The Doctor Will (Not) See You Now

Good things come to those who wait, or so we are told. In politics, the art of timing is vital. Public perceptions can often matter more than actual results. When it comes to health care reform, the politics of delayed gratification do not match the political rhetoric of imminent necessity recently espoused by health care reform proponents in Washington. If I remember correctly, President Obama and Congressional Democrats recently passed sweeping changes to the way Americans obtain health insurance largely on the catchphrase of "health reform cannot wait." As President Obama and Congressional Democrats took their case to the American people last summer, they used gut-wrenching stories to get this point across. "Sally" from Small Town, Middle America had just lost her second job and could no longer afford her rising health care premiums as a single mother. "Stanly" recently had his pension cut and was forced to choose between paying the rent, or paying for his life-saving prescription drugs. So why are we still waiting? Hasn't the bill already passed Congress?  Could it be possible that the fierce urgency of now has turned into the ultimate experiment in political inexpediency?

As it turns out — in a great stroke of political oddity — many of the provisions of the recently approved health care bill will not go into effect until the year 2014. Around this time, aspects such as providing subsidies for families earning under $88,000 per year to purchase health insurance begin to take effect. It is also around this time that individuals will be compelled by the government to purchase health insurance, even if they cannot afford it or do not wish to have it. Prior to this, however, the taxes levied to pay for the bill will start going into effect. Some will begin as soon as this next fiscal year. Not until the year 2019 will the health care proposal cover "32 million" previously uninsured Americans. So much for "Sally" and "Stanly." The next nine years will be hell for them.

It is understandable to note that any legislation signed into law will take time to go into effect. What is difficult to comprehend is why any politician in their right mind would support taxing voters for provisions that won't go into effect until years later. 2014 provides a perfect time frame for the critics and the opposition to define the bill. After arduous and painful debate, Americans want proof that the health care bill was actually worth it. Leaving the final judgment of health care reform open until 2014 at the earliest, and 2019 at the latest, provides a dangerous window of opportunity for Republicans. Not only does this ensure that the deeply contentious recent health care reform measure is an issue for the 2010 mid-term elections, but it also guarantees that the 2012 election will be defined by it. As Republicans look to regain control of both Congress and the presidency, they will have a solid narrative to drive a concerted political effort, a narrative which is clearly polarizing to many key constituencies of voters such as seniors, the middle class, and small business owners.

While Democrats may be congratulating themselves on a "historic" achievement, maybe they should take a second look at the political infeasibility of the health reform package from a policy standpoint. Imagine this scenario: In the next four years, health insurance premiums continue to rise. Americans being typical Americans, we blame the health care bill for being ineffective, and it swells in unpopularity, even more than it already has. As this phenomenon is unfolding, many Americans start to shoulder a growing tax burden and the negative economic effects which go along with it. In short, Americans pay more to the government, pay more to the insurance company, and have the same lousy coverage. Not to worry. Remember the 32 uninsured Americans who simply could not go another year without health insurance? They won't be "covered" until 2019. Whether or not this health care reform will actually work to lower costs, improve quality, and expand coverage will remain a mystery for quite some time. Can something even be called delayed gratification if it may not be all that gratifying after years of waiting?