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Instead of cheering or jeering the House passage of the Health – I mean, the lobbyist-corporate – Insurance Reform bill, let’s assess winners and losers. Others have depicted the relative, rather delayed strengths (wider coverage, no life-time limits, added users) and weaknesses (no cost control, no public option, thus no competition, four long years for insurance lawyers to get around onerous aspects, no incentives to expand medical worker/doctor services).
1) Obama and his right-leaning, centrist White House. Specific provisions aside, the bill shows the party in power can execute – political symbolism always precedes real-world changes, with surer electoral impact. Honor is due: this is the first big political win for the first pro-government, big-city, northern president since Jack Kennedy, that is, in living memory. Note, I didn’t say “liberal” or “progressive” president, for that’s now less likely. Whatever Rahm Emanuel lost in reputation by pushing a fragmented approach (enemy to the public option) gets offset by corralling House Blue Dogs, reinforcing his Congressional clout and cementing his job. The status quo is unshaken; Rahm rules still.
2) Democratic leadership in the House and Senate delivered, kept wobbly coalitions together, and piloted through storms for an incredibly (unnecessarily) extended period. Leadership won a victory on a tough issue, despite being swamped by anti-reform millions and assassination politics.
3) Millions of eventually-insured new patients will join up thanks to tax subsidies. Join up under duress but whatever.
4) Hospitals, especially money-losers, will benefit from stability, consistent customers, and greater efficiencies.
5) Large insurers, big pharma, and health service companies: many stock prices rose the morning after this fat pill because a) they weren’t savaged, quite the contrary; b) the immediate future is now predictable, and c) massive lobbyist-peddling worked, enhancing this covert corporate takeover of any regulatory government “takeover.”
6) Centrist, Liberal Democratic House members with something, finally, worth bragging about, with six months to election. Generally, big bills gets more popular after passage, especially when absurd partisan claims turn out completely wrong. Also, after surviving any fake scare, people embrace what majority rule produces as inevitable and comfortable, the “law of the land.” Modifications are typical but only that rare bird, like Prohibition, gets repealed.
7) Rightwing fringe fundraising gains if able to leverage rage over this high-handed, unAmerican “takeover of the country” everyone knows belongs to the Tea Party. Forcing people to buy insurance for just being Americans offends the right, with or without subsidies. And yet, the more the fringe appears racist, toxic, and fascist, the less electoral positives they have, taking less radical GOPers down with them. “Kill the bill” frenzy hurts Republicans when morphing into “kill the bill makers” (alongside totally irrelevant anti-black and anti-gay smears).
1) Republican leadership, especially media talking heads, who displayed far more self-righteous indignation and delayed obfuscation than ultimately power or leverage. Just Saying No is no positive for centrists. Worse to come I predict after full-throated Democratic Party sales pitches convince Americans this reform is a game-changer, akin to Medicare or Civil Rights (even if in fact closer to Bush’s corporate-friendly prescription drug bill or Clinton’s NAFTA success). Rightly skeptical of budget savings from any blockbuster program, the GOP will not ride health reform to take over Congress. Top Democratic slogans should impugn Repugs for defending a system already “pulling the plug on grandma,” its party’s anti-health hysteria its own “death panel.” Every controversial, costly big bill starts out with millions of doubters, but this one, so open-ended, won’t be hard to sell as another of the public’s God-given “rights.”
2) Progressives: Arguably, all Democrats but progressives (Blue Dogs, unions, women, pragmatists, conservative Dems) got something of high value. Progressives were shut out, and I fear the anti-progressive Obama-Axelrod-Emanuel Way (default big-time to Congress massaged by lobbyists) got strongly reinforced: if a system-serving, right-leaning centrist coalition wins the president this impressive a victory, why change tactics? With leftists like Kucinich folding without much to show, why should this incredibly wary White House listen to the left on anything? Why should progressives get their way on climate or energy or business regulations, arguably less passionate issues to the base? I see no reason Emanuel backs off his career-making assault against progressives. I see nothing here to dissuade this risk-adverse president from staying right-center all the way to re-election.
3) Single-payer, universal health, Medicare buy-in proponents: ObamaCare is the law of the land for the next decade, despite higher than expected costs and big trade-offs and likely judicial takeaways by radical jurists way before we get to the Supreme Court.
4) Political pundits and prognosticators (predicting no bill or doomsday) especially on the right. FOX News won’t gain much centrist credibility for nonstop fulmigation of indefensible distortions and fear-bating. Rush Limbaugh sounds increasingly crazed and racist. Right-leaning CNN won’t gain, having made rightwing frenzy and advocates equal to adult centrist and liberal voices talking reality and solutions, not ideology.
5) Medical cost control, Access: Cost is going up, by formal projections, and shortages are predictable: add great demand without enhancing supply (office space and doctors-nurses) encourages an eventual two-tier class systems, plus pushes up prices. Small companies with 60 employees may drop to 50, below the size for mandated coverage; doctors or hospitals may restrict lower-paying customers. Where are programs that train more talent, grow small-town clinics, or address higher demand issues? What if stretched facilities and medical schedules produce more malpractice litigation or unprovable mistakes, thus lowering overall quality of care?
Complexity means Unintended Consequences
Add your own winners and losers. No doubt, with any complex, national program (with 50 separate state systems and adjustments) that takes four years to start, there will be unintended circumstances, certainly negative impacts, and unpredictable outcomes demanding serious modifications. Will there be the political will to fix what’s broken or reign in skyrocketing prices? Will industry lobbyists show more restraint or openness to compromise? Unlikely, since the industry, like the credit card issuers, will have four years to concentrate power, by 2014 massively well defended against doing what they don’t like.
Finally, who knows – the political rightwing may convince a majority ObamaCare is really a “government takeover” with noxious “death panels” and neutralize it politically. Enough reaction could make today’s “corporate takeover” now in charge look good. That disaster reifies for another century health care as for-profit, high-growth business with lots more forced customers and no incentive to lower prices or improve quality. You know, like today’s flying buses. Oh goody.