health & medicalpolitics & government

This is the bet

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You are an elected Democrat. You have voted for Obamacare and you may be asked to do so again. In any case, the two of you are now married. But Left and Right agree, she is on life support. Sentiment aside, do you want her to live or do you pull the plug?

The downsides of becoming a widower are uncontroversial. Failure after so public and full a commitment is electorally devastating. She may well take you with her politically. But what of success? Here is the calculus as understood by the gunslingers on all sides:

We know that short term, the bill is a loser. Rarely has the public been so familiar with a piece of legislation and abhorred it so comprehensively. We will leave aside those pesky “merits” and just address the stone-cold tactical issues. The Left objects to it of course because it does not go far enough. The further Left you go the less they like it. From the Right, natch, it goes too far. In the Center, they are disgusted by how it was done and their crinkled nose epitomizes the mood of the nation at large. Passage, immediately, will hurt. Supporter incumbents (all Democrats) see their numbers take a hit while challengers earn quick, cheap inroads whether in primaries or the general. So short term, it’s bad.

Long term it is worse. The claims that this enterprise will be “deficit neutral” do not survive the slightest scrutiny. All gub spending comes in WAY over budget; can anyone dispute that? Medicare is something like fifteen times as costly as it was projected to be today and much of Obamacare is a re-imagining of Medicare and Medicaid. No serious players believe that the long term costs will not balloon dramatically absent radical reductions in services. Combine that with the simple fact that the overwhelming majority of citizens report high levels of satisfaction with their current health plan (if they have one) and it is impossible to deny that long term, O-care is a net drag. On this also, the tacticians agree.

The upside for those who make their living being elected is all in the mid-term. Axelrod, Emanuel and Plouffe all say the same thing when admitting what must be admitted. The implemented program, they say, will be so well administered and so popular that it will make the complaints of today seem quaint if not utterly erroneous. We will all know the truth and the Death Panelers, the I-Got-Miners, the Tea Squealers and the No-Dealers will be silenced by a general enthusiasm for the joys of O-care. Now, for this to be physically possible wouldn’t implementation have to have happened around Labor Day? Oh, that is carping and obstruction. And if you do lose your seat, well, you will have done your duty; you will have served your purpose. That is the deal being sold to those Democrats worried about November ’10.

For those worried about the long term, the deal being offered is quite similar. Isn’t this yet another wave in the inundation of deficits? Is that good electioneering? I thought we took down W largely on his deficits that were about a tenth of what is already booked. Again, Team O tells these nervous types that whatever the hard actuarial facts the new medical delivery system will prove such an improvement over the debased status quo that costs will be immaterial. Like Roosevelt on Social Security, Obama will declare confidently that no politician will ever dismantle his system. From intensive care she will rise and be our eternal, beloved mother and THAT, friends, most certainly IS good electioneering. Anyone threatening her will be electoral toast before he gets his shoes laced up. Democrats will reap the rewards and Republicans the woe. Gotta love that!

If you are an elected Democrat, or a supporter of Democrats, this is the deal. The program not only will BE perfection, it will be sufficiently PERCEIVED as perfection to make all the negatives recede to irrelevance. Forget the sentiments of today; they will melt before your eyes and all will agree it was just reactionary grumbling. Ignore the bills in the future; citizens will pay what it costs and be happy… indeed grateful to do so because improvement will be undeniable.

This is the bet.

And the big players are all in. The lesser players are clicking their chips.

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