Happy Birthday, Health Care Reform!

The Patient Protection and Affordable Care Act – Obama’s health care reform program – turns one years old today. Obviously it’s a little weird celebrating the birth of an inanimate piece of legislation, but now is as good a time as any to reflect on where we are right now. I’m not going to explain the law for you. Ezra Klein, Jonathan Cohn, and the Kaiser Health Foundation are here for that. But come with me after the jump for a few words on where the U.S. and this ground-breaking, near-toddler stand today.

First and foremost, as is abundantly clear, the Patient Protection and Affordable Care Act is perhaps a sickly child. You all know the story: the right – led by the Tea Party – hates the law, and has been working since the moment it first drew breath to either repeal it or get the courts to knock it down. As has been the case for a year now, repeal is unlikely: it would have to overcome both a Senate held by the Democrats and the veto of Barack Obama. Full out repeal is therefore just not going to happen. A congressional fight over defunding the law, however, is certainly something you all can expect to see in the law’s second year.

As to the courts. The Supreme Court currently has no plans to expedite a case over reform’s constitutionality, and at best this is going to be a long road – and one very fraught with politics. As things stand right now, we’re very likely to see the bulk of this law crawl to a second birthday.

And the thing is, beneath all of the shouting and bloviating, there has been a pretty constant stream of support for health care reform. The Kaiser Health Foundation has found that, one year out, there is a slight majority of people who favor keeping the law in place or expanding it over repealing it entirely or replacing it with a Republican alternative. No, of course this is not a ringing endorsement. But it’s a start.

And a big reason for the steady-split on public support over the law is a supreme lack of understanding about what the law actually does. Because so much of the law’s major provisions don’t come into effect until 2014, most people don’t currently have a sense of what the law will actually do for them. Instead, they have a sense of the loud – and often misleading – arguments about the outstanding cost of the law (a reminder: this law will save or raise $100 billion more than it spends within the first ten years according to the politically independent CBO).

So what is to be done about this? Largely, waiting. This isn’t the first time a piece of major social legislation has had pitfalls early on due to an extended window before the law goes into full effect. See, for example, the Social Security Act of 1935. Back in 1935, there was a whole lot of anger about a social welfare law that would allegedly kill jobs and waste money. Sound familiar? And again, a lot of the initial opposition was a function of the law not immediately handing out benefits.

In the case of the Social Security Act, benefits were pushed up to help quell that opposition. And it worked. Social Security became “the third-rail” of politics that it is today. Sure, it’s also not a perfect system, as the current fiscal crisis over entitlements makes clear. But the frame-work of that 1935 law is something that the majority of Americans hold very dear – as has been made startelingly evident by the widespread opposition to privatizing the program under the most recent President Bush. And the fiscal crisis surrounding Social Security (specifically the Old Age, Survivors, and Disability Insurance program) is something that is very fixable (see: raising the tax-cap), and it will be fixed in time for the program to remain solvent.

So, how does this fit into the Patient Protection and Affordable Care Act? Like the early days of the Social Security Act, this legislation is about the long game. As with the SSA, it would be impossible for the PPACA to immediately hand out benefits without being both fiscally and institutionally irresponsible. This is about waiting, about being patient, and about flexibility.

The law still has plenty of problems. The cost-control mechanisms are going to need some work and, again, time to really figure out the best way to “bend the curve” on health care costs. But unlike a year and a day ago, today we have a fundamental framework from which to build the health care system of our future.

Just like any one-year-old, there’s no saying what exactly this little guy will look like five, ten, thirty years down the line. And just like any one-year-old, this law is going to need careful guidance, instruction, and supervision to make sure it reaches its full potential. Because, believe it or not, the potential is there.

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