Julian E. Zelizer: The Real Threat to Health Care Reform





[Julian E. Zelizer is a professor of history and public affairs at Princeton University. He is the author of "Jimmy Carter," published by Times Books, and editor of a book assessing former President George W. Bush's administration, published by Princeton University Press.]

When U.S. District Court Judge Henry Hudson ruled that the mandate to purchase health insurance in the new law was unconstitutional, many people began looking to the Supreme Court for a final determination....

But the truth is that a Supreme Court ruling along these lines, which is against the odds, is probably not the greatest threat that health care faces. Nor is outright repeal. As Americans become more familiar with the benefits of the program, Republicans will find it more difficult to attack health care outright. With all the discussion about constitutional challenge or congressional repeal, the more likely threat is that Republicans will gradually weaken the program to the point that it is ineffective....

Since Ronald Reagan became president in 1980, Republicans learned it was more politically effective to undermine programs through funding cuts and administrative appointments than it was to mount outright challenges that aimed to dismantle public policies. When Republicans directly targeted benefits, such as Reagan's effort to cut Social Security benefits 1981 or the effort by the Republican Congress to reduce Medicare spending in 1995, they were burned.

So Republicans mastered an alternative strategy that has proven to be damaging to government programs. Instead of directly attacking programs, they have relied on more subtle mechanisms to scale back government. For example, both parties in Congress have found they can use the power of the purse as a weapon....



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