The amazing disappearing bill
There's a lot of talk over whether the health-care bill should begin before 2014, and whether the long delay will give the GOP sufficient time to foment a backlash. On the one hand, the bill should certainly begin before 2014. The delay is a budget trick, an attempt to lower the 10-year cost of the bill at the expense of the very people we're trying to help. As for the backlash, I don't buy it.
Last night, on C-SPAN, a listener called in with a very simple message. "I grew up in Canada," he said. "You have no idea how terrible this will be." Some in the audience probably nodded their heads. Government-run health care is terrible, after all. Others were probably annoyed. Canada covers everyone, pays less, and gets outcomes about as good as ours. Canada is great!
In reality, the problem with the caller's argument is that Canada is immaterial. We're not passing Canada's health-care plan. We're not changing our health-care system very much at all, in fact.
Nothing happens in 2010. Or in 2011. Or in 2012. In 2014, when the bill really begins, the insurance situations of 18 million people change. A full 16 million of those people are uninsured. Aside from the small sliver of people who will pay a surtax on the final few dollars of uncommonly expensive insurance plans, the country simply will not notice this legislation.
We're reforming the margins of the health-care system. The small and non-group markets, which serve a small minority of the population. The uninsured will be the main beneficiaries, while the vast majority of Americans who get their insurance through their employers, or through the government, will see no difference, at least in the first 10 years or so.
A year after the president signs health-care reform, the country will have largely forgotten about it. That's not to say it won't be mentioned in the elections, or argued over in occasional op-eds. But what keeps it on the front page? It's easy enough to write about health-care reform when it's dominating the congressional agenda. When it's waiting to be implemented? Or when it's being implemented, and the main effect is that 16 million people without political power now have health-care coverage? I don't buy it.
The working theory appears to be that voters will blame Congress for the yearly increases in insurance premiums that will happen anyway. Again, I don't buy it. Most people don't see those increases. If they did, this would be a very different conversation. Health-care reform is very big on the scale of things that Congress normally does, but very small in comparison to our health-care system, or even our health-care problem. This bill isn't as good a bill as it needs to be, in large part because it leaves so much of a broken system untouched. But by the same token, it is not as vulnerable a bill as it could be, because it leave so much of a politically powerful system untouched. The political system will move onto other things, and the underlying policy isn't dramatic enough to hold America's attention.
December 21, 2009; 10:48 AM ET
Categories: Health Reform
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