Passage of this bill is too big for my little brain, and therefore I’ll share some small comments. I’m going to leave out the many anecdotes which orient me around stupid red tape conflicts in the US, how much better my health care was in Canada (and how some Canadian friends flew to the US for optional procedures), etc.
I am glad that some of the worst elements of the American health care system are getting reined in. I can think of few worse ways to accomplish that goal, and many better ones. People thinking as I do are why the system perpetuated in the form that it did.
I am pessimistic that the system proposed will achieve its broader goals. The Massachusetts model is cumbersome and ineffective. Optimistic ideas about how prices would fall in a regulated market did not come to pass. The likely next step is a government run health system with supplemental insurance available. I expect this will come to pass in 10-20 years. Medicare seems reasonably well run for an American government program.
The Republican failure to push a coherent and principled alternative will haunt them. Going into the next election cycles, 32 million people will have some idea that the Democrats gave them
bread and circuses health care. David Frum describes it as a Waterloo. I’m hopeful but not optimistic that the Tea Bagger Party will follow in the tradition of the Know Nothings and just fade away. I used to be hopeful that the Libertarians would split from the Republicans, but they’ve failed to. I would not be surprised to see the Republican minority shrink in 2010 and 2012, and I think some (but not all) of the shrillness I hear is people who fear that outcome is now inevitable.
I do expect that removing the health care impediment to entrepreneurship will be very positive for smaller companies. I wish we’d apply that same thinking to health care, enable people to make choices for themselves, and let the government own the residual risks, as it does today. But no one offered a credible way to un-couple employment and insurance that would let people keep their doctors, short of nationalization.
Anyway, there’s my negative 8 cents on the bill.
Please keep comments civil.