Eric M. Patashnik and Julian Zelizer: Now the Real Health Care Fight Begins





[Eric M. Patashnik, a politics and public policy professor at the University of Virginia, is the author of “Reforms at Risk: What Happens After Major Policy Changes Are Enacted.” Julian E. Zelizer, a professor of history and public affairs at Princeton University, is the author of “Arsenal of Democracy: The Politics of National Security — From World War II to the War on Terrorism.”]

Many liberals are euphoric about Congress passing health care reform. When President Barack Obama signed the most ambitious social legislation since President Lyndon B. Johnson's Great Society, the tide seemed to have turned for the Democrats.

But this is not the end of the political struggle. Just the start of a new chapter.

While outright repeal of health care reform — as many conservatives demand — seems unlikely, there is no guarantee this reform will stick. Future Congresses could erode or undercut the law.

For there is a long history of major social legislation coming under attack post-enactment. New legislation, whether misunderstood or poorly designed, often can take several years to gain solid public support. Political sustainability is not automatic.

One of the Democrats’ most embarrassing moments involved the Medicare Catastrophic Coverage Act of 1988, which Congress repealed 16 months after adoption.

The reform was the biggest expansion of Medicare since its creation in 1965. It earned some of the same praise we hear today for Obama's health care reform.

But soon after passage, the public soured on it. When House Ways and Means Committee Chairman Dan Rostenkowski (D-Ill.) went home to his district, angry seniors surrounded his car in a parking lot. They were protesting new taxes that they believed they would have to pay.

The protesters screamed “Liar!” “Coward!” and “Impeach!” One elderly lady jumped on the hood of Rostenkowski's car as he and his driver tried to get away....

This reform is especially vulnerable because the public does not see it as a broad middle class entitlement and because its most generous subsidies won't kick in until 2014. The benefit backloading was one factor that helped undermine public support for Medicare Catastrophic Coverage Act.

In addition, as Henry J. Aaron and Robert D. Reischauer point out, the federal government is relying on state authorities (some of whom oppose the reform) to play a big role in the law's implementation. If the Republicans win the White House or Congress in 2012, look for the law's taxes and mandates to be significantly modified.

Supporters of health reform need to put the cork back in the champagne bottle and get back to work.

In the next few years, they must find ways to make the law more acceptable to a skeptical public, more workable and, most of all, more fiscally sustainable.

If they don't, their hard-won political victory could remain at risk.

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