Politics of Health Care, 2010 and 2012

Politically, I've argued that the big tests for liberals in the final health care bill should be: 1. does it make anything worse? 2. Can it be built on? And, 3. What are the short-run political effects?

The big issue for liberals with "make it worse" is about Stupak; it looks to me as if this will be compromised away. The big issues for liberals with "built on" is, I think, establishing the public option; looks like that's going to happen, although of course the votes haven't been taken in the Senate quite yet. That leaves the short-run effects. Those following the bill(s) closely will know that the main provisions don't actually go into effect until 2013 (House-passed bill) or 2014 (Reid's bill), but other things will take effect earlier.

On the plus side, Ezra Klein has a quick list of the things that will happen right away. Unfortunately for Democrats, several of these items (such as eliminating lifetime caps) are things that will not be identifiable benefits for most citizens. For example, on lifetime caps, healthy people won't receive any benefit, and my guess is that people who unexpectedly find that they need very expensive care won't realize that they wouldn't have received full benefits if not for the law. Only those currently worrying about reaching lifetime caps will notice. Same with rescissions; this is a major reform that will affect quite a few people, but virtually none of them will realize that they've been helped by the bill (the whole idea of rescissions is that people lose benefits they thought they had once they put in a claim). It is true that Democrats running in 2010 and 2012 can make ads contrasting the Bad Old Days vs. Reform!, but very few people, as far as I can see, will actually have the experience of these changes helping them and connecting it to Democratic action.

Some items, however, will be both helpful and noticeable. At the top of the list, in my view, is that young adults can stay on their parents' health care through age 26. I think the same is true of the early retirees provision, and possibly the temporary help for pre-existing conditions (pending it really working; I'm not sure whether that's the case or not). All three groups are currently aware of their insurance problems, and would be aware that policy changes helped them get insured. It's possible that some of the other things would be helpful and noticeable, but those strike me as the big ones. It's also worth noting that all three are situations that matter a lot in recessions by making job loss not as terrible, and by encouraging retirement.

Now, the down side for the Democrats is that as soon as the bill finally is signed into law, Republicans will immediately attack Obama and the Democrats for, well, every preventable death in America. No, really -- the attacks are going to be both vicious and incoherent. Someone has to wait for a specialist? It's Obama's fault. A rural area doesn't have enough doctors? Obama's fault. Medical error? Obama's fault. Health care bureaucracy gone wild? Obama's fault. Never mind whether these things are in any way at all connected to provisions of the bill that haven't yet been implemented; the attacks are coming, and the attacks will be magnified by Fox News and the rest of the gang. And that's just the stuff that will have happened; the sky is the limit as far as claims about what's going to happen any minute now.

Bottom line is that Democrats should continue placing a high priority on having some very concrete things to show for health care reform by 2010 and 2012, to balance out all the junk they're going to receive (attacks they can do virtually nothing to stop, by the way). Just as a guess, and based on nothing but speculation, I think the Senate bill does enough in that direction, but I do think thta Democrats in conference should place a very high priority on those short term effects.