The Inevitable Health Care Reform Letdown


One of the problems for health care reformers is that they've had to both promise that their legislation will bring about both a world of difference and not much change. Things will be much better under reform, we're told, but if you like what you've got now, nothing will change.

The fact is, for many, maybe most, people, not much will change: For those on employer plans, premiums will probably rise faster over time than they would have, and depending on what sort of exchange and public plan options get put in place, some number of people might find their employers dropping coverage—leaving employees to buy coverage through the exchange.

But of course, Democrats have had to sell health care reform as the solution to all our health care problems. Certainly, many less politically informed voters are likely to think of it that way. And as a result, I suspect lots of people aren't going to be too happy if reform passes and then things don't change much. The fact is, even if reform passes, many people who don't like their health care situation aren't going to see much improvement. And, as Politico explains, that could have some consequences:

After all the controversy over the public option, people might think that everyone can sign up right away if Congress passes health reform.

Or that insurance premiums will go down.

Or that they'll be able to shop around for insurance if they don't like what their company offers.

Think again.

When it comes to the public option, for instance, only about 1 in 10 Americans will be eligible, mainly people who don't get insurance through work. Only about 6 million are expected to enroll. The plan doesn't even start until 2013.

And most people who get insurance on the job would have to stick with it. No shopping in the new "insurance exchanges" for them.

President Barack Obama and Democrats in Congress stand to reap the political rewards if they can pull off health reform, by achieving near-universal coverage, toughening regulations on private insurers and transforming the way health care is delivered.

But Democrats have glossed over nagging details of just how limited reform's reach would be for some Americans. And if voters figure it out, experts warn there could be a political backlash. 

On a note that's scary in a different way, the piece quotes Harvard health policy professor Robert Blendon as saying that even if the bill passes, the health care issue is never going to go away:

If the bill becomes law, Blendon said, the campaign for maintaining support for health care reform would only just begin. "It is not really over in people's mind," he said.

This is one of the side-effects of health care reform I suspect people think about less: Reform won't just mess up our health care system, it will infect our political system; the more our politics and our health care are tied together, the more our political debates will become indistinguishable from our health care debates. They'll become permanently intertwined, going on and on, forever and ever, cable news without end.