RALEIGH – After months of maneuver, bluster, blather, and bullying, Democratic leaders have now moved sweeping health care bills through both houses of Congress. The bills differ significantly and will probably have to be melded in a conference committee.
So what happens next? I’m not quite sure, and I’m not sure that the proponents of ObamaCare know, either.
The plan is unpopular and likely to become more so. The vast majority of Americans have correctly deduced that it will not lower health-care costs, the goal that President Obama claims was the top priority all along. What the bill will do, as health care economist John Goodman explains in this blog post, is destroy any viable market for true health insurance while nationalizing the resulting, heavily regulated health-plan industry.
Essentially, health care finance will become a public utility run out of Washington. Fewer and fewer Americans will have any idea how much their medical care actually costs, so the only way to control health expenditures in the future will be through government rationing.
The Democratic leadership is smart enough to know that its handiwork has antagonized independents, mobilized conservatives, and disappointed leftists hoping for an instant government monopoly. Politically, ObamaCare seems to be a sure loser. So why continue the effort?
I think most of the leading Democrats, the president included, are confident enough to believe that they can weather the storm in 2010 and remain in power in Washington. They are willing to pay a modest political price for the sake of creating a new subsidy and regulatory apparatus that, once fully implemented, will permanently move American politics leftward as millions of Americans become dependent on annual health care handouts.
Furthermore, while they’ve postponed most of the mandates and regulations in the plan until 2013 or beyond, they don’t think that a Republican resurgence in 2010 will halt implementation. Republican legislation to repeal all or parts of ObamaCare would be subject to the same filibuster barrier that Democrats just scaled. And there’s even some talk that the Senate bill contains provisions that future Congresses can’t repeal, though I don’t see how that’s possible.
As for the policy itself, I think that liberals believe that, regardless of what they say now, most Americans will come to appreciate ObamaCare eventually. Indeed, many liberals are truly mystified at the current public opposition, arguing that most Americans should be gratified to be net recipients of federal aid – receiving more in premium support than they’ll pay in new taxes or fines. They consider the current polls to be evidence of a kind of false consciousness, a misunderstanding of where the interests of the middle class truly lie.
But this is not yet Europe. Most Americans don’t yet believe that they are entitled to steal from their more-prosperous neighbors through an expanded welfare state. While Americans have gotten used to the idea that Washington can compel them to set aside their own money, through payroll taxes, to fund Social Security and Medicare benefits when they retire, most voters are properly suspicious that additional middle-class entitlements are affordable, workable, or laudable. (The fact that the current Social Security and Medicare programs already redistribute income to some degree is not widely appreciated, as many people think they “pay” for their benefits during their working years.)
So supporters of ObamaCare are counting on two things: that the plan will grow in popularity over time and that it will pay off politically. I remain unconvinced.
More important right now are the short-term effects. If a final bill must again work its way through both houses, there remain opportunities for opponents to prevail. Many Democrats in swing districts, asked to sign their own political death warrants, may balk. And the language on abortion required to break the Senate filibuster may prove impossible for dozens of liberal House Democrats to swallow.
The story isn’t over. Here’s something we already know about it, though – it’s heavy on the fantasy, light on the reality.
Hood is president of the John Locke Foundation