Thursday, November 19, 2009

What We’ll Remember

Ezra Klein of the Washington Post has a first look at what is in the Senate’s version of the healthcare bill.

The numbers came first. The Senate bill, we now know, costs a smidge under $850 billion during its first 10 years, cuts the deficit by $127 billion, and covers 31 million people. In the second decade, it cuts the deficit by an improbably large $650 billion. But we don’t know anything else. We haven’t seen the CBO’s full score yet, nor do we know any of the specifics in the bill. Reid’s office released the numbers before it let anyone see the language. It wants the numbers burned into the media’s mind. They’re the message, at least for now.

In a way, it’s fitting. Health-care reform is increasingly hostage to numbers that are disconnected from the reality of the bill and its purpose. It’s a real victory to push your bill below $850 billion if the point is to get it below $900 billion. But what if that’s not the point? Most experts think the bill needs about $1.2 trillion to be truly affordable. Compromising beneath $900 billion might be necessary, but it’s nothing to celebrate. It’s a concession, not an accomplishment.

It is, in fact, quite far from the questions that will determine the bill’s success. In 10 years, no one will remember whether the bill cost more or less than $850 billion, and I doubt that the public option, if it remains in the legislation, will be particularly relevant either. They’ll remember whether the bill worked — whether it covered people at a price they could afford, and began the overdue and urgent work of cost control.

It’s part of the collective short-term memory loss that we all have; we quickly forget how much we paid for something if it gives us what we want or need. Quick; how much did the Medicare prescription benefit cost when the Republicans passed it in 2003? ($42.75 billion, and none of it paid for, but it’s working so who cares?) That’s why the US Chamber of Commerce anti-healthcare reform ads on cable TV, replete with grainy monochrome pictures and scary music that warn us about the cost of the bill Congress is considering (which, based on the scary talking points, is woefully out of date with what actually passed), are falling flat. Trying to scare people into calling their congressperson because healthcare might be expensive is a waste of time; the American people don’t care how much healthcare costs the taxpayer, they care about how much it will cost them.

That also holds true for the philosophical part of reforming healthcare. We’ve heard a lot of noise about socialized medicine and bureaucrats getting between you and your doctor. As a lot of people have noted, we already have socialized medicine in the form of the VA health administration, Medicare, and Medicaid. Under the steaming cloud of irony, a lot of people at the town hall meetings this summer were adamant about keeping the government out of meddling with Medicare and VA benefits. As for bureaucrats getting between you and your doctor, we have that already in the form of insurance company regulators who view domestic violence as a pre-existing condition.

We’re now about to enter the granular phase of the healthcare debate and for the next few weeks we’re going to get breaking news and breathless stories about who’s meeting with Senate Majority Leader Harry Reid and the delaying tactics of the GOP who, one hopes, will drop all their pretense of worrying about the deficit and just come out and say they don’t want to pass the bill because they know that by the time the next presidential election comes around, the voters will remember who voted against healthcare.