874 Chapter 32 Shocks and Responses: 1992–Present
medical profession for failing to weed out incompe-
tent doctors. Nearly everyone blamed the insurance
companies, which earned large profits by processing
forms. A major factor was Medicare itself: By push-
ing so much money into health care, the federal
government, which paid for nearly half of all health
care expenses, increased the price of health care ser-
vices and goods. Technological improvements, too,
rendered medical treatment more costly.
Obama’s goal was twofold: to provide health care
to Americans who lacked it and to reduce health care
costs. Some advocated a government-run system,
such as Franklin Roosevelt had done with old age
pensions through Social Security. Many European
governments operated health care systems along simi-
lar lines. But opposition to socialized medicine in the
United States was intense. Polls showed that few
Americans wanted their doctors to be employees of
the federal government.
Supported by Democratic leaders in Congress,
Obama proposed a system that combined private
and public health insurance. Elderly and poor
Americans would continue to be covered by the
government; private insurers would continue to
insure millions of Americans, but they could not
kick people out of their systems when they became
ill; companies with more than fifty employees would
be required to provide health care insurance for
employees and their families or else face stiff penal-
ties; most other persons would be eligible for
publicly supported health insurance.
Republicans almost uniformly denounced the
plan; they insisted that Americans did not want
the federal government to control health care.
Republicans instead recommended tax incentives or
state initiatives to encourage private employers to
broaden coverage. Republicans added that the fed-
eral government, with a looming annual deficit of
$1.8 trillion, would be hard-pressed to pay for
Medicare in the future; to embark on a major new
commitment was madness.
The Democrats, despite strong majorities in
both houses of Congress, were themselves divided
on Obama’s plan. The final compromise provided
for his reform to be phased in over ten years at a cost
of $1 trillion, and coverage would not be universal:
By 2019, 24 million people would still lack health
insurance, about a third of them illegal immigrants.
In March 2010, Congress approved the mea-
sure—the vote in the House was 220 to 207. No
Republican voted for the bill. Obama had neverthe-
less engineered the first major health care reform
since 1965, when President Lyndon Johnson signed
Medicare into law.
Immigration Reform
Buoyed by this success, Obama turned to immigra-
tion. Early in his presidency, he strengthened border
security to cut down on illegal immigration from
Mexico, an action that angered Mexican leaders (see
the introduction to Chapter 11, pp. 296–297). Yet
illegal immigration persisted. In 2010 Arizona gover-
nor Jan Brewer, complaining that “the majority of
illegal trespassers” were “bringing drugs in,” signed
the toughest immigration law in the nation. It
required immigrants to carry alien registration forms
at all times and authorized police to stop and ques-
tion anyone they suspected of being an illegal immi-
grant. Legislators in dozens of states introduced
similar bills. Obama denounced such laws as a form of
racial profiling and ordered the Justice Department to
take legal action against the Arizona bill. He also
called for a federal initiative to prevent states from
acting “irresponsibly.”
Obama also steered toward a compromise. He
rejected state plans for rounding up and deporting
the nation’s 11 million illegal immigrants; he also
opposed liberal proposals to declare an “amnesty”
against illegal immigrants and grant them immedi-
ate citizenship. Instead he proposed a “practical,
common-sense” solution—a “pathway to citizen-
ship.” Illegal immigrants would be granted citizen-
ship only after they admitted they had broken the
law, paid a fine and back taxes, and provided evi-
dence of a willingness to assimilate, such as by
learning English. As with health care reform,
Obama outlined few specifics, preferring to allow
Congress to shape the plan.
Republicans bristled; without more effective
policing of the border, Obama’s “reform” would
encourage more illegal immigrants to pour into the
country. Many complained that Obama was court-
ing Hispanic voters just a few months ahead of the
2010 congressional elections. The prospects for
quick passage of comprehensive immigration reform
seemed poor.Environmental Concerns and Disaster in the Gulf
During his first weeks in office, Obama had pledged a
“new era of global cooperation on climate change.”
Nearly everyone assumed that he intended to push
for ratification of the 1997 agreement, signed by
more than 130 nations at Kyoto, Japan, to reduce
emissions of carbon dioxide and other atmospheric
pollutants. The Senate had opposed the Kyoto
accords because developing nations—including