“I am not the first President to take up this cause, but I am determined to be the last,” President Barack Obama declared during his health care speech to a joint session of Congress last September.
Last night’s historic vote to pass comprehensive health care legislation means a lot of things, but it does not end the health care debate in America--not by a long shot.
When Obama signs the largest government expansion of entitlements since the introduction of Medicare, he will be ensuring that health care becomes an even more contentious political issue from now on.
For liberals, the legislation doesn’t go far enough. And in the coming years, they will continue to push for tighter regulations on insurance companies, higher subsidies for purchasing coverage and for the inclusion of a government-run plan in the exchanges. Further, those who still believe the legislation is insufficient will continue to press for a single-payer system.
In the meantime, conservatives will begin the immediate drive to legally overturn and/or legislatively repeal the health care bill, or at least scale back its major provisions. Even if none of the efforts to overturn or repeal the health care legislation finds success, the implementation of "Obamacare" will help clarify for the American people what it means to have the government take such an active role in the medical system.
That's because once the bill is implemented, lawmakers who voted for Obamacare and those who advocated for it will now own the problems with the nation’s health care system. And while the legislation will expand insurance coverage, the bill is unlikely to help–and in many cases will hurt–the roughly 85 percent of Americans who already have insurance. They will experience longer waiting times and declining quality of care, while paying hundreds of billions of dollars in additional taxes without receiving direct benefits. Americans who now are uninsured by choice currently don't pay any premiums. Under the legislation, they’ll either have to shell out thousands of dollars a year for a government-approved insurance policy that they don’t want, or pay a tax of $695 per year.
Despite all the talk among Democrats about restraining spending, the chief actuary for the Centers for Medicare and Medicaid Services estimated that if the Senate health care bill passed, spending would actually rise to 20.9 percent of gross domestic product, compared to 20.8 percent under a status quo that Obama has rightly deemed “unsustainable.” If the cost-containment provisions in the bill don’t work or never get implemented, those numbers would only rise higher, as people with insurance tend to consume more health care services.
Years from now, we’ll have actual data on the bill’s fiscal impact absent the accounting gimmicks needed to obtain a "positive score" from the Congressional Budget Office. So arguments are sure to continue within the health care policy community about how best to rein in costs.
Finally, one of the most contested assertions Obama made during the debate was that “if you like your [health insurance] plan, you can keep your plan.” It’s clear that he made the point to reassure the overwhelming majority of Americans who are happy with their coverage.
But in reality, major changes to the health care system aren't possible without some disruption. Obama can’t guarantee that people won't lose their current coverage -- any more than he can guarantee, by signing an executive order, that no public funds will be used to subsidize abortion.
And speaking of abortion, it’s fitting that in the final hours, the outcome of the vote hinged on the issue. While many saw abortion as tangentially related to the health care debate, in reality the dispute is central to it, and a harbinger of things to come.
The expansion of government’s role in health care will elevate the importance of social issues and trigger contentious battles in the future over the government’s role in personal decisions. Given that abortion is a legal procedure in a free market, government cannot restrict private policies from covering it. But once ostensibly private policies are regulated by the federal government and subsidized with tax dollars, Washington has a say in the matter.
While the year-long debate over whether this particular legislation should pass this particular Congress has just ended, the broader debate over the future of America’s health care system has only begun.
Philip Klein is the Washington correspondent for the American Spectator.