
elected president in 1932. Representatives from California and 
Massachusetts provided congressional leadership to steer old-age 
proposals to passage.

Social Security also provided language that shielded politicians from an 
American public that can become hostile to government, even when public 
opinion is in favor of action. The makers of Social Security called the 
payroll taxes for the program ''contributions," making them seem like 
private insurance policies, and levied them on employers and employees 
alike, claiming that burdens were being shared. Roosevelt railed against 
the ''dole," which represented in the public mind the European approach 
to social policy.

The Massachusetts legislation provides similar political cover. By 
requiring individuals who can afford health insurance to buy it, the 
proposal emphasizes individual responsibility. By placing fees on 
businesses that fail to cover their workers, the proposal sanctions 
those not carrying their weight. A Massachusetts proposal writ large can 
be favorably contrasted to the highly complicated and much maligned 
Clinton health security plan of the 1990s.

It is also key, however, for mass-based political organizations to 
demand a more radical approach. Social Security would never have never 
gotten off the ground without the demands of the Townsend Plan, which 
organized 2 million older Americans into Townsend clubs that demanded 
far more generous treatment to retirees than Roosevelt and Congress 
offered. The Townsend Plan and other pension organizations also had 
supporters in Congress calling for universal, government-provided pensions.

Their analogues today include advocacy groups such as Health Care for 
All and others, like Senator Edward Kennedy, supporting the extension of 
the single-payer Medicare program down to younger Americans. As in 
Massachusetts, for America to solve the problem of health coverage 
religious organizations will have to press for an alternative, and, so, 
too, will labor unions and other groups with membership and clout like 
the AARP.

Unfortunately for Mitt Romney, the Massachusetts governor who hopes to 
ride the issue to the White House, if healthcare is going to run 
according to the Social Security playbook, he cannot lead the way. The 
governor is threatening to veto an uncontroversial $295 per employee fee 
on businesses who deny coverage to prove his antitax credentials to 
Grover Norquist and the Republican right.

But such a substantial governmental commitment will take some revenues, 
whether one calls them fees, premiums, or contributions, and can happen 
only if the Democrats return to power. Social Security was hashed out 
over 15 years during which only Democrats Roosevelt and Harry Truman 
occupied the White House, while former president Herbert Hoover and 
candidate Alf Landon were taking potshots from the outside. Too many 
Republicans today are tied to regressive tax-cut policies in the way 
that Hoover and his congressional supporters were.

That earlier Democratic run took more than a little luck. Though not 
entirely the fault of Hoover, the Great Depression discredited the 
Republican Party as whole, including its tax cuts and backward approach 
to social policy. Possibly the highly unpopular war in Iraq, the 
mishandling of Katrina, and the bribery and illegal fund-raising 
scandals will engulf the Republicans in a similar way.

It happened before. It could happen again.

Edwin Amenta, professor of sociology at University of California, 
Irvine, and New York University, is author of the forthcoming ''When 
Movements Matter: The Townsend Plan and the Rise of Social Security."

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/04/08/can_mass_health_plan_go_national/
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