The result is a 10-year, trillion-dollar contraption full of political risk and unintended consequences for a health-care system that constitutes one sixth of the economy. Many of the people who will benefit directly from the reforms, the uninsured, don’t vote. Insurance premiums will continue to shoot up for most of us; Democrats fret that they will be blamed for those increases in the 2010 elections. Some regulations on the industry kick in immediately, but most don’t begin until at least 2013. And yet, to allow the bill to “save” money in the first decade, most new taxes and fees go into effect immediately. “We’re collecting money before we’re giving all the benefits!” lamented a Democratic senator facing reelection. “That is a political disaster.”
Maybe for that guy and his congressional colleagues, but what about Obama? For now, he is safely behind a blast wall, since many of the law’s features wouldn’t come into play until his second term, if he has one. But if he’s lucky enough to get that far, he will discover that even simple things in government never go as planned; a project as large and complex as his health-care “fix” is certain to be more costly and disruptive than anticipated, and in ways no one can predict. “Never allow a crisis to go to waste,” Emanuel declared a year ago. “They are opportunities to do big things.” Yes they are, but Obama has to hope he’s not creating another crisis in the process.
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