As I have commented before, our country tooled up and entered WWII, fought it, and won it, in about 4 years. This was an enormous undertaking compared to setting up such a basic, minor modification to the nations method for paying for health care. I'm very sure the "need" to delay it so long is in no way dependent on the size of the job. It is a political calculation, kow-towing to the conservative Democrats by letting them have another 4 years of opportunities to eliminate any significant parts of that bill, thus protecting the opportunities to amass great wealth by their supporters.

There are very few political decisions made in our country that are not closely tied to allowing the wealthy to become ever more wealthy. That appears to be the primary benefit of capitalism.

As somebody who has pre-existing conditions and will lose my current health policy (due to unemployment) in a few months, I am also very disappointed that the changes don't go into effect until 2014.

That's FIVE YEARS where insurance companies can deny me coverage -- all because fiscal scolds in the House and Senate wanted the bill to be under $900 billion.

Now, I would fight against any repeal attempts, because the mandates plus regulation will do me (and people like me) a lot of good in the long run. If the Dems were smart, they would pass this bill, then use reconciliation in 2010 to offer an instant Medicare buy-in for everyone (even those in their 30s, like me) who want it.

2010 doesn't worry me that much because even if the Dems get absolutely crushed I'm confident that President Obama isn't going to sign a repeal of his signature piece of domestic legislation.

Huh? That would be your opinion I suppose. My opinion is that if it helped him politically Barack Obama would sign a repeal of his "signature piece of domestic legislation" in a heartbeat. And there would be easily 35-45 Democratic Senators perfectly willing to do the same if it would help them maintain political power.

But at least Josh, unlike some, admits he's not sure:

Josh, in order for Republicans to get rid of it they will need 67 Republican Senators and 218 Republicans in the House because Obama is the President and he will veto any obstruction by Republicans if they take over the Senate and the House

That's just a plain statement of fact. Reality based community indeed.

Again, it is my belief that Obama would sign a repeal in a heartbeat if he believed it would help him hold onto power and there would be more than enough Democratic Senators that would vote for repeal if they believed it would help them.

You guys put way to much faith in these scumbags...

Josh, thank you for asking the question that was central to the dilemma facing your post midweek from the distressed 50-something reader AK. AK thought the liberals were abandoning him or her by not backing the Senate bill because AK's COBRA benefits ran out in 2010 and they had a pre-existing condition that made it tough to find a new policy. Under the Senate version it won't be until 2014 that the subsidies and bar to pre-existing conditions for AK's age group kick in.

Reading about this elsewhere it looks like many states already have their own plans for people who lose their COBRA and can't buy a new plan, which may save AK. But what the current bill would do for voters expecting relief in the here and now is a mystery.

If it goes wrong, people want someone to blame - and we ought to make the case, right away, that it is the centrists and obstructionist Republicans, that this is a step forward, but not as good as they'd like because there are still too many Republicans in office obstructing things. People want HCR, Republicans want to undermine the public, and the public loses confidence in Dems any time the GOP succeeds. They're more likely to stay home than vote GOP, unless they make this a teabag referendum on sucking up to the Insurance industry, in which case, we ought to make the case that the bill got sold out to the insurance industry because of centrists and the GOP obstructionists.

I would be hesitant to make the mistake of becoming defenders of this bill, where we are to blame before these things go into effect. We ought to be critics, admitting it's a major step forward and the best that we can do with Lieberman, Nelson and the GOP united against anything we want.

The GOP isn't convincing people they are right - that HCR is bad. They are only going to gain if they make the Dems appear ineffective and too incompetent and nice to do what it takes to twist some arms and get a good bill. Enough people stay home, and the wack-os they rile up will turn the election - and riling them up is a matter of pushing the "Outrage" button back at headquarters.

If we pass the best bill we can, we can make the case that we are effective and could be more so with fewer obstructionists. My fear, however, is that people will say, how much of a majority do you need, for gawdsakes? The GOP could steamroller you with less... and they got a point.

As for timelines, we also have the problem that our leaders are too separated from average voters to realize that they've gotten rid of pretty much everything the GOP feared voters would immediately recognize as a benefit.

Question: if the insurance industry is benefiting so much from this bill, wouldn't they want to strong arm some centrists before it collapses?

The number one objection to this bill is the freaking mandate. Even with a subsidy, I can't afford to buy insurance. Americans will not take kindly to being labeled criminals for not buying junk insurance from a PRIVATE company, and that's putting it very, very mildly.

I may be all wet, but I'm pretty sure the delay until 2014 is so to raise the revenue necessary to pay for the 30 million that are currently uninsured.
I'm sure there are lots of elected Democrats who would like to start this as soon as possible. But they are going to need massive amounts of money to fund it - money the country hasn't got right now.
I have a separate question relating to procedure: Assume the Senate version passes. Then we have reconciliation. Once the bills are combined, does Sen. Reid need to come up with 60 votes before the final bill comes to a vote?

People! Don't you watch CNBC? Increasing employment takes time! How do you expect the Insurance Industry Attorney Full Employment Act to work until the job creation is complete? And then it will take time for them to come up to speed so they can dig in and write the insurance regs. I don't know what you expect the Obama administration to do until it has gotten its regs from big insurance. I mean really, people. Incremental change is incremental. What's the rush! If you wanted it work faster, it needed more bonuses.

Surely it is just to delay implementation until after the next presidential election? Good policy or bad--and there is no predicting the ultimate outcome, except that insurance companies will make out like bandits for a while--when the mandates hit the uninsured, the howls of outrage are going to be audible on Mars.

Defend and Demand

I've said b4 - Theda's a goddess!

In poli sci speak we're witnessing the closing of a rare (Kingdon) policy window on health care and the opening of incremental policy making (Charles Linblom)

As Kingdon reminds us, once a window closes there is a huge temptation among policy elites and the public to think that the problem has been solved

Defend and Demand then is a difficult task...easy to defend HCR from the Teabaggers ...very much more difficult to demand further progress

When the proposal to delay implementation of HCR to after 2014 first came up I immediately thought of Johnson's "Great Society" programs.

Under Tricky Dick they died of neglect- budget cuts and implementation by hostile administrators. The conventional wisdom has been that 'Nam sank them, but the Nixon Administration gave them the shove under the bus. And these programs went into effect, and had positive results, before 1968!

A point that I was thinking about. Will the republicans be involved with the process of reconciling the senate and house HCR bills if not one of them voted for either bill?

We are calling our representatives and neighbors to tell them to have the HOUSE stand up for its bill.
If we are going to give up the public option, we should get some turkey for it.
what turkey?
Yes, the stuff should start in 2013. Forget the impact on the CBO score, or hike the medicare tax on 200k earners to 1.2%.
what else?

Americans can still insist on improvements to the Senate bill and that has to come from House conferees who point out that they gave up the public option to give a healthy stroke job to Lieberman and Nelson.

If we can’t have a public option, we should require insurance companies to spend 90 percent of premium on medical care, pre-existing condition ban for everyone not just kids starting in 2010, the House 2x rating for older insured and, we must have a permanent COBRA extension for workers who lose their jobs.

Particularly important is for the HOUSE to stand up for COBRA extension for the unemployed, which is in the House bill, Section 113.
We need to help the unemployed keep their insurance until the exchanges start, without forcing them into expensive high-risk pools.

Section 113 of the House bill permits the unemployed, many of whom can’t get individual coverage because of pre-existing conditions, to buy into their old group insurance until the insurance exchanges start in 2013.

Can't disagree with anything you've said here. Atrios has been repeating for weeks that the Democrats will own the health care system politically after this passes, and if things get dramatically worse before they get better, it's not Republicans who will be blamed (even if they share responsibility for changes not being made that could have helped exedite progress).

It's not like there aren't historical precedents. Medicare Catastrophic was repealed in less than two years by a majority-Democratic Congress. You could even make an argument that this retrenchment contributed to the Republican takeover a few years later. For that matter, AFDC was savaged politically throughout its existence.

Republicans can and will campaign on transferring wealth from the haves (the currently insured) to the have nots (the uninsured), and will get a lot of votes doing it. Remember the big applause line at the town hall meeting earlier this year when some teabagger said to a working single mother without insurance that he wasn't going to pay for her bad choices? Remember any post-LBJ Republican campaign, some with coded racist appeals? Remember that Bill Clinton actually ran for re-election on ending welfare as we know it?

That's not to say that redistributive efforts aren't a good thing and shouldn't be encouraged, but politically, they tend to be dead losers. Even the VA gets gutted by the Republicans. Anyone who thinks that this is a one-way ratchet and reforms can't be undone is smoking something.

Well As I read this post and all the comments the one thing that stands out is the people here are arguing substance and Washington hasn't been about substance for over 30 years.

This became apparent to all when Kennedy beat Nixon..not because he had a better platform or the public wanted the then current version of liberalism. No it was simply because Kennedy looked better. This of course was proven true 8 years later when a "new and improved" Nixon...complete with a fresh coat of paint...beat the old and worn looking Humphrey. And it has been true ever since.

Image is what sells in this virtual, processed , internet world.

And that is what will determine the fate of the next election and there by the fate of this (and any other) legislation.

He with the best make-up artist, writer, producer and directory wins.

This is not you father's GOP or your mother's Democratic Party. hose people who were genuine, real and committed are gone. Dead and buried long ago. They have been replaced by images...slicked up for public consumption.

And the legislation is exactly what you would get from such a group.

C

I think major part of the problem begins and ends with the Obama administration. You have the president, the vice president and the president's chief of staff all freshly in place in their positions after being legislators. The HCR process needed strong chief executive leadership but instead it was handled without strong leadership by glorified legislators who feel they only way to do things is a process of endless compromise with your political enemies.

Why is it some kind of almost foregone conclusion that Democrats will lose control of Congress in either 2010 or 2012? They won in 2008 after 8 years of idiocy unprecedented in 150 years of the Republican Party, and now that madness has to be the unspoken norm? 8 years of rack, ruin, and Ignorance, Encore Ignorance, Et Toujours Ignorance, followed 2-4 years of tepid 10% cleaning up of the mess. This is some kind of inevitable cycle?

Shame Shame Shame. Are the Democrats homo sapiens or some species of invertebrates?

Now that Snowe is out for sure and there is not one Republican on board for this bill, you can see what we got for the grand strategy of taking single-payer off the table. Nothing.

We could have expanded the very popular signature Democratic progressive program Medicare. We got zero Republicans votes for rejecting that idea and building a mountain of a bill that does something else, what else the American people totally don't get.

Once again we surrendered to ourselves. Good Job!

Richard Perle is an ass.

Steven Benen gets it

But since repeal of the policy is all but impossible, Republicans will still be stuck with a ambitious national health policy they could have made far more to their liking if they hadn't been such knee-jerk reactionaries.

http://www.washingtonmonthly.com/archives/individual/2009_12/021557.php

I assume Senate Democrats decided to extend the timeline, in part, because they realized that the implementation of the bill's major provisions is likely to produce some rather massive political blowback, and so they want to delay implementation until after the election. This became especially true after they took a meaningful public option out of the bill, and then took out a public option altogether.

Many people in need will benefit from this bill, and that's good. But it is quite possible that a majority of Americans will not benefit at all, and will even see things get worse. Once the final stages of the reforms kick in, it will become apparent to a lot of people that their own health care costs are still going up and that the quality of service delivered is still going down. They will learn that they are not eligible for the exchanges, and will then rue the absence of a public alternative. They will see others benefit, but realize they have been stiffed.

2014 is also when the tax credit kicks in. That credit is either going to cause a substantial budget shortfall and sharp rise in the deficit, or else prompt calls for new taxes, or both. Either way its going to be a difficult political ride for Dems, so it is no wonder they want to delay it until after the election. There may also be a surge in small-business failures when the employer mandate becomes law in 2014, and that will be no political picnic either.

The whole point of health care reform was to provide care to the uninsured, the under-insured and the expensively insured by shifting the burdens away from individuals and large employers, and distributing them more evenly. There was a choice to be made: one option was to shift that burden to the private providers of health care and health care insurance by forcing lower profits and cost efficiencies on them, and by passing on the benefits to the vast majority of Americans through substantially lower costs and hassles, and improved deliverables.

The other option was to pass those burdens on to people who already have decent insurance through their employers, by letting the industry pass the costs of the new regulations and restrictions onto their other paying customers, and by letting the industry profit from the larger number of customers force fed their way by mandates and subsidies. In appears to me that Congress has opted primarily for the latter course of action.

Political decisions are much more simple to evaluate then they are often made out to be. The chief question is always the same: Who is losing and who is winning? From whom are you taking something away, and to whom are you giving something? While it is true that not every public policy choice situation is a zero-sum game, it is just as true that there are hardly any choice options that are an all-around win for everybody. In the real world, somebody always loses, and legislators have to decide who that is going to be. But center-leftish Dems continue to believe in the myth of the miraculous rising tide that lifts all boats, and refuse to get down to brass tacks about the distribution and redistribution of wealth in this country. They have been running hard away from "class warfare" for decades.

Well, I hope I am wrong, but it looks to me like these centrist Democrats, the adherents to the DLC and Third Way movements that have been running the party for decades, have just run themselves into a tight political corner. I have been arguing on this blog for years that the key to a revived Democratic Party and progressive movement is to find solutions that build a new alliance between the poor and the broad middle class, by devising policies that take from the wealthiest Americans and redistribute those benefits to the other 80% or so. This would counter the perpetual Republican strategy of building an alliance of the wealthy and the more affluent parts of the middle class, and small business people, by dividing the middle from the bottom - culturally, politically and economically. We can indeed get a tide that raises all the boats in that bottom 80% if we are willing to lower the water level in the warm and gentle pools in which the yachts of the wealthy float. But it looks to me like the inertial forces within the Democratic Party are too strong. The Democratic Party - with its recent decades of trembling awe and respect for the property rights of the affluent - continues to allow itself to be maneuvered into being an anti-middle class and anti-small business party, and this regrettably means the pendulum is likely to swing back once again.

They idea that we might use political power forthrightly and unapologetically to take something from the rich is too scary and too disturbing for the squishy centrists who think there is always a kindler, gentler way out, one in which nobody experiences any pain, even the most absurdly well-off members of our society. When Obama mentioned something about "spreading the wealth around" during the election, he took a little bit of heat, and immediately got very cold feet. But perhaps the impending political storm will finally drive a stake through the myth of the pain-free, redistribution-free possibility of goodies for everyone, and convince Democrats to get real, and start making frankly redistributive arguments again as part of their basic pitch.

Some good comments, too. Like this, from zeitgeist:

Part of why we on the left get our asses handed to us on messaging, and why the general public tends to believe lies from the right over truths from the left is that Conservatives boldly and confidently proclaim victory even when they've lost, while Liberals snarkily and grumpily despair their "losses" even when they win.

Is it really any surprise which of those models the low-information masses follow or believe to be more successful?

Not that this would be an unalloyed victory, but the general observation is pretty painfully accurate. We've really gotta do something about that...

Although the delay in implementing the Exchange, the mandate, and other features is dictated by the practical demands involved in laying the administrative groundwork for these features, other important benefits will start immediately. The establishment of high risk pools has already been mentioned, but floors on medical loss ratios and other insurance requirements are also part of the immediate package. Equally important, efforts to establish cost controls on health care providers (hospitals, physicians, etc.) begin immediately, as well as efforts to evaluate alternatives to the standard fee for service paradigm that rewards excessive service rather than value. All of these should yield beneficial effects observable to the electorate at least as early as 2012, although probably not to a large extent by November 2010.

One of the things about delayed reform, if inadequate, it could be supplemented by additional legislation before it goes into effect. It is often far easier to make changes in a house plan, as the house is being built as opposed to making them after the house is complete and occupied. When I’ve asked others, why not use the reconciliation process to get reform through the Senate without fear of the filibuster, the answer was that too many aspect of any plan so passed could not bear directly enough on budgetary matters to qualify for this sort of passage. Consequently, any such a plan would wind-up with too many holes in it to be practically applied. But, if the foundation is already there, well then… I’ve been wondering about this, and I have not seen any speculation along these line in print. But then, such a scenario is really too goofy to warrant discussion. Wink, wink. Nudge, nudge.

I have to laugh that Josh:

(a) Admits that he doesn't understand the policy, yet mocks those who have concerns about the botched policy provisions in the bill.

(b) Wonders why the bill is set to take effect in 2014.

Hello? It's for the very same reason many of us consider this bill a turd: Special interest appeasement has gutted the usefulness of this bill -- including its start date.

The biggest flaw I see: The anti-trust exemption stays intact. As it is, this is a gift to the price fixers.

An aside: The R Senators are on TV right now, they seem about to blow a gasket while they plead for one vote.

I am a swing voter in a swing state (Colorado). We have a Democratic senator up for re-election next year, and my representative is a Democrat in a primarily Republican district.

For me, it's all about results. Either my health care expenses will (1) go up, (2) go down, or (3) stay the same. If they go up, I will vote for Republicans in the next election. If they go down, I will vote for Democrats. If they stay the same, I won't vote at all.

Having all of the Democrats vote for this, while all of the Republicans vote against it really clarifies things.

Talk is cheap. Let's see what happens when the rubber hits the road.

It's hilarious how from time to time the far left convinces itself that they are single-handedly electing Che Guevara to the presidency of the United States and then feel betrayed and dejected when it turns out they merely helped elect a liberal Democrat. I can't wait to see the "Polished Turd" bumper stickers pasted over the soviet style Obama poster.

We know that Republicans have ceded the non-white vote and the educated vote of all ethnic groups to the Democrats. In their acerbic, fanatic opposition to a bill in which private insurers and the drug industry are felt to be winners, are they not in the process of burning their bridges to an important segment of corporate America as well?

It's interesting how few times in this thread that Obama comes up, but the bottom line is that he's spent the last eleven months shredding progressives expectations, even in spheres, like the banks, where the executive has enormous control without the interference of Congress, where there's a maze of agencies that answer directly to the white house. And in the financial domain this administration's behavior is impossible to square with even the most microscopic notions of fairness or progressivism. It's appalling.

And then there's the war, where Executive power also operates with enormous discretion.

Enacting health care reform is obviously a different challenge: Congress has much to say. And right now the bill is essentially still opaque--it's too big, too complex, too formative to know what's really in there. Which is exactly the problem. As so many of us stare into this fuzzy frame trying to make out details, we realize that we have absolutely NO REASON to imagine that there's anything remotely likable in it. Particularly given the half-hearted nature of the adminstration's defense of the only thing that progressives really wanted, the PO. For a large segment of the progressive community, the trust is simply not there.

Everything about the legislation is getting parsed on these pages within the prism of that distrust: why is it's enactment is so late is yet another odd detail that is open to a thousand interpretations. But one thing that will prove difficult for the Democrats is that as the GOP readies a withering propaganda assault against it that will last years, they sure as hell could have used the ballast of an energized democratic base to counter. And the Obama administration has so abused their base, has so effectively estranged a large segment of those who worked like crazy to get him there, that they won't have it. If you were going to have a contentious bill that was going to have to wait four years for enactment, you should have made doubly sure that your most active and vigorous supporters felt invested to defend it.

By way of Andrew Sullivan, who got it from Ben Smith, here are all the things that the Senate bill will enact before the 2010 election:

Immediate Benefits of the Senate Health Bill (PDF)

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