One wild ride ends, another begins
It's been a wild ride over the past two years: first the campaign, then the stimulus debate, and finally passage of health reform. As I've written elsewhere, this has been the ride of a lifetime for me personally. This is probably the most significant thing I have ever done. A long list of delayed projects and papers awaits me.
Our charge is to describe the implications of this complex new law. I would say that the implications are somewhat indeterminate. Libertarian legal scholar Richard Epstein complains that a 2,500-page bill will require a 20,000 page rule book to implement it. I agree, though I am less bothered by this fact of modern life than Richard is. One page per $130 million of economic activity doesn't seem excessive to me.
I am gratified that this bill establishes -albeit imperfectly--the principle of near-universal health insurance coverage. I am gratified that this bill will curb discrimination against our fellow citizens facing serious injury and illness. I am gratified that we will provide about $200 billion every year to help poor and working people obtain health coverage. I am gratified that the bill includes important measures to help the disabled. I am immensely gratified that we have embraced the principle--albeit imperfectly--that people should not go bankrupt because they get cancer. That bill was worth every moment tens of thousands of people have spent over many years to get this done.
I am also gratified by the fine work done by so many people to design an intricate, complex, and politically feasible piece of legislation that could accomplish everything in the above paragraph at an acceptable cost. This wasn't in any way easy. The army of White House, HHS, and Congressional staff that made this happen receive less public credit than they deserve. So do the reporters. I think this was the best-covered domestic policy story, ever. Writers at this very newspaper are among the best in the business at explaining a complicated bill to an often-clueless and innumerate public. They did an amazing job.
To me, the most agonizing feature is no special interest deal barnacled to the bill, or anything left out. It's the simple timetable. For no good reason, really, we must wait until 2014 for critical measures to kick in. I met so many people on the campaign trail and in my public health work who need help: People with multiple sclerosis, people near retirement waiting for Medicare before getting their glucose and blood pressure checked, street drug users who need Medicaid, liver transplant patients on Medicare waiting lists. High-risk pools and other stopgap provisions will help before 2014. Unfortunately these measures are obviously inadequate.
We must do more now. Millions of people can't wait.