1 President Obama’s Health Care Reform: The Inevitable Impossible

Presidential candidate Barack Obama first outlined his proposals for health care reform in Iowa in May 2007, eight months before the caucus that launched his campaign. He promised that all Americans would have health insurance and that their insurance would cost less. Noting the Democratic legacy of support for universal coverage from President Harry Truman to the present, Obama concluded: “The time has come for affordable, universal health care in America ” (Obama 2007). The American health care system did have serious problems. The number of uninsured was enormous and steadily rising. In 2000 about 38 million individuals in the United States (almost 14 percent of the public) lacked health insurance, and these figures had grown to 46 million (over 15 percent) by 2007 (U.S. Census Bureau 2010: Table HIA:1). Health insurance costs had risen 120 percent between 1999 and 2008 and were poised to rise yet further (Kaiser Family Foundation 2009a: 10). Many were anxious about their ability to afford health insurance, if they were able to obtain it at all. President Obama addressed the American people triumphantly in March 2010, as he signed the Patient Protection and Affordable Care Act: “Today, after almost a centur