Lowering Expectations for Health Care Bill

(The New Republic)  Jonathan Cohn is a senior editor at The New Republic..

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On Monday, the full Senate will begin deliberations over the bill Majority Leader Harry Reid introduced before Thanksgiving. And the ultimate resolution of that process wouldn't seem to be in much doubt.

Republicans will do whatever they can to drag out the debate. But unless political circumstances change drastically, they probably will not succeed in stopping reform altogether. Instead, the Senate will vote for a bill, work out its differences with the House, and send legislation to the White House for the president to sign.

But the debate that unfolds over the next few weeks will be full of drama--and not just the manufactured kind. While it's hard to imagine opponents of reform stopping a bill from passing., it's not at all hard to imagine the opponents of reform drastically altering the bill before it goes forward.
You can look forward to amendments on abortion, immigration, employer responsibility, tort reform--amendments that plenty of more conservative Democrats will find hard to resist, out of either principle or political necessity, even as they further alienate the left.

You can also expect to hear complaints that the bill tries too hard to cut costs, as well as complaints that the bill costs too much. Often you will hear those complaints coming from the same people, which will make them hypocritical but not necessarily unsuccessful.

By the time all of this complaining and amending is done, legislation might end up a lot worse than it is now--which is saying something, since the bill is already full of compromises. Legislation could end up putting even less money into helping people buy insurance; it could have even weaker efforts to change the behavior of the health care industry; and, of course, it could have an even more timid version of the public insurance option.

And the debate that's about to take place isn't simply about whether legislation passes. It's also about how legislation is perceived after it passes--in the 2010 midterm elections, which suddenly loom large, and even the 2012 presidential race.

The conservative base hates the bill moving through Congress a lot more than the liberal base loves it. And while swing voters don't seem particularly moved by arguments about abortion or death panels, they will react harshly if they perceive health reform fails to improve their lives.

Some of this imbalance is inevitable, given the nature of the legislative process. When you're trying to pass a law--and have to clear an absurdly high 60-vote hurdle to do it--you're bound to make compromises that disappoint supporters while doing nothing to pacify the harshest critics.
But some of this also reflects the dynamics of the debate as it's played out lately, with the heavy focus on whether health care reform really will be fiscally responsible. Critics say it won't be; defenders say it will. In that debate, the best the advocates of reform can do is to avoid damage--to convince the public that, no, health reform really isn't going to cause the big problems that critics say it will. That's not exactly a recipe for generating enthusiasm.

One response is to remind the majority of Americans with insurance of all the ways in which health care reform really will help them. A new memo from MIT economist Jonathan Gruber, published over the Thanksgiving break, ought to help in that regard. The memo is a reminder that, thanks to reform, premiums for people buying in the non-group market should come down--in many cases, way down.

Of course, that won't actually happen until the new insurance exchanges are operating--something not scheduled for a few years, under both the House and Senate bills. In this sense, the ambivalence about reform is rooted in the fact that it's not everything it could be--that it really is, in some important respects, a disappointment.

That's why the architects of reform ought to look hard at a proposal Paul Starr has made and touted in Sunday's New York Times: Providing federal funds to states that want to get their exchanges up and running early. It's the type of change that would seem to have a shot at passing, even in this limited fiscal and political environment. And it's the type of change that could help change perceptions about health reform for the better--precisely because it would result in helping more people, more quickly, than will be possible if legislation passes as is.

To be clear, you can count me among those convinced that health care legislation will never be repealed--that, once enacted, it will become a permanent part of the American social welfare state, something people cherish. But along the way to implementation, a lot of bad things can happen to the new system, not to mention the lawmakers who championed it.

The key for the next few weeks, as the Senate debate moves forward, is figuring out how to minimize that danger. And that alone should create plenty of drama.


By Jonathan Cohn:
Reprinted with permission from The New Republic.

[Canon547]

You libtards keep dreaming about how much this administration cares about you. As for contributions from big insurance, you better do your homework as to who is receiving money before pointing fingers.

[askagain]

On Thanksgiving, my young nephew complained that things are becoming too confusing. He mentioned things such as immigration, crime, gay marriages, and banning Christmas displays at town halls. He then summed it up by saying "Americans are losing their identity." How profound for a young person to say something like that.

[noloyalisti]

Yeah, the private health care system is a complete failure and may doom our economy. But hey, big, greedy, uncaring corporations who run EVERYTHING can do no wrong so let's give them even more. In fact, let's just go back to serfs and masters because we are close now.

[jsachse]

I don't know how you can enact something of this size without some kind of test to see if it will work. I'd like to see the scope document with the user approvals (that would be the voters) before they attempt to implement this thing.

I guess I shouldn't confuse a government program with the real world...

[jtdev1]

Doesn't anyone add in the fact that health care costs will go down if everyone is insured?

Right now when an uninsured person goes to the hospital the hospital and doctor get NOTHING. Who pays for that???

YOU AND ME! in the form of higher health care costs. Same as any other business. Costs get shifted to those who can pay.

So if 100% of the time doctors and hospitals get paid, then they don't need to shift/raise the cost of providing service.

[Constitionalist]

Not everyone will pay their share. 100% gaurantee on that. That leaves the rest of us to pick up their tab. Just like car insurance. That is required by 48 states, yet we still have people driving around without it. This is why you have an 'uninsured motorist' premium tacked on. You are paying for what they are not. The same with be true with healthcare, although it probably won't be as obvious.

[askagain]

That has already been tested and failed. Massachusetts enacted mandatory health insurance for all citizens in the state several years ago. They discovered that health insurance premiums continue to rise at an alarming rate. More people paying into the system does not mean premiums will remain level or go down. People will be using health care services more with health insurance. Incidentally, that happened under a Republican governor.

[californiadreaming]

Does it not cross anyone's mind why this bill (if passed) will not go into effect until 2014? If so, then its a big oversight.

The CBO scoring is based on costs between 2010 and 2019 - as was Obama's criteria for costs. If nothing happens until 2014, then we are looking at costs over a 6 year period - not 10 year period.

Bottom line - the cost projections are all flawed - purposely it would seem - and we are buying into their deception.

[askagain]

This isn't an oversight. It is intentional to show a lower cost for health care reform over the next ten tears. It is creative finance designed to mislead the American people. It appears no one is willing to question this type of financial shenanigans.

[dmwj2]

That is because it is designed to build a revenue base... I don't understand how so many people want to see this as being an "oversight" or "fraudulant". What we NEED to make sure of is that that those rascals up in DC don't raid the cookie jar for pet projects and wars!!

[rightbehind]

The republicrats are turning it into poop.

[askagain]

Open your eyes and think with your brain. There are going to be winners and losers with health care reform. Young people who have opted not to pay for health insurance will be mandated to have it. That is money out of their pocket. Young people will be paying higher premiums to subsidize the premium of older people. All of us will be paying for millions of people who can't afford health insurance. Where do you think this money will come from? My current plan will be considered a "Cadillac" plan. I will have to pay a penalty unless I opt for a cheaper plan. Heralth insurance benefits will be taxed for the first time. My taxes will be going up because of my income level. As a person heading toward medicare, there will be less money for Medicare which means there will be less money for procedures older people are likely to need. The upside will be eliminating preexisting clauses and making it easier for some people to get health insurance. Whether you support health care reform or not depends, in large part, by how it affects you. Will you be a winner or a loser with health care reform?

[proudscot]

If you can't look after the health of your own people America, you are a disgrace. It's not socialism, or communism to simply treat the sick. It's common decency

[RegVoter]

I strongly want a healthcare fix that is simple and effective: an elegant solution.

It appears to me that what has evolved in Congress is akin to the parable of the blind men describing an elephant. In this case healthcare is the "elephant" and the members of Congress are the "blind men." Attempting to accommodate so many diverse viewpoints has resulted in an extremely complex piece of legislation that is a disaster waiting to be implemented.

The bills that are on the surface now are like a giant fruit salad: something in it for everyone, but taken as a whole they taste awful and smell terrible.

[dmwj2]

excellant analogy... it's going to be worse than the tax code when they all get their say added to it... un-real!

[Ferrell-2]

Most comments on this health bill are from Democratic voters lambasting the Republicans for holding up its passage. They fail to mention that quite a few Democratic congressmen are against this bill plus millions of rank and file Democrats in the electorate are opposed to it also. Granted, more Republicans are opposed to it than Democrats but only the Dems have fears of the upcoming elections and they should be.

[ckh123mmm]

Unfortunately for all of us, we have elected officials who don't know anything about health care. They were elected because they were popular, not because they have knowledge about any variety of industries. They play to the lobbyists who pay for their campaigns and could not care less about the people they (supposedly) represent. The health care bill will fall short in many ways and the same companies that profited before will end up making more.

Additionally, although we elected a President we thought would do the right thing for the people, it is clear that he is a puppet of big industry. Perhaps at reelection time the voters will stop voting for popularity and start voting for experience and know how.

Say good bye to America because the time is not only at hand, it has passed us. We deserve what we've chosen and now the corporate dictators are our Masters. Mr. Obama, you have let us down. G.O.P. you have let us down as well. The lobbyists and the churches have manipulated our officials to the point that it is impossible for qualified people to actually be elected.