Health care reform's costs will be enormous
The victory came ugly and it was narrow. But it was also sweet. It was historic and, politically, it was big.
The question is: Will the passage of health care reform also prove a Pyrrhic victory for Democrats -- one that will devastate the winners in the 2010 elections?
Republicans think so, citing polls showing health care reform to be deeply unpopular.
As former speaker Newt Gingrich, declared in an e-mail blast Wednesday -- titled "This Will Not Stand" -- "in every recent poll, the vast majority of Americans opposed this monstrosity."
That was largely true up to the moment that the House passed the health care bill Sunday. But on Tuesday, the USA Today/Gallup poll show-ed that opinion had flipped and that, by 49 percent to 40 percent, those polled said it was "a good thing" that health care passed.
And, on closer examination, the most negative of the pre-vote polls showed a silver lining for Democrats.
The top line of the March 19 to 21 CNN/Opinion Research poll showed that, by 59 percent to 39 percent, voters opposed the bill that the House was about to vote on.
But when asked why, 13 percent of those opposed said the bill was "not liberal enough." Add them to the 39 percent in favor, and the balance came out 52 percent in support and 43 percent against, just about President Barack Obama's margin of victory in 2008.
Almost certainly, Democratic voters will be energized by their party's achievement of the long-sought goal of near-universal insurance coverage -- for sure, compared to the demoralization that failure would have produced.
And, they may be further motivated by the ugliness demonstrated by Tea Party opponents of the measure -- racist and homophobic slurs and threats of violence -- and the condoning of misbehavior by some Republican leaders.
The chances are, with unemployment remaining high, Republicans will score major gains in the November election.
Moreover, seniors, who vote, remain opposed to health care reform, while young and poor people, who favor it, don't vote.
But Speaker Nancy Pelosi , D-Calif., had it right in one major argument that she used to sway wavering members: You're going to get attacked whether we win or lose, and if we lose, you'll have nothing to show for it.
Now Democrats have something to show -- 32 million people now without health insurance will have it, though not until 2014.
But almost immediately, insurance companies will not be able to deny coverage to children based on pre-existing illnesses, will not be able to cancel the insurance of those who are sick and will not be able to impose lifetime benefit limits.
Moreover, parents will be able to cover their dependent children up to age 26.
All this will come at huge cost, of course. As Republicans, led by Rep. Paul Ryan, R-Wis., have demonstrated repeatedly, health care reform will balloon the federal deficit, not contain it, when all costs are figured in, especially the forthcoming $371 billion "fix" to protect doctors from Medicare cuts.
Insurance premiums will rise even faster than they would otherwise because the government is mandating increased coverage without guaranteeing that everyone will have to buy insurance.
The overall health care cost "curve" will bend even more steeply upward -- contrary to Democratic claims -- as 32 million more people have access to health coverage and a finite supply of doctor and hospital services.
Cost-containment mechanisms in the Democratic legislation are largely experimental, including changes in fee-for-service medicine, comparative effectiveness measures and a commission to impose Medicare cuts.
Nothing in the bill enlists patients to be cost-conscious consumers. In fact, to placate labor unions, the final version weakened the effect of the tax on "Cadillac" insurance, one of the few certain cost savers in the legislation.
Republicans are right in asserting that, instead of reducing unsustainable entitlement costs, the Democrats have created a massive new entitlement that will add to the burden of debt piled on the next generation, menacing the nation's long-term well-being.
And they are right to say that health care was passed with special interest deals; in secret, Democrats-only negotiations; and with some votes "purchased" with state-specific benefits.
Independent voters, the Gallup poll showed, disliked the way Democrats in Congress handled health care by a wide margin, 37 percent to 22 percent.
Yet, at the end of the day, Democrats won and Republicans lost. Obama emerged stronger, not weaker. That may help Democrats avoid a wipeout in November.
Morton Kondracke is executive editor of Roll Call, the newspaper of Capitol Hill.