Health Care!

President Obama, last night:

In the end what this day represents is another stone firmly laid in the foundation of the American dream. Tonight, we answered the call of history as so many generations of Americans have before us. When faced with crisis, we did not shrink from our challenges. We overcame them. We did not avoid our responsibilities, we embraced it. We did not fear our future, we shaped it.

A few thoughts.

Couldn't they have thought of a better name for the bill than "Amendments to the Internal Revenue Act of 1986"? Perhaps the "Edward Kennedy Memorial Health Care for All Americans Act"?

The man behind me on the train this morning was scanning the headlines of his newspaper, saying, "premiums will go up, taxes will go up, benefits will go down . . . and yeah, right, we're going to save money. Huh." That is, I thought, a perfect expression of the American cynicism that has dogged all government initiatives for decades. There is in America an abiding suspicion that every government action will enrich a few insiders, provide jobs for a few thousand bureaucrats and screw everyone else, if it does anything at all.

Maybe he is right, and this bill will be an expensive boondoggle. That depends, of course, on how future administrations run it and future Congresses amend it. I am optimistic. The bill is not some radical utopian scheme. It is pretty much the same system Clinton proposed in 1993, so experts of every party have had decades to ponder all its ramifications. It is very much like the arrangements in place in Switzerland and similar to those in Germany and France. Health care in all those countries is better and cheaper than in the US. That is one reason for optimism -- the American health care system is so expensive and so screwed up that there is a lot of room for improvement.

Despite what you sometimes hear, our government does a lot of things well. Social Security is hugely popular and has a very low administrative overhead cost. Medicare is hugely popular. The National Weather Service is the best in the world. The National Park System remains the model for a worldwide movement to protect the earth's most beautiful places. Etc. There is no reason to assume that the health care exchanges will not be run well.

I am excited by this bill, because I think that everyone should have access to affordable health care, and because I think we need to get to work in a serious way to reform how we deliver medical care. I think this bill will make that easier. But I am even more excited because the passage of this bill means that it is still possible, sometimes, to do big things in America. It is still possible to do something that will help poor people. It is still possible to pursue justice, not just profit and leisure. I feel optimistic today about the future of my country.