Where Should Health Care Rank on Obama's List of Priorities?

By Maggie Mahar, Health Beat. Posted November 10, 2008.

This article originally appeared on Health Beat.

On HealthBeat I have talked about social solidarity as the key to meaningful healthcare reform.

Last week, President-elect Obama sounded that theme repeatedly throughout his victory speech, reminding his audience that he had been elected "by young and old, rich and poor, Democrat and Republican, black, white, Hispanic, Asian, Native American, gay, straight, disabled and not disabled -- Americans who sent a message to the world that we have never been just a collection of individuals ... "

In the recent past, some progressives have warned that liberals made a mistake when they reached out to minorities, new immigrants, and gays, "ignoring" the mainstream middle class.  But in fact, "mainstream" America is no longer one recognizable culture. It is fast becoming a "magnificent mosaic," the phrase Mario Cuomo used when he ran to become mayor of New York City in 1977. 

Barack Obama won, not because he managed to win over the white middle-class, or the white working class, but because he managed to put together a coalition from so many groups -- including white voters.  Many thanks to Ezra Klein for breaking down the vote: 31.82 percent of voters who chose Obama were white, just as 31.57 percent of the voters who stood for John Kerry in 2004 were white.  But Obama won. What was the difference?

"Obama increased the share of the black vote from 11 percent to 13 percent," Klein explains, "increased the share of the 'other' vote from 2 percent to 3 percent, grew his share of the black vote by seven percentage points, grew his share of the Hispanic vote by 13 (!) percentage points, grew his share of the Asian vote by five percentage points, and grew his share of the 'other' vote by 11 percentage points. Consequently, while just 16.12 percent of 2004 voters" who chose Kerry "were non-white, fully 20.15 percent of 2008 voters" who plumped for Obama were non-white. "That 4.03 percentage point increase was the difference maker."

Drawing from such a diverse population, President-elect Obama is now asking us to come together, and to think about our country, not as individuals, but collectively: "Let us summon a new spirit of patriotism; of service and responsibility where each of us resolves to pitch in and work harder and look after not only ourselves, but each other ... "

He is asking that we focus, not on ourselves, our families, or even our favorite causes, but rather on the challenges that we must face as a nation: "two wars, a planet in peril, the worst financial crisis in a century. Even as we stand here tonight, we know there are brave Americans waking up in the deserts of Iraq and the mountains of Afghanistan to risk their lives for us. There are mothers and fathers who will lie awake after their children fall asleep and wonder how they'll make the mortgage, or pay their doctor's bills, or save enough for college. There is new energy to harness and new jobs to be created; new schools to build and threats to meet and alliances to repair."

But where, on that list, is healthcare? 

It's not there.  Here, I will say, as I have said before, that collectively, we have other priorities that may have to come first. Some months ago, a solider told me about a friend, also in the army, who volunteered to learn how to help Iraqi soldiers detect buried land-mines. His first day of training, he saw his instructor vaporize, before his eyes. This solider then had to stay in Iraq for another six months, disabling land-mines, despite the fact that his hands shook.

He is a priority. The poor, who are more likely to die prematurely, whether or not they have access to healthcare -- they are a priority. The soon-to-be-unemployed, they are a priority. Reforming healthcare will not create jobs. Building schools and exploring new forms of energy will. (While we need more primary care doctors and nurses, very, very few people are interested in filling these jobs. Rational health care reform would lead us to close some hospitals, eliminating redundancies in the system, while opening community health centers. Net, net we would lose jobs.) 

It is worth remembering that, even before the economic melt-down, Obama talked about trying to provide health care coverage for all Americans only "by the end of my first term." He never planned to rush ahead, understanding that if health care reform was to be done in a way that contains costs and lifts quality, it would take time and serious seed money. Keep in mind: one reason we elected Obama is because he projects a sense of calm and maturity. He moves thoughtfully and deliberately.

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Maggie Mahar is a fellow at the Century Foundation and the author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006).

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