We are now starting to see the beginning of a game of health care Jenga. The problem is the Democrats have seriously constrained themselves on what they can do. Obama set an arbitrary numeric cap of around $900 billion and demanded reform be fully paid for. Conservatives like Baucus, Conrad, and Snowe demanded that health care reform be paid for with only dollars inside the health care system. Sweetheart deals with the the different industries (hospitals, pharmaceutical companies, etc.) eliminated the possibility of producing hundreds of billions of savings with serious system-wide reforms. Fierce opposition to “too much government” solutions or a Medicare-like public option also took some of the biggest money savers off the table.
These many restrictions make it nearly impossible to add to new, meaningful reforms. Without the room to add to the bill, creating compromises becomes extreme difficult. For example, a theoretical compromise for weakening the public option would be to add for liberals more affordability subsidies or improvements in Medicaid. Another example: reducing the excise tax on health insurance benefits could be paid for with the money saved from drugs re-imporation. Neither of these compromises is now possible because of the different restrictions and secret deals.
Really, the only option left for concessions is the removing of things that one group or another find most objectionable. The result is a destructive downward spiral that best can be called health care Jenga: Different groups keep trying to remove building blocks while trying not to knock over the whole towering health care reform bill.
The employer mandate was removed to appease Olympia Snowe. To get the bill under budget, affordability tax credits were slashed. To increase the number of people “technically” insured without spending more money, what is defined as minimum insurance was scaled way back. It now seems that without a public option, progressives may threaten to join conservatives in killing the individual mandate. Block by block, reform is being both reduced and made less stable.
The White House may credit their secret deals with the different stakeholders (i.e. health industry lobbyists) with getting reform this far, but the strict limitations those deals put on possible compromises may prevent it from getting any farther. At least not without America getting left with a very wobbly new system, full of gapping holes.