Why Health-Care Reform Begins in 2013
Most of the major provisions in the House's health-care reform bill begin in 2013. That's a bit of a lengthy ramp-up period, but these things happen. Jon Cohn, however, makes a point I haven't heard before: The Congressional Budget Office scores bills across a 10-year budget window. And, even more arbitrarily, we seem to have decided that the final bill will cost $1 trillion over that period.
The slow start is a way of holding down costs in the 10-year budget window. If the bill begins in 2010, but the subsidies don't kick in until 2013, then that's three years that are under the budget but aren't costing much money. That means the new health-care system can really cost an average of $140 billion each year, as opposed to $100 billion, and that means you can afford a better system.
On the other hand, that means you have some pain happening before you see significant benefits. That strategy has backfired before, in the Medicare Catastrophic episode of 1988. But given that the pain is concentrated among a small slice of the wealthy, and given that you will have some insurance regulations and so forth going into effect immediately, it doesn't seem like a huge deal.
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