Wednesday, April 28, 2010

The Democrats' Long Game on Health Care

If you read the conservative press, you'll see a litany of stories about how the health care bill is already showing signs of trouble. It'll increase costs, they say. It'll force people to change insurers, they say, or even to change doctors. It'll increase budget deficits, they say. It'll create moral hazard for people to game the system (as they have in Massachusetts under a similar plan), they say. All of this runs counter to the Obama administration's statements during the debate about the bill.

I can't, however, shake the feeling that this is all part of the plan. Of course a massive reform of our health care system is going to cause unexpected consequences, many of them painful. Of course you can't increase coverage massively while also cutting costs. Surely the Democrats know this. So what, exactly, is the plan?

It's simply this: the worse, the better. The existing bill is a horrendous mishmash of conflicting measures, poorly-understood provisions, and possibly unenforceable and/or unconstitutional mandates. This will all become apparent in a few years. And when it does, what will the Democrats say? Think they'll say, Oh, sorry, we were wrong, now we're ready to consider the Republican ideas? No. They'll say: See what happens when we're forced to compromise?

President Obama is already getting ahead of this. He laments the exigencies of democracy. If only, he said, he could have crafted a perfect bill with an academic imprimatur and no messy legislative fingerprints. That "perfect" bill will, of course, be single payer. Next time this comes around, that's what they're going to demand. Enough compromise, they'll say. It's time for purity.

The conservative pundits highlighting the problems are not wrong to do so, though. Their hope is that all or part of the bill might actually be repealed before it's implemented. This won't happen before 2013 at the earliest, because of Presidential veto power, and it's unlikely even then. But pointing out all the flaws as they become apparent is the best way to swing enough public opinion to make repeal a possibility. So more power to them... but watch out for the other side's long-term strategy.

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