December 7, 2009
by Hanns Kuttner
Sometimes the drama in Washington, D.C., is real and sometimes it is like the theater, filled with emotion generated by actors’ skill.
Last year at this time, we had real drama. The economy was at the edge of an abyss. The situation was urgent. Doing nothing posed a greater danger than doing the wrong thing.
This year, Congress is tackling health reform. The Senate majority leader, Sen. Harry Reid, says he will keep the Senate in session during evenings and weekends if necessary to pass a health reform bill before Christmas.
This drama is theatrical. It involves the use of urgent rhetoric to push a plan that will not produce change for some time.
The number of people who do not have health insurance supplies the first fact favoring urgency. In 2008, 47 million Americans did not have health insurance, and given what has happened in the economy since then, the number is almost surely higher now.
Yet the parts of the bill before the Senate that would bring health insurance to millions would not take effect until Jan. 1, 2014. The four-year wait to help people without health insurance shows that the drama unfolding in the Senate is melodrama. Images of people facing bankruptcy or unable to buy medicine are being used to force senators to vote before they finish asking questions or talk to many of their constituents.
It was less than one year from the time Lyndon Johnson signed Medicare into law on July 30, 1965, that the first senior citizen entered a hospital knowing that Medicare would pay for the hospital stay.
Even if the Senate acts before Christmas, the House-Senate differences quickly resolve and the legislation reaches President Barack Obama before he gives his State of the Union address at the end of January, it would be almost four years until millions of people got help. Speeding up the legislative process won’t speed help to the uninsured.
This long delay reflects two factors. First, this is a complex plan, much more complex than Medicare. Much of the plan does not yet exist. The software industry would call this “vaporware,” something marketed before it is ready to ship.
Rather than taking the time to figure out all the details, Congress would leave many decisions to be made by the executive branch over the next few years.
Second, the delay responds to budget rules.
The president has said he does not want health reform to add to the deficit. Thus some parts that generate offsets to spending, like lower payment to health care providers under Medicare and the income tax surcharge, would start before 2014. That allows savings to pile up before the spending starts. Starting offsets first makes a more expensive plan look affordable.
Getting a program in place by Jan. 1, 2014, does not require the Senate to finish this month. The Senate could be debating health care reform well into 2010 and the plan could still get going on Jan. 1, 2014.
The additional time would allow Congress to assemble more of the product before shipping it to the American people. And it would let members learn how their constituents feel about the fine print.
Last fall, Congress gave the secretary of the Treasury hundreds of billions of dollars to save the financial system. The plan was half-baked when presented to Congress and still a work in progress when it was signed into law days later. Had Congress not acted, there’s a good chance that the economic problems of the last year would have been worse. That was a case of real urgency.
The number of people without health insurance may be urgent. But when the proposed solutions do not take effect for nearly four years, one wonders why there is such a rush to pass legislation.
Unlike the financial rescue, health care reform can surely move at a pace that allows more conversation between legislators and their constituents — first, about how all this would work, and second, whether the American people want it.
Hanns Kuttner is a Visiting Fellow at Hudson, working on the Institute's Future of Innovation Initiative.
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