Passage of healthcare reform should not come as a surprise
On the left, bloggers and pundits are crowing Obama’s success and adding him to the pantheon of historic presidents whose names will live forever as truly great presidents. On the right, bloggers and pundits are doing their best to not have to eat their words on the matter after many obviously wrong predictions about the life and death of healthcare reform. Bill Kristol probably takes the cake in the latter camp, writing preemptively of the actual passage of the bill:
I predict the great majority of what passes tomorrow — if it does, and that’s by no means a given — will never become settled law or public policy. Instead, its passage will intensify a great debate over the size and scope of government that could well result in public policy, in health care and other areas, moving, in the coming years, in the opposite direction.
As Daniel Larison notes, Kristol is notoriously wrong on most of his predictions. This is likely because he is not in fact making predictions, but rather attempting through rhetorical means to make fit the world to his crystal ball, a strategy the entire Republican party and its affiliates ran with to combat healthcare reform and which failed as miserably as most of Kristol’s predictions.
I am left feeling somewhat underwhelmed – not because this isn’t an historic moment, or because I am not impressed by the enormity of this legislation – but because I am not particularly surprised at its passage. People have been lamenting the death of reform (or calling for its demise and predicting its downfall with glee) for months. Everyone – on both the right and the left – has given the president far too little credit on this one. They have underestimated him – again – and so he has surprised them – again – with his political skill.
But, lest we give too much credit to the skill of the president, we should also recall that the Democrats had huge majorities and lacked only the sort of lockstep party unity that the opposition has maintained. It would have been far more surprising, to me, had healthcare reform not passed. Indeed, the more I think about this, the more I realize that it was, in some form or another, really a foregone conclusion. Democrats simply had to pass this thing or face much worse consequences than they will face in November.
This combination – of a very skillful and determined president and huge Democratic majorities in the House and Senate – made healthcare reform all but certain (though it was certainly possible that the bill could have been much more watered-down, and of course there is still the reconciliation process.)
What I predict now is a move over the remainder of Obama’s term (and his almost-inevitable second term) are preemptive fixes to the bill, including a likely push for a public option, better and more generous subsidies, and – hopefully, if we want this thing to actually work – a stronger mandate. I predict that even with weaker Democratic majorities we will still see these fixes pass.
This is not to say that healthcare reform will be all patched up and rosy by the time Obama leaves office. Like the rest of our entitlements there will be a long road ahead of us. Larison notes,
“One of the major problems we face as a nation is the complete inability to dismantle an entitlement once it is established. Every entitlement typically creates a constituency that benefits from it and is forever dedicated to its defense. The most electorally significant resistance to the current legislation has come from Medicare loyalists who wish to preserve it just as it is, and it may be that even this is not enough. While Republicans have been able to tap into the fear that Medicare will have to be cut, a repeal effort will tap into a much smaller electoral base that never wanted health care legislation of any kind passed.”
Of course, to avoid bankruptcy and the sort of problems we’ve seen in countries like Greece or Iceland, America will need to make serious changes in both spending and taxation. On the spending front, we will need to – at all levels of government – rethink our promises. Public pensions, Social Security, contracts with unions, our reliance on borrowing, and the still-massive and still-looming problems with Medicare (as well as this new healthcare entitlement) will all eventually need to be scaled back and taxes – probably in the form of a value-added tax – will need to be raised to make the transition.
All that being said, I think this bill does provide an opening for future reforms, and if we view it in that light we should be a little more hopeful. After all, the good news here is that many more people will have health coverage; a reasonable insurance marketplace will be created in the form of health insurance exchanges; and the groundwork has been laid to go about making the system better. It may not be much of a start – and in many ways it may be a very expensive blunder – but hopefully we can learn from its shortcomings and craft something more sensible down the road. Perhaps it is just a work in progress.
(Image via Daylife)