Obama didn’t “have” to do health reform. It wasn’t in his in box. A historic economic collapse was. He could have devoted himself exclusively to economic crisis management. (Though even if he’d done that, it’s not clear the recovery would be further along. After all, the Republicans blocked the sensible infrastructure investments in his Jobs Act a year ago that would have left 1 million more Americans working today — and unemployment at 7.2 percent, not 7.9 percent).
But Obama took the longer view. He knew U.S. health care was a scandal, with outsize costs and 50 million people uninsured. Now, thanks to the president’s reelection and the certainty that the law will be phased in by 2014, everything will change.
For the first time, Americans will have guaranteed access to coverage at group rates outside the employment setting. This fact got zero discussion in the campaign, but it’s impossible to overstate its significance. We’re the only wealthy nation where such access isn’t the case today. It’s been bad for people and disastrous for entrepreneurship (because budding entrepreneurs routinely stay in jobs they dislike in order to keep health coverage if there’s illness in their family).
The status quo has been bad for business, which carries the cost of health care on its payrolls. It’s also been bad for workers, because the cash devoured by employer-paid health premiums would otherwise be available for higher wages.
With Obama’s reelection, the great hope now is that in the years ahead, as politicians and business leaders in both parties realize that the new insurance exchanges are a safe and sensible way for folks to get coverage, more Americans will be allowed to migrate to the exchanges, with sliding-scale subsidies for those who need help to buy decent policies.
Everyone needs to realize that this development would be terrific — good for people, good for business, good for the economy. Republicans have talked inanely about people at risk of being “dumped” into the new exchanges, when in fact private plans will be offered exactly like those employers have offered, except that people will have many more choices.
Smart employers see this trend coming and know it makes sense. When I spoke to an audience of human-resource executives not long after Obamacare passed, I polled the audience on what it expected. Today about 20 million people get coverage outside the job setting (not counting folks on Medicare and Medicaid). What would that number be in a decade, I asked. 20 million? 40 million? Or 100 million? Most said 100 million — which would obviously represent a dramatic shift in so short a time. It may be a threat to the benefits empires these folks run for their companies, but it represents huge progress for the country.