Youve got to give it up for the political media: Somehow, through sheer force of will, weve actually managed to turn the most complex and consequential piece of legislation in decades into Washingtons version of March Madness just another step for American politics down the ruinous Road to Sports Center. No longer is the health care law about the uninsured or bending the cost curve, or any of that boring stuff. Now its all about beating the spread.
Can the Obama administration get to 6 million by the original enrollment deadline next week, or even after the extension into next month? Is it a victory if the president comes within 500,000 of the goal, or a crushing defeat? Maybe we can break it down in a chart.
The truth is that whether it takes six weeks or six months to meet the next arbitrary benchmark, the health care law is now embedded in the society, and its not going anywhere. So the only important, longer-term question, and the one that almost no one is talking about, is whether our ailing political system can actually function well enough to make it work.
I recently thought about a conversation I had with Max Baucus, then the chairman of the Senate Finance Committee and now ambassador to China, at around this time in 2009. Barack Obama and Democratic leaders on the Hill were just starting to open talks about a health care bill, and Baucus told me he was adamant about getting some Republicans behind it. He rejected the idea that Democrats could unilaterally push a contentious bill through the Senate with a simple majority, through a budget maneuver known as reconciliation which is exactly what ended up happening.
I asked Baucus why it mattered. Whether a bill passed with bipartisan acclaim or through the use of some arcane legislative gimmick, it would still be law, right?
Sure, Baucus told me, you could ram through a health care overhaul on a partisan vote. But you wouldnt be able to sustain it.
As it happened, Democrats didnt have a whole lot of choice. Republicans ultimately made a decision to oppose any reform, and it became clear that if Obama were going to achieve his partys 70-year goal of universal coverage, he was going to have to do it in a way that left Congress and the country deeply divided. Im not going to second-guess that strategy now.
But Baucus turned out to be prescient. He wasnt only saying that a law passed by one party alone would be litigated or overturned. Baucuss larger point was that this kind of sprawling social legislation, which Congress hadnt really endeavored to pass since the 1960s, doesnt end with a single vote. Inevitably, it needs to be tweaked and revised, as conditions change and unintended consequences reveal themselves. A massive undertaking like health care reform isnt so much a single law as it is a yearslong process, and one that requires some buy-in from both sides.
Look at Social Security, which Franklin Roosevelt signed into law in 1935, over the objections of factions in both parties. Just four years later, Congress made sweeping changes to the new program, expanding its reach to widows and fatherless children while also tinkering with the financing mechanism so that workers could see benefits sooner. It wasnt until the 1950s that agricultural and workers in service industries many of them African-Americans who had been left out of the initial law became beneficiaries, too. The Harvard sociologist Theda Skocpol, who has written extensively on the program, says it wasnt until the Nixon administration that Social Security really became enshrined as the untouchable program we know today.
The imperfect health care law will need tinkering, too. We may need to raise or otherwise amend the threshold of 50 employees that triggers a mandate for an employer to provide coverage, so that employers arent tempted to fire their 51st and 52nd full-time workers to avoid the mandate, and so that more workers can take advantage of the exchanges. Sen. Mark Begich, an Alaska Democrat, has proposed adding a new copper level policy choice to the exchanges, which would offer less expensive plans with less elaborate coverage, and broadening tax credits to make more small businesses eligible.
Such changes would affect only the coverage side of things, though; the more pressing concern in years ahead may well have to do with reining in costs. Looking to make the law politically palatable, Democrats front-loaded most of the benefits that were sure to be popular (eventually, anyway), while pushing off a lot of the cost-saving measures. Some liberal defenders of the law will tell you this is all well and good, because health care costs have been growing at a much lower rate recently anyway, which they attribute chiefly to the effects of the new law.
But in fact, economists say there are probably several explanations for the slowing growth in expenses chief among them that consumers simply seek less medical care during a steep recession. And this means that as the economy slowly rebounds, and as the retirement of the boomers accelerates, cost containment may once again become a pressing problem.
http://news.yahoo.com/what-really-matters-on-health-care--making-it-work-234038897.html
face it obama care is here to stay
Can the Obama administration get to 6 million by the original enrollment deadline next week, or even after the extension into next month? Is it a victory if the president comes within 500,000 of the goal, or a crushing defeat? Maybe we can break it down in a chart.
The truth is that whether it takes six weeks or six months to meet the next arbitrary benchmark, the health care law is now embedded in the society, and its not going anywhere. So the only important, longer-term question, and the one that almost no one is talking about, is whether our ailing political system can actually function well enough to make it work.
I recently thought about a conversation I had with Max Baucus, then the chairman of the Senate Finance Committee and now ambassador to China, at around this time in 2009. Barack Obama and Democratic leaders on the Hill were just starting to open talks about a health care bill, and Baucus told me he was adamant about getting some Republicans behind it. He rejected the idea that Democrats could unilaterally push a contentious bill through the Senate with a simple majority, through a budget maneuver known as reconciliation which is exactly what ended up happening.
I asked Baucus why it mattered. Whether a bill passed with bipartisan acclaim or through the use of some arcane legislative gimmick, it would still be law, right?
Sure, Baucus told me, you could ram through a health care overhaul on a partisan vote. But you wouldnt be able to sustain it.
As it happened, Democrats didnt have a whole lot of choice. Republicans ultimately made a decision to oppose any reform, and it became clear that if Obama were going to achieve his partys 70-year goal of universal coverage, he was going to have to do it in a way that left Congress and the country deeply divided. Im not going to second-guess that strategy now.
But Baucus turned out to be prescient. He wasnt only saying that a law passed by one party alone would be litigated or overturned. Baucuss larger point was that this kind of sprawling social legislation, which Congress hadnt really endeavored to pass since the 1960s, doesnt end with a single vote. Inevitably, it needs to be tweaked and revised, as conditions change and unintended consequences reveal themselves. A massive undertaking like health care reform isnt so much a single law as it is a yearslong process, and one that requires some buy-in from both sides.
Look at Social Security, which Franklin Roosevelt signed into law in 1935, over the objections of factions in both parties. Just four years later, Congress made sweeping changes to the new program, expanding its reach to widows and fatherless children while also tinkering with the financing mechanism so that workers could see benefits sooner. It wasnt until the 1950s that agricultural and workers in service industries many of them African-Americans who had been left out of the initial law became beneficiaries, too. The Harvard sociologist Theda Skocpol, who has written extensively on the program, says it wasnt until the Nixon administration that Social Security really became enshrined as the untouchable program we know today.
The imperfect health care law will need tinkering, too. We may need to raise or otherwise amend the threshold of 50 employees that triggers a mandate for an employer to provide coverage, so that employers arent tempted to fire their 51st and 52nd full-time workers to avoid the mandate, and so that more workers can take advantage of the exchanges. Sen. Mark Begich, an Alaska Democrat, has proposed adding a new copper level policy choice to the exchanges, which would offer less expensive plans with less elaborate coverage, and broadening tax credits to make more small businesses eligible.
Such changes would affect only the coverage side of things, though; the more pressing concern in years ahead may well have to do with reining in costs. Looking to make the law politically palatable, Democrats front-loaded most of the benefits that were sure to be popular (eventually, anyway), while pushing off a lot of the cost-saving measures. Some liberal defenders of the law will tell you this is all well and good, because health care costs have been growing at a much lower rate recently anyway, which they attribute chiefly to the effects of the new law.
But in fact, economists say there are probably several explanations for the slowing growth in expenses chief among them that consumers simply seek less medical care during a steep recession. And this means that as the economy slowly rebounds, and as the retirement of the boomers accelerates, cost containment may once again become a pressing problem.
http://news.yahoo.com/what-really-matters-on-health-care--making-it-work-234038897.html
face it obama care is here to stay
