As pundits and the public eagerly await the Supreme Court’s ruling on the constitutionality of the Affordable Care Act – aka ObamaCare – it’s worth pondering how a nation mired in a debt crisis and an economic recession has become embroiled in a political fight that addresses neither problem.
This quandary is all the more puzzling because polls show that half the country, including nearly 40 percent of Democrats, opposes all or part of the health care law. But then, popular appeal was never a factor in ObamaCare's passage. When President Obama assumed office, public opinion and a strong bipartisan consensus held that the economy was the primary issue facing the country. Deaf to the national mood, the president instead declared that “we can no longer afford to put health care reform on hold.”
Then as now, Obama's choice seems to defy logic. In fact, it is less surprising than it may seem that from the get-go Obama made expanding government’s role in health care a top legislative priority – even as the ailing economy was paramount for most voters. As we show in our just published book, "The New Leviathan," what seems like a case of profoundly misplaced priorities is really a tribute to the disproportionate capacity of the champions of universal health care on the left, backed by the financial might of progressive foundations, to bring their agenda to bear at the national level.
President Obama was not the first to pursue universal health care, but before him those efforts had always failed politically.
In 1945, President Harry Truman proposed a sweeping “economic bill of rights” that included a right to universal health-care coverage but was repeatedly rebuffed by Congress.
The late Ted Kennedy took up the issue in the 70s, deeming health care “a fundamental right and not just a privilege,” but his ambitious plan to make health care a universal government benefit failed to win the support of even liberal stalwarts like Jimmy Carter.
Most recently, Hillary Clinton almost singlehandedly engineered a Republican takeover of the House in 1994 after her secretive attempt to push through a 1,367-page bill that would have forced all Americans to purchase health insurance and socialized one-seventh of the economy, galvanized a popular backlash.
Because these efforts to pass universal health care met with repeat failure, many failed to notice that even as the left's agenda stalled in Congress it won an important constituency: tax-free progressive foundations.
In 1989, the Ford Foundation published a report called "The Common Good: Social Welfare and the American Future" concluding that “The national goal should be universal health coverage for all Americans.” The Rockefeller Foundation announced that it working to “support the transformation of health systems toward universal health coverage.” The Tides Foundation described universal health care as one of the organization’s “fundamental principles.”
Perhaps most influential was the Robert Wood Johnson Foundation, the largest philanthropy focused exclusively on health care. Long a backer of universal health care coverage, the foundation spent millions in the 90s backing state and national efforts to pass legislation expanding government-provided health care and even sponsored community forums in which Hillary Clinton promoted her health-care plan—this despite being ostensibly nonpartisan. Such was the foundation's financial influence on the health care debate that by 1995 it alone accounted for almost 45 percent of all giving in the area of health policy in America.
While that was not enough to purchase the passage of HillaryCare, the left learned an important lesson. Massive expenditure of funds on health care advocacy could keep universal health care in the national discussion even when there was no national support for it. The realization gave rise to a series of single-issue political coalitions funded by foundations and advocating for universal health care legislation – with lasting consequences for health care policy.
The most successful of these coalitions was Health Care for America Now (HCAN). Created shortly after Obama won the Democratic nomination in July 2008, HCAN's twenty-one-member steering committee included such left-wing groups as ACORN, the Center for American Progress, MoveOn.org, the National Council of La Raza, and the Center for Community Change. Those groups in turn enjoyed the support of the leading left-wing foundations, ranging from the well-known Ford Foundation to health-care-focused funds like the Annie E. Casey Foundation and the David and Lucile Packard Foundation. Though its members groups were sustained by millions in foundations' grants, HCAN styled itself as a "grassroots" campaign -- this even as it pledged to spend $40 million to make health-care reform a reality.
Amplifying HCAN's voice on health care was its alliance with public sector unions like the Service Employees International Union, the American Federation of State, County and Municipal Employees, and the United Food and Commercial Workers union.
This was a novel development in American politics, since unions hadn’t always supported health care. Labor leaders like Samuel Gompers, the legendary head of the American Federation of Labor, opposed mandatory health insurance on the grounds that it was “paternalistic and repugnant.” But as unions’ membership dwindled, they came to see government's involvement in health care as a lifeline that would turn health care workers into government union members while maintaining their generous pay and benefit packages.
HCAN thus represented a tremendous arsenal of financial resources -- and it used it to its advantage. HCAN launched a media campaign urging health care reform that included a $1.5 million ad buy in national print, online, and broadcast media, all part of an eventual $25 million media blitz. Before long, HCAN was able to claim that its goals “are supported by President Obama, Vice President Biden, and more than 190 members of Congress."
This proved no idle boast, as the Obama administration and Congressional Democrats moved full speed ahead with a socialized health care plan, which became known as “ObamaCare.” HCAN was just one of several health-care focused coalitions that leveraged their foundation-funded might into a decisive role in the health care debate.
This history helps explain why President Obama and other supporters of an increased government role in health care won't be chastened even if the Supreme Court strikes down the health care law. Already, the Obama administration is threatening to move ahead with major parts of the law if its most controversial provision, the individual mandate, does not survive. Government health care may be pronounced politically dead, but as it has so often in the past, the left’s million-dollar money machine is determined to keep it on life support.
David Horowitz and Jacob Laksin are the authors of "The New Leviathan: How the Left-Wing Money-Machine Shapes American Politics and Threatens America's Future" (Crown Forum).