And that’s it, then. With much fanfare and an acceptable amount of self-congratulation, on Sunday night Congress passed health care reform.
We are relieved.
So what now, you ask? Where, if you’ll pardon the expression, is the beef? What does our future look like in this fresher, newer, health-reformier world?
Beats the hell out of us. We’re a humble blogger, for God’s sake, and while the light of our brilliance may have swept away the cobwebs of your ignorance from time to time, our talents don’t extend to fortune telling. But we’ll promise you this: It’s gonna be a bit of an anticlimax.
See, that’s the trouble with telling the future. Throughout this process, there have been so many lies, so much dishonesty and deliberate misrepresentation, such fear-mongering and obfuscation, that it’s impossible to figure out what the opponents of the bill expect to happen. An immediate tripling of the federal budget? Babies thrown to lions? Stalin’s jackbooted thugs to march through the hallowed halls of Premera Blue-Cross while the ghost of Lenin angrily unplugs grandfather’s ventilator?
Probably not. In spite of the agreeable furor on the Republican right, the Constitution remains relatively intact. The sun will rise tomorrow. And, for the 90% of Americans enrolled on the employer-insurance market, absolutely nothing will change about your health insurance.
Absolutely. Nothing.
. . .
That thought may take some getting used to.
If you’re a part of the majority, the bill isn’t designed to affect you. That’s not how it rolls. It’s been written to alleviate the deep and real suffering of uninsured Americans, slap a bit of sense into our dysfunctional individual market and, maybe, introduce some small steps to taking control of our rising healthcare costs. We could have done more, but quite frankly you lost your shit when we wanted to introduce a fucking research panel, so forgive us if we aren’t tripping over ourselves to fix the rest of your innumerable problems.
Still, as you know, this blog likes to consider itself an armchair expert on health care, the economy, and politics in general. Silence just won’t do. So against our better judgment, we’ll take a quick look into the future and see what changes are wrought from this most unexpected bill.
On Healthcare
First, let’s make a bold claim: This bill is not going to be repealed.
Over the next few weeks, you’ll hear noises on the Republican right that they’ll stake their campaigns on the repeal of this bill. That is not going to happen. The very second a Republican majority advances the repeal of healthcare the Democrats will filibuster the hell out of it, and the Republicans are not going to get near enough seats to ram it through. That would mean weeks of painful political haggling followed by eventual defeat, and the Republicans are not idiots. Even weasels have a certain base cunning.
Secondly, it’s a lot easier to scare people with the unknown. In six months, insurers will no longer be able to deny coverage for pre-existing conditions. 80 cents of every dollar they earn will have to pay for care, or be rebated to individuals. Children up to the age of 26 will be able to ride on their parent’s policy.
After the midterms, in 2014, individuals without insurance will start receiving subsidies to help them purchase it. They’ll have access to insurance exchanges, where private policies can be purchased, and where insurers can’t jack their rates up without giving reasonable cause. And they’ll be able to read community ratings, from people like them, talking about how good or bad an insurer is at doing their job.
People are going to like these things. They’ll become popular. In other words, “Vote GOP: Taking Insurance Away From Children” is not going to gain traction as a campaign slogan.
But for most of us, nothing changes. And that is a pretty big problem. Our system of employer-sponsored insurance is still expensive, dysfunctional, and getting worse. This bill doesn’t fix that. There will be even bigger changes to health care in the years to come.
This bill, though, gives us a structure. First, by requiring people to purchase health insurance, it makes us stakeholders in a system that desperately needs reform. Secondly, employer-sponsored health insurance is going to continue to fail – and as it fails, we’ll have the chance to bring these people into the exchanges. The Strawman Blogger loves a backup plan.
On The Budget
Our budget problem is a health care problem. You could cut every bit of waste, stop every dollar in discretionary spending, fix Social Security and the Pentagon, dismantle welfare, gut the federal prison system, and annihilate the FBI, and healthcare would still bankrupt America. It’s just a matter of timing.
Healthcare continues to grow at rates in excess of 7% a year. Our economy will be lucky to manage half of that. Fixing the budget means controlling rate of growth in healthcare spending.
The healthcare bill starts the messy process of cost-control. Ezra Klein has the dirt here.
It won’t, however, be enough. It’s easy to bend the cost curve in health care. Trouble is, it means reducing payments to doctors or cutting back on unnecessary care.1Our budget problem is still largely unsolved.2
On Politics
Conventional wisdom says that health care has canonized the culture of “No”. In other words, it’s better for a minority party to block legislation than compromise on it, better to defeat a bill than make it better, better to misinform than to mediate. In other words, make the other guy look bad, and you’ll probably be a winner when the next election rolls around.
It’s a pretty good strategy, politically speaking. Let’s be perfectly clear - Republicans are going to win in the midterm election, and they’re likely to win big. That’s just how these things work.
But it’s not much of a strategy for governing a country. The Republicans will ride back into power, and it will be the Democrats turn to filibuster every bill in sight. And so on and so forth, and the only legislation we’ll be able to pass will go through reconciliation.
So if you oppose the bill, think about this: Over 130 amendments were accepted by Republicans in committee. The public option was dropped and a Medicare buy-in was never truly considered. This is a conservative bill, and not a single conservative voted for it.
Next time around, how willing do you think the Democrats are going to be to compromise? How many days are they going to waste in committee or compromise when they know the minority party is just waiting to stab them in the back?
Fighting legislation in this way makes it more likely you’ll see legislation you hate. The next time a Democratic congress considers health care, they won’t bargain with you. They won’t invite you to sit on a committee or offer an amendment. They’ll craft a liberal bill to suit the rules of reconciliation, and they’ll ram it through. Why not? They know that nothing they do will buy your vote, so they might as well use theirs.
Or maybe not. They’re still Democrats, after all, and they aren’t bright species. But it’s still a crap way to govern a country.
1In case you have not been paying attention: Neither of these are likely to be popular.
2Tort reform, you say? Don’t make us laugh. $11 billion a year. Come up with something new – and try not to embarrass yourself this time.
