Viewpoint: Health reform's failure could have far-reaching consequences

Reprinted from Baltimore Sun

By Andrew L. Yarrow

As the health-care reform debate moves into its home stretch, a significant but hidden potential consequence of failing to reform health care is lost: What do the nature of the debate, the potential failure of reform, and the likely inadequacy of any reform that maybe passed mean for America's mood and self-image?

Don't get me wrong: The substantive issues of health-care reform are enormous-controlling costs in a dangerously out-of-control spending spiral that could sink our economy, lack of access to medical care and quality care for tens of millions,and a system that is so dysfunctional that neither market mechanisms nor the commanding heights of government bureaucracies perform well. And despite their political posturing, most Democrats and Republicans recognize that without cost control, quality, access and efficiency, government finances, business competitiveness and Americans' living standards are threatened more than at any time since the Great Depression.

Yet the delicate, demagogic and the parlous condition of Washington and grass-roots politics makes one wish that Nero was merely fiddling while Rome burns (which politicians have done for too long on health care). Instead, too many of our leaders are torching America, taking angry, hard-line positions when virtually all agree that at least some reform is essential.

The failure of meaningful health-care reform not only would have enormous,deleterious consequences for America's long-term fiscal and macroeconomic outlook, and for Americans' physical health; it could also, perhaps irredeemably, damage Americans' faith in their nation and dim their outlook for America's future.

It may sound histrionic to peg such things to the fate of a single piece of legislation, but the symbolic significance of failure or fake reform on an issue that has bedeviled America since World War II could swing the United States[3]into a dangerous bitterness and pessimism. It could make Jimmy Carter's summer of '79 look like the epitome of euphoric national confidence.

Despite various bursts of national confidence during the last 40 years - with President Ronald Reagan,the 1990s economic boom, and initially with President Barack Obama- the United States has experienced a long-term decline in its people's confidence in the nation's future, its institutions, its leadership and its economy. Poll after poll has found that Americans are less trusting of their leaders, government, business and other private institutions, and convinced that future generations will not have as good lives as adults today or in the late 20th century.

When Dwight Eisenhower left office, 92 percent of Americans believed that the country was on the right track and that things would only get better. When George W. Bush left office, more than 80 percent felt that the country was on the wrong track and were worried about the future. This is far more than a tale of economic pessimism, disgust at corrupt leaders, and fear of a dangerous world. Around1960, the United States was coming out of two late-1950s recessions, and many crowed that economic growth was not high enough (although, by the early 1960s,growth was very robust). While not Abu Ghraib or Watergate, there was the rather seamy trading of new refrigerators and mink coats to influence high government officials. And if our dangerous world is symbolized by terrorists,what can one say of a nation that lurched from the U2 crisis to the Cuban Missile Crisis?

Fast forward to today. While surveys have found erosion of support for President Obama, congressional Republicans and health-care reform in the last six months, they have found a corresponding decline in the proportion of Americans saying that the country is on "the right track" -pollsters' tried-and-true confidence index. Even if one does not support all aspects of health-care reform, the sheer failure of the United States to accomplish something big and meaningful has huge implications. Once, we could win world wars, send men to the moon, pass landmark legislation from Social Security to the Federal-Aid Highway Act (creating the interstates), to the 1964Civil Rights Act. It increasingly seems that even setting out to achieve big national goals is no longer possible, although one can hope that Mr. Obama was right when he said, "we can do great things." Blame partisanship,lobbyists, whomever, but it also comes down to a limited desire to take on big challenges, a characteristic that historically had been a hallmark of American greatness.

The long-term polling trajectory of growing or persistent unhappiness with the nation's direction also may stem from economic and other causes, but our inability to articulate a vision for America's future and act on it may well be another very important cause of our discontent. If our leaders can't come together to tackle the biggest issues, and garner Americans' support, it is a form of giving up.

It is not just health-care reform. The last few decades have seen intense fighting over so many issues, with the result that only small legislative reforms become law. It's like not going for the touchdown, instead settling fora yard or just holding onto the ball. People are inspired by big achievements -from the touchdown to the moon landing to the Civil Rights Act. Such things instill pride, a sense of success and optimism: If we're successful achieving one big thing, we'll be successful in the future.

If we wind up with a watered-down mishmash of so-called health-care reform, it sends another signal that America can't do great things anymore. We used to; we can; we should. Whether with health care reform, overhauling our broken tax code, providing good and affordable education, nourishing ground-breaking new technologies(think of the government's development of the Internet), or even building new communities, such projects not only could have huge tangible economic benefits but also could strengthen Americans' confidence in their nation and its future.

Doing nothing, or doing only small things, is not a sign of greatness.

Andrew L. Yarrow is vice president and Washington director of Public Agenda and an adjunct history professor at American University. He is the author of"Forgive Us Our Debts: The Inter generational Dangers of FiscalIrresponsibility" and the forthcoming book "Measure of America."His e-mail is ayarrow@publicagenda.org.