Biden’s big win came from a long policymaking tradition
Incrementalism doesn’t excite activists—but it’s how health-care systems are built
President Joe Biden is finally on a winning streak.
He and his congressional allies have either passed or are on the verge of passing several major pieces of legislation. The health-care provisions are a case in point. The prescription drug measures and insurance subsidies will make a difference in the lives of many Americans, but they do not fundamentally change a health-care system that is inefficient, expensive and inequitable. They are also more limited than the proposals in the original Build Back Better bill, which included new Medicare benefits, increased Medicaid coverage for postpartum care and premium subsidies for those whose states did not expand Medicaid as allowed under the ACA. The bill also subjected a wider range of prescription drugs to price negotiations.
The history of health-care policy, however, suggests that this is how change usually happens in this area—not only in the United States but around the world.
Not that liberal leaders haven’t tried for sweeping reforms.
For decades, U.S. presidents have labored to transform the health-care system. Franklin D. Roosevelt did not include national health insurance in the 1935 Social Security Act because he feared that opposition from doctors might defeat the entire bill. But Harry S. Truman picked up the baton, twice proposing such legislation, only to see the leading physicians’ organization, the American Medical Association, mobilize in exactly the manner Roosevelt had feared.