Tuesday, June 23, 2009

"Predictions: What Will Happen With Health Reform?"

Ezra Klein:
These days, about one in three conversations I have includes the question, "What's going to happen with health reform?" So for ease of use, I'll just put my prediction here: I think health reform is going to go the way of stimulus.
The stimulus was a huge and important accomplishment. If you had told liberals in 2007 that they were going to pass an $800 billion dollar spending bill that made good on decades of promises about infrastructure rebuilding and comparative effectiveness research and train construction and broadband internet and green energy, they would have laughed at you.

But by the time the bill actually wound its way through Congress, most liberals were frustrated by the outcome: A few Senate moderates had lopped $100 billion in spending off of the total and done so for no apparent reason. Top economists said that the legislation, though helpful, would not be enough to close the output gap and should thus be larger. The stimulus was a historic legislative accomplishment that nevertheless left liberals frustrated because they made concessions they didn't see any reason to make and ended up with a bill that they knew would not fully solve the problem.

That, I'd bet, is how health reform will close out as well. We will spend a trillion or a bit more covering the un- and underinsured. We will regulate a fairer and more decent insurance market into existence. We will expand Medicaid and build out subsidies to at least 300 percent of poverty and create health insurance exchanges. We will fund all this through sharply progressive taxes. We may even have a public plan. In 2006, it would have been a great deal. But as the legislation winds its way through the Senate, there will be unpleasant compromises, and unconscionable omissions, and the constant knowledge that though this is progress, it is not sufficient, and the people who stand in the way of a better bill are frequently incoherent or disingenuous. And that will be terribly frustrating for supports of the effort.
The result will probably be a historic win when compared to the status quo, but I doubt it's going to feel like that for supporters of the initiative.

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