Well, it is done. Obama has signed the Senate bill into law. Americans now have a statutory right to health insurance, and in most if not all cases a right to have someone else pay for that insurance. I believe we have only the dimmest understanding of the full consequences of this legislation. It will raise taxes. Its cost-controls are unproven and trivial. The bill will increase demand for a fixed commodity and thus increase the overall price of that commodity. So health care spending will continue to rise as more people enter the system, the population gets older, and technology continues to improve. Susan Ferrechio runs through the various unintended consequences here.
Even when the exchanges become fully operational, not everyone will be insured. The penalty for violating the mandate is too small to coerce universal compliance. In fact, as Scott Gottlieb points out, it is quite likely that there will be more uninsured in the medium run as businesses fob off their employees to the exchanges and those employees who do not receive subsidies (43 percent of the individual market, according to CBO) cannot afford the higher premiums for government-mandated insurance. Liberals will respond to this crisis of their own making by calling for an increase to subsidies, a public option, or universal Medicare.
But leave all that aside for a moment. What I don't understand is the media compliance in the massive White House spin operation now underway. Yes, the health bill signing is a historic achievement -- the realization of a liberal dream that also puts us one step closer to national insolvency. And perhaps it is better for the Democrats to have something to run on in the fall rather than nothing. Even so, reading the accolades, you get the impression that the Democrats have just averted electoral disaster and the Republicans have committed a catastrophic political error in opposing a flawed and expensive big-government bill.
Please. All of this is partisan posturing. The truth is, we really don't know what will happen in November. But the underlying facts are these: The public and the GOP, and a not insignificant number of Democrats, oppose the Senate bill. The electorate is ideologically divided, with independents swinging right. Republicans are running even or better in the generic ballot. They need a 40-seat pickup to take back the House. The 49 House Democrats from districts who supported McCain are in real danger. The Congress is exhausted. Democrats must defend the legislation they passed by a slim, partisan margin. Unemployment remains high and the president's economic recovery program is not what you'd call a tremendous success.
Does the president have momentum? Of course. But memories are short. The momentum may not last. Michael Tomasky: "A mere forty-eight hours ago, Barack Obama was a struggling president, even a likely one-termer. Today, in the wake of the House’s narrow passage of the health-reform bill—which is to say, on the strength of a grand total of four votes, which if cast the other way would have ensured reform’s defeat—he’s suddenly once again a political mastermind and one of the most consequential presidents of the last half-century!"
Also do not forget that Obama's final argument to the House Democrats was an argument from weakness -- vote for this, he implored, or else my presidency is finished. He got 219 votes.
Conservatives and Republicans may not be able to undo fully the damage this legislation does to government finances, insurance markets, and the American economy. But, as someone once said, the work goes on. The cause endures. The hope still lives. And the dream shall never die.