Like Medicare & Social Security? These Programs Were Far From Perfect at the Start

Ezra Klein of the Washington Post makes the point that I think many, including Democrats, have missed during this health care debate. Barring the passage of really bad legislation, getting an imperfect bill passed is better than nothing at all. Because the next time around it will be harder, not easier, to make the bill more robust.

Failure does not breed success. Obama's defeat will not mean that more ambitious reforms have "a better chance of trying again." It will mean that less ambitious reformers have a better chance of trying next time.

Conversely, success does breed success. Medicare and Medicaid began as fairly limited programs. Medicaid was pretty much limited to extremely poor children and their caregivers. Medicare didn't cover prescription drugs, or individuals with disabilities, or home health services. Link

Paul Begala, former advisor to President Bill Clinton, expands on this point in evaluting the evolution of Social Security.

No self-respecting liberal today would support Franklin Roosevelt's original Social Security Act. It excluded agricultural workers -- a huge part of the economy in 1935, and one in which Latinos have traditionally worked. It excluded domestic workers, which included countless African Americans and immigrants. It did not cover the self-employed, or state and local government employees, or railroad employees, or federal employees or employees of nonprofits. It didn't even cover the clergy. FDR's Social Security Act did not have benefits for dependents or survivors. It did not have a cost-of-living increase. If you became disabled and couldn't work, you got nothing from Social Security.

If that version of Social Security were introduced today, progressives like me would call it cramped, parsimonious, mean-spirited and even racist. Perhaps it was all those things. But it was also a start. And for 74 years we have built on that start. We added more people to the winner's circle: farmworkers and domestic workers and government workers. We extended benefits to the children of working men and women who died. We granted benefits to the disabled. We mandated annual cost-of-living adjustments. And today Social Security is the bedrock of our progressive vision of the common good. Link

John Judis of The New Republic echoes what Begala says about Social Security, stating:

[I]t was a bare shell of what it became in the 1950s after amendment. Benefits were nugatory. And most important, coverage was denied to wide swaths of the workforce, including farm laborers.

[T]he bill that the House passed last Saturday is considerably more robust that the original Social Security bill. Link

And there is the take away from this debate. We are on the precipice of passing a health care bill that is a more progressive than either Medicare or Social Security in their initial stages.