What Social Security Can Teach Us About the Future of Health Care

Americans will learn to love health care reform, just as they did Social Security, if it’s made to work for all of them.

Fight disinformation: Sign up for the free Mother Jones Daily newsletter and follow the news that matters.


At the heart of the right-wing attack on the new health care law’s individual mandate is the fact that law has the potential to become like Social Security, a popular entitlement that is an integral part of the American social fabric. Whether that promise is realized depends on no small measure on whether Congress will make improvements over time in the health care law to assure that health coverage is affordable.

If Social Security was the crowning achievement of the New Deal, health care was its greatest missed opportunity. FDR decided not to include health insurance in the retirement insurance measure for fear that opposition by the American Medical Association would end up sinking the whole package. Now 75 years after Social Security became law, the nation has finally enacted a legal promise to make health coverage affordable. It’s worth taking a look at the trajectory that Social Security took after its passage in order to understand the biggest challenge facing the health care law.

The history of Social Security after it became law was a great comfort to those of us who watched as the health care bill was continually weakened during the Congressional debate. It’s easy to forget now just how limited Social Security was when it first was enacted. The Act included meager payments to a limited set of workers and left out job categories that included most women and minorities. The NAACP said that it was “a sieve with holes just big enough for the majority of Negroes to fall through.” However, over the next 15 years Social Security was expanded to include surviving spouses and dependent children. Jobs that were dominated by women and people of color were added. The miserly benefits were enhanced over time too but it wasn’t until 1972 that cost of living adjustments became automatic.

Despite its original weaknesses, as Social Security was implemented an increasing number of Americans felt like they owned it and would benefit from it.

While unlike Social Security, the Affordable Care Act is not a social insurance program in which everyone is covered under one program, it does have features that will make it feel more like a social insurance program than is obvious at first glance. To start with, every legal US resident will be required to get coverage, either at work or through government subsidized insurance. People who are poor or near poor will be covered by Medicaid. Millions of low-and-middle-income people who don’t get coverage at work will be eligible for income-based subsidies from the federal government to buy health insurance, collected through the IRS. As the system is implemented and becomes familiar, it will become expected that everyone will get health coverage and that the government will either provide it or pay for a portion of the coverage. When the subsidies and mandates kick in, starting in 2014, millions of people will have a new government benefit, creating a popular new entitlement. No wonder the right is pushing hard now for repeal.

The rightwing attack on the new law is focused on the individual mandate, which exposes the law’s biggest shortcoming. While for most people the subsidies will enable them to afford health coverage, there will be some middle-income people who will be required to pay more they than they can afford in premiums, even after receiving a subsidy. As a result, there will be political pressure on Congress to improve the subsidies, as people are required to pay high premiums or pay a fine (and still remain uninsured).

If Congress responds by improving the subsidies so that all families can afford the mandated coverage, then the Affordable Care Act will realize its promise of close to universal coverage and will come to enjoy broad popular support. The need to finance affordable subsidies is also likely to drive other potential improvements in the law, including money-saving measures that would challenge the role of private insurers, such as greater reliance on integrated health delivery systems and establishing a public health insurance option.

If instead, Congress keeps in place requirements that some families pay more than they can afford for coverage, there may be a backlash against the law. Under these circumstances, Congress will feel pressure to end the individual mandate as over time, as more and more families could again see health coverage priced out of their reach.

My bet is that when the time comes, Congress will act to be sure that all families can afford coverage. Doing so has a clear political advantage, increasing the number of Americans who feel that government is delivering a benefit that is essential to their well being. Just like Social Security.

As we look back at 75 years of Social Security from the vantage point of year one of health care reform, history teaches us to be optimistic that we can build on a modest beginning, if we keep fighting to improve what we’ve started.

This story first appeared on the New Deal 2.0 website.

AN IMPORTANT UPDATE

We’re falling behind our online fundraising goals and we can’t sustain coming up short on donations month after month. Perhaps you’ve heard? It is impossibly hard in the news business right now, with layoffs intensifying and fancy new startups and funding going kaput.

The crisis facing journalism and democracy isn’t going away anytime soon. And neither is Mother Jones, our readers, or our unique way of doing in-depth reporting that exists to bring about change.

Which is exactly why, despite the challenges we face, we just took a big gulp and joined forces with the Center for Investigative Reporting, a team of ace journalists who create the amazing podcast and public radio show Reveal.

If you can part with even just a few bucks, please help us pick up the pace of donations. We simply can’t afford to keep falling behind on our fundraising targets month after month.

Editor-in-Chief Clara Jeffery said it well to our team recently, and that team 100 percent includes readers like you who make it all possible: “This is a year to prove that we can pull off this merger, grow our audiences and impact, attract more funding and keep growing. More broadly, it’s a year when the very future of both journalism and democracy is on the line. We have to go for every important story, every reader/listener/viewer, and leave it all on the field. I’m very proud of all the hard work that’s gotten us to this moment, and confident that we can meet it.”

Let’s do this. If you can right now, please support Mother Jones and investigative journalism with an urgently needed donation today.

payment methods

AN IMPORTANT UPDATE

We’re falling behind our online fundraising goals and we can’t sustain coming up short on donations month after month. Perhaps you’ve heard? It is impossibly hard in the news business right now, with layoffs intensifying and fancy new startups and funding going kaput.

The crisis facing journalism and democracy isn’t going away anytime soon. And neither is Mother Jones, our readers, or our unique way of doing in-depth reporting that exists to bring about change.

Which is exactly why, despite the challenges we face, we just took a big gulp and joined forces with the Center for Investigative Reporting, a team of ace journalists who create the amazing podcast and public radio show Reveal.

If you can part with even just a few bucks, please help us pick up the pace of donations. We simply can’t afford to keep falling behind on our fundraising targets month after month.

Editor-in-Chief Clara Jeffery said it well to our team recently, and that team 100 percent includes readers like you who make it all possible: “This is a year to prove that we can pull off this merger, grow our audiences and impact, attract more funding and keep growing. More broadly, it’s a year when the very future of both journalism and democracy is on the line. We have to go for every important story, every reader/listener/viewer, and leave it all on the field. I’m very proud of all the hard work that’s gotten us to this moment, and confident that we can meet it.”

Let’s do this. If you can right now, please support Mother Jones and investigative journalism with an urgently needed donation today.

payment methods

We Recommend

Latest

Sign up for our free newsletter

Subscribe to the Mother Jones Daily to have our top stories delivered directly to your inbox.

Get our award-winning magazine

Save big on a full year of investigations, ideas, and insights.

Subscribe

Support our journalism

Help Mother Jones' reporters dig deep with a tax-deductible donation.

Donate