While there are many other technical changes, the most significant features
of reform -- the establishment of the insurance exchanges, the ending of denials
for pre-existing conditions, and the enforcement of an individual mandate to buy
insurance, along with subsidies for those with low and middle incomes -- don't
happen until 2013. This is true of the Senate bills as well and will almost
certainly be true of whatever bill emerges from the conference committee that
will reconcile the bills that pass each house.
Why? While things like setting up exchanges and implementing an
individual mandate could take some time, the real reason is money -- namely,
that by delaying the implementation of the reforms for a few years, the total
cost of the bill becomes much lower. That total, which will likely end up
somewhere between the $774 billion plan put forth by Sen. Max Baucus and the
$1.04 trillion plan passed through three House committees, is calculated by the
Congressional Budget Office for a 10-year window from the point the bill is
passed. Speed up implementation by an extra year, and you could add $100 billion
to the cost. And since President Obama has pledged that the bill will be
entirely paid for by spending cuts and new taxes, that would mean coming up with
more spending cuts or more taxes, something few in Congress have a taste
for.
So when reform passes, our deeply pathological health-care system
will remain nearly as pathological for three full years. That's three years of
people being denied care because of pre-existing conditions, three years of
climbing premiums, three years of "job lock," three years of families going
bankrupt when they get sick and discover all the exclusions and limits of their
insurance, and three years in which millions of Americans (46.3 million at last
count) go without any insurance at all. A recent study from Harvard Medical
School found that 45,000 Americans die every year because of lack of health
coverage, which means 135,000 will die while they wait for reform to take
effect.
At that glacial pace, we'll have a revolution and a switch back to Republican control, who will rescind all the changes before they even take place. What is wrong with these people?
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