Many random thoughts on health care reform passage

1) Hooray!!!  This is a very big deal. This is hugely important legislation and it is damn good legislation.  Sure, it's not perfect– what is– but it sets down a structure that can be improved upon.  Want a public option to compete with private insurers in the exchange– it can be done.  Want to open up the exchanges to all employers to start moving us away from an employer-based system– it can be done.  Want to implement more Medicare-based priced controls to drive the market– it will be done.  And, there's a good chance these things will happen in the medium-term.  This bill extends health coverage to millions of Americans who otherwise would not have it– that saves lives and makes many, many lives a hell of a lot better.  It also makes a very important start on cost controls.  This part needs some work, but the CBO estimates on cost control are pessimistic, if anything, and very importantly, we've got basic structures in place that make getting costs down further much more technically and politically feasible. 

2) The Republican party has absolutely embarrassed themselves on this issue.  They've completed foregone any shred of intellectual dignity they have had.  From "death panels" to arguing about a "socialist government takeover" of medicine, their rhetoric has been absolutely absurd and intellectually incoherent.  We could have actually had a better plan, e.g., a more effective excise tax, more movement away from an employer-based system, if the Republicans did not demagogue the issue so.  Of course, in many ways, given the stunning ignorance of so many Republicans in Congress, I'm not sure it could've been any other way.  In his recent visit to NCSU, David Frum suggested that their might be only a dozen or so Republicans in the House who truly understand policy.  I won't even waste but a sentence on the tea-baggers.  Talk about embarrassing– what complete and total ignorant buffoons they are (oh, and racist, too). 

3) As Ezra Klein has pointed out repeatedly (and I think I parroted here), this is quite a moderate and centrist bill– bipartisan in spirit, if not actual practice.  This is pretty similar to what moderate Republicans were proposing in the 1990's.  That said, in one sense it is actually not so moderate any more.  It is clearly liberal.  And that's not because of anything about liberals or Democrats, but because Republicans are in the process of driving themselves off a rightward cliff.  Thus, what used to be considered centrist (e.g., market-based health care reforms; market based energy policy reform), is now clearly liberal because the Republicans have gone so far right. 

4) It was an interesting development the way in which abortion, which really has nothing to do with this bill, almost brought it crashing down.  In the end, Obama's executive order was nothing but a face-saving move for Stupak and friends to walk back from their intellectually untenable position. What I'll take away from this aspect…the US Conference of Catholic Bishops behaved in a shockingly ignorant and immoral (yes, immoral, damnit) manner.  They were willing to sacrifice the lives of tens of thousands already-born Americans for legislation, which, in all likelihood would diminish, rather than increase abortions.  Also, the institutional right-to-life movement showed themselves to be nothing more than an arm of the Republican party.  A recent NRLC committee claimed this to be the "most pro-abortion legislation" in history.  Talk about a lack of intellectual credibility.  I actually used to be somewhat sympathetic to the pro-life movement, but they have shown repeatedly that their interests in life end at birth and that they have decided whatever is good for the Republican party is good for them. 

5) The Democrats are going to lose a lot of seats in 2010.  But not because of the health care vote.  The economy is still very weak and the Democrats are overextended after two very strong Congressional elections.  It's inevitable to lose a lot of seats.  They would be so much worse off if health care reform had failed.  That would've have allowed Republicans to completely define the issue and why it failed; and showed the Democrats to be completely ineffectual.  I think I heard EJ Dionne on the radio say today something to the effect of, the only thing worse than a socialist is an ineffectual socialist.  The press and the country for the longest time has been totally focused on the process.  We're done with the sausage metaphors!  Except this: sausage is awfully tasty.  Of course, a lot of the taste doesn't kick in till 2014, but we've got some good nibbles to take effect soon (e.g., closing the Medicare donut hole; allowing young adults to stay on parents' insurance until 26).  The Democrats can now actually defend a good solid bill, not just mythical abstractions and lies (not that the Republicans won't keep lying, but at this point the media can be much more straightforward in rebutting lies). 

6) I've basically been obsessed with the issue for probably about a year and a half and paying real close attention ever since I started teaching Public Policy in the Fall of 2000.  I think I shall always remain a health care policy wonk (now that I think about it, I did an undergraduate paper comparing European health systems way back sophomore year in college), but I'm looking forward to not being totally obsessed with the present political battle. That said, there's still lots of room for improvement in our health care policy that I look forward to following, but, this jumped us at least half-way up the staircase.

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