While I am bitterly opposed to it simply because our country cannot afford it, there is always a small chance that I could be wrong. I think our history with Social Security and Medicare bear out my concerns, but maybe this time it will be different.
No one seems to remember all of the doom and gloom that was predicted when welfare reform became law back in 1996. Was welfare reform an overwhelming success? No. But it was moderately successful, which is all you can hope for with any government program. The doom and gloomers were wrong; the reformers were right. In this case the reformers were the Republicans.
Now, 14 years later, the roles are reversed on another piece of major social legislation.
I don't know who'll be right, but I am curious as to whether there is any way to measure the outcome. Because one side will be mostly right and the other mostly wrong.
So who said what? Well here's a good general overview of what the bill's proponents argued:
However "imperfect" this bill is, you got what you wanted: virtually all the uninsured are covered, and those who aren't covered probably aren't particularly unhealthy. So now you should be willing to state that all the marvelous things you claimed would come to pass, will actually come to pass. Over a reasonable time frame. You cannot tell me that we will save hundreds of thousands of lives over a fifty or sixty year time frame. I mean, you can, but then I don't take you seriously. That's a few of thousand lives a year, far lower than the number of American lives claimed annually by "non-steroidal anti-inflammatory drugs such as aspirin"--at a cost of $200 billion a year, or $70-100 million per life saved. I know, every life is priceless, but US policy cannot actually be operated as if this were true. Moreover, when you stretch out the time frame this way, your theory is non-falsifiable: a few thousand lives a year is too small to be distinguished from statistical noise.
To me, that just won't do. Americans were not told that American households would be 1% less worried about bankruptcy, or that we'd save a hundred thousand lives over thirty years. They were regaled with eye-popping statistics on deaths from lack of health insurance--I certainly was, by many of the very same commenters who are now suddenly wary of prediction making. If you quoted those statistics, you were committing to a pretty strong position on the benefits of this bill. By my count, since we're now supposed to be covering at least 2/3 of those who are currently uninsured, and the remainder are often immigrants who trend younger than the general population, you believe that we should see a reduction of at least 15,000 deaths a year. You might argue me down to 12,000, but you couldn't get me as low as ten. That is what is implied by citing a figure of 20,000 deaths a year.
If you quoted Himmelstein et al's 45,000, obviously you should be expecting deaths to fall by at least 25,000 a year, very conservatively. If we don't see such improvements, then those studies were wrong. And if you won't commit to saying that you expect such a sizable reduction in our mortality rate, then you were wrong to cite them.
I mean, maybe we say that there are a bunch of combo benefits: we reduce bankruptcies by a third, save five thousand lives a year, get some harder-to-measure morbidity benefits, and so on. But there have to be some measurable benefits. If this helps families stave off financial ruin, we should see a meaningful and sustained reduction in the number of bankruptcies. If it improves health, that should show up in life expectancy. If it doesn't, then the bill doesn't do what you said you expected it to do. That's valuable information! Not so much about you, as about health care bills.
Of course, all of these benefits won't happen overnight, especially since the bill back loads everything that really matters except for the tax increases. But we'll see how it all plays out, won't we?
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