When President Obama decided to make health care reform the first major battle of his fledgling presidency, it left many politicos scratching their heads. With the economy in the gutter and two wars still ongoing, many people asked, "Why waste the political capital? Why not wait until his second term, when the economy will be stronger and he won't have to worry about reelection?" The reason is simple. President Obama made a clear statement: In America, our commitment to community is what makes us the greatest country in the world, and, being the greatest country in the world, it was unacceptable that we had 46 million Americans without access to health care.
The Affordable Care Act, or Obamacare, as it is known by supporters and detractors alike, is a monumental accomplishment, but not simply because of the legislative hurdles involved, or even because health care itself is such a major issue. Obamacare is a legacy accomplishment in the same way that FDR's creation of Social Security is a legacy accomplishment. In both programs we have a system meant to grow and last through generations, one that is meant to be built upon, and one where the country must come together for it -- and us -- to succeed. Obamacare declares that we, as a whole society, have an obligation to each other, and that by meeting that obligation, we are stronger as a country. This is a commitment to the value of community.
Social Security lifted millions of seniors out of poverty generations before mine and can continue to do so generations from now, but the Social Security program that FDR signed into law is not the same Social Security program that we rely on today. Notable additions over time have included survivors benefits in 1939, disability benefits in 1956 and the COLAs in 1975. We established a level of decency underneath which no American should fall, and we did it all together. Social Security created an intergenerational compact, one where one generation of Americans says to another, "You worked hard to build this country into what it is, you made it a success, and I benefit from it. Now I will work to make sure that you enjoy the retirement you deserve. And later, when I have worked all that I can, the generation that follows me will pay it forward."
What does this all have to do with President Obama and health care? Under FDR, the number of seniors living in poverty proved to be a major problem facing the United States, so he recommitted the country to community and found a solution. President Obama showed the same kind of leadership in the passage of Obamacare.
And I say this as someone who was unreservedly critical during the formation of the law. As many of us in the progressive community did and still do, I think the law needs work. We wanted, and still want, more. Just as Social Security had to evolve, it is clear that Obamacare will have to change over time to be an effective reform of the health care system. There's no question that the passage of Obamacare is a huge legislative accomplishment. The question facing Obama's political legacy is whether or not Obamacare will be remembered as the law that was the first step in creating universal health care -- a legacy accomplishment -- or as the bill that temporarily bailed out the insurance companies.
For his legacy to be cemented over the next few years, President Obama will have to work to ensure that Obamacare is ready to grow and evolve just as Social Security has. So what action can he take now to make that a reality?
First and foremost, he and his administration must work with the states to innovate new ways of implementing Obamacare that take power from the insurance companies and move it into the people's hands. Next, he cannot act as though this law is finished; instead, he must work with leaders in Congress to protect and expand Obamacare and ensure that we elect congressional leaders in 2014 who will fight for patient first, even if that means reforms to the law. Finally, the changes coming to Medicare over the last few years of his administration will dictate whether we move toward a more universal health care system or one dictated by the insurance companies.
In taking on health care reform President Obama made a very clear statement that community is an American value. It is how he chooses to defend and expand Obamacare that will dictate whether he is remembered for his commitment to community or to the special interests of Washington.
This blog post is part of a series produced by The Huffington Post that closely examines the most pressing challenges facing President Obama in his second term. To read the companion article by HuffPost's Jon Ward, click here. To read the companion blog post by John Sides of the George Washington University, click here. To read all the other posts in the series, click here.