Supporters of the health care bill may have seen their legislative victory as a culmination, the end of a long campaign. But the events of last week have only inflamed the controversy.
This is about much more than health care. What the Democrats have done — load another entitlement onto the unsustainable commitments we already have — was a monstrous policy error. It will radically change the relationship between the government and the individual.
Fantasy cost projections aside, it also will be fiscally crippling, and one result will be the steady erosion of America's leadership role abroad.
Obamacare was passed in the teeth of considerable popular opposition. It should be fought through the courts — Can the feds really force us to buy a product from a private company? — and on the hustings, although opponents should avoid creating unrealistic expectations.
Most of Obamacare's benefits won't begin rolling out for four years, but some provisions will become effective within six months. Many of those aren't likely to be repealed, even in the most optimistic GOP scenarios.
The bill plugs the "doughnut hole" in the Medicare prescription drug benefit, for example. Republicans won't repeal that, even if they get the chance — unless, like the Dems, they're prepared to say, "The public be damned."
For the next four years, the politics of health care for Democrats are not favorable. The bill distributes the castor oil long before the sugar.
Democrats are going to be playing defense as a mass of taxes, regulations and mandates flows out of Washington in ways the public may not expect. Last week, for example, there was a brief flap over the tanning-bed tax. (What? A tanning-bed tax? What else is buried in that bill?)
Even some provisions promoted as benefits will arrive with a catch.
Within six months, policies can't be refused to people with existing health problems. Those people will be winners under the legislation — as long as they can afford the costs because premium rates could skyrocket. It's not what President Obama had in mind with his talk of "bending the cost curve" down.
The bill calls for creation of federally subsidized high-risk pools to handle those previously excluded from coverage, with the goal of keeping rates close to standard premium costs. But there's no way of knowing this will work; the uncertainty surrounding the legislation is enormous because the implementing rules have yet to be written.
Cary Hall, president of Benefits By Design Inc. in Overland Park, said it wasn't even clear from the bill summary whether the risk pool would be created by the feds or by state governments. Nor does anyone know whether the $6 billion or so allocated to subsidize it will be enough.
Bottom line, Hall expects rates to "explode" as more people with ailments sign up for coverage over the next two years and the claims begin rolling in.
Scott Gottlieb, a physician and resident fellow at the American Enterprise Institute, expects many insurers to begin pulling out of the individual market and jacking up rates in the small-group market, thanks to the requirement that insurers must soon take all comers.
"The net result is that two years from now we will likely be looking at an insurance market that has become worse, not better, with premiums higher and more Americans joining the rolls of the uninsured," Gottlieb wrote in a posting at National Review Online.
Hall said the bill would gradually impose a high degree of centralized, federal control over the entire health care system.
"They have total control over everything — insurance company budgets, minimum losses, what the plans must cover, what the benefits must be, the whole nine yards," Hall said. "It's totally the federal government.”
And it's also totally the Democratic Party. The Dems have purchased American health care. They own it now, every single premium increase and bureaucratic foul-up. The next four years are going to be quite interesting.