U.S. Health Care -- Good for America, Bad for the World

Germany's Iron Chancellor, as Otto von Bismarck is known, was never a huge fan of democracy. Bismarck led the country from 1871 to 1890 -- and preferred to keep the process of governing away from the public eye. Lawmaking, he once pointed out, was not all that different from what a butcher does. "The less people know about how sausages and laws are made," he famously said, "the better they will sleep."

President Barack Obama has a significantly different view of democracy than Bismarck did, but the German's observation remains valid. For more than a year, Obama watched his healthcare reform churn through the law-making grinder. His political opponents sliced piece after piece from his most important domestic political project -- Obama himself even grabbed the knife occasionally. The public show was such that American voters slowly lost faith in the president's health care reform plan. On Sunday evening, it finally made it through the House of Representatives. Obama's apron, though, is splattered with blood.

There is little doubt that the reform package, which guarantees health care coverage for 95 percent of Americans, is one for the history books. It was a scandal that the world's richest country for so long offered its citizens such pitiful protection against illness or injury. It seems entirely possible that, in 10 years time, Americans will find it hard to believe that they didn't always have the right to health insurance. In the long fight for the reform project's eventual passage, Obama showed himself to be persistent and pugnacious. The accusation that Obama has accomplished nothing vanished in a single House vote.

The First Promise Has Been Fulfilled

Nevertheless, he cannot really celebrate the reform that he promised for so long. Since his campaign, Obama has provided two primary justifications for universal health care. First, was the moral necessity to eliminate the existential risks posed by illness or injury to more than 40 million Americans without coverage. The second justification was an economic one -- rising health care costs, so goes the argument, must be brought under control in order to reduce stress on the U.S. budget.

The first promise has been fulfilled -- the new legislation demonstrates solidarity with those unable to afford health coverage and with those who were refused insurance. The second promise, however, has been postponed. The reform bill only half-heartedly addresses the reduction of health care costs and those measures aimed at savings can easily be skirted. Insurance companies will get millions of new customers, but no real competition. Their shares are currently skyrocketing -- they are the true winners of US health care reform.

The president, in other words, won the moral debate, but he is paying a high price. The bid to introduce social reforms of the 1960s, providing health insurance to the poor and elderly, was also deeply controversial. And back then the Republicans also made huge efforts to block the reforms. Congress, though, passed the bill with a clear majority in the end, with votes from both parties. This time Obama has failed to get a single Republican to back his health care reform and polls show that there is a deep public mistrust.

Obama's show of strength, in fact, most closely resembles the fight for greater civil rights for African-Americans in the South during the 1960s. Democratic President Lyndon B. Johnson pushed through the Civil Rights Act because he believed it was the right thing to do. But he did it in the clear knowledge that the Democrats would have to pay a heavy political price.

Concerned about Re-election

Obama has made it clear that he too is less concerned about the political consequences than about doing the right thing. "We rose above the weight of our politics," he said after the bill was passed. "When faced with crisis, we did not shrink from our challenges. We overcame them. We did not avoid our responsibilities, we embraced it. We did not fear our future, we shaped it."

However, many Democrats are deeply concerned about their prospects for re-election and have only hesitantly followed their president. It is difficult to say whether mid-term elections in November will bring punishment or reward for passing the reform. One thing, however, seems clear: the debate over health care is far from over.

Even during the vote in the House of Representatives on Sunday, the Republicans were trying out what will likely become their new campaign message. Who will be forced to pay for the $940 billion reform? Can America afford it now? Can America afford it at all?

Obama counters by saying that the reform will pay for itself, indeed, he claims, it will ultimately save money. Nonetheless the billions of dollars he is currently juggling seem to be making many Americans feel faint.

Further Successes Doubtful

The debate will dominate the next few months -- and will no doubt also have an impact on the other projects that Obama is finally planning to tackle. The attention that the president will have to continue to pay to health care, in fact, makes further successes that much more doubtful.

Every other issue has become a sideshow, particularly those outside the borders of America. The Afghanistan mission: of marginal interest. Protecting the environment: postponed. Peace in the Middle East: off in the distance. Sanctions against Iran: delayed. Europe: not even worth a trip.

The one remaining global superpower has succumbed to navel gazing. The nature of Obama's hard-fought victory means little will change in the near future. On the contrary: Now he must explain to the country and to his own party why the entire health care journey, as all-encompassing as it turned out to be, was worth it in the end. He will have little time for anything else.

Such a realization should not spoil the celebration over health care for the Americans themselves. But the rest of the world won't be joining the party quite so enthusiastically.