Assume this passes; what happens afterward? I don’t think that many people believe that the answer is “Nothing: the bill becomes law, and we sing happy smurf songs all the way to the longest life expectancy in the Western world!” Even the bill’s proponents expect it will need some follow-up work. But what will that follow-up work look like?
Her view of the worst case scenario for Democrats is that a reaction not unlike that which followed the Catastrophic Care Act of 1988 sets in. I’ve been reminding of that possibility for some time. That’s what always occurs to me when progressives chortle about the enduring character of entitlements. It ain’t necessarily so.
To refresh your memory the Medicare Catastrophic Care Act of 1988 was an amendment to the Medicare Act passed under Ronald Reagan. It provided protection against catastrophic medical expenses under the aegis of the Medicare system and, indeed, it’s not a bad idea and not dissimilar to things that I’ve seen proposed lately. Despite its merits the system was phenomenally unpopular for a fairly obvious reason: the benefit was paid for with a Medicare premium tax to be paid by everyone eligible for Medicare.
Human nature is remarkably durable over time; just as today people have little problem with accepting benefits, it’s paying the tab they don’t much care for. The act was repealed in a panic as long-serving Congressmen came under heavy fire for their support of the act.
Here’s my prediction. The House will ultimately pass the Senate bill. The Congress will then add more benefits and repeal the meager curve-bending components of healthcare reform via reconciliation. People will see tax increases, premium increases, employers dropping their employee insurance plans at an accelerating rate, and not much in the way of benefits (that’s the way the law is written). Will the Congress then repeal the bill in a panic? Beats me. Either way we’ll be in worse shape than we would have been in had we done nothing, passed Wyden-Bennett, or about a half dozen other approaches.
Congress will have lost its appetite for healthcare reform (although progressive strategists will not). And Medicare’s default will be that much closer.