If there was any one single completely terrible political decision made by Democrats during this health care debate, it was to “save money” by delaying the start of reform. This is an act of political foolishness so profound, I'm, to this day, at a loss for words. Making the bill appear $100-300 billion cheaper simply is not worth the medium term political damage that delaying reform will do to the Democrats.
Paul Krugman thinks it is a very bad politics for Republicans to run on repealing the bill. His evidence is even though reform is not very popular in Massachusetts, repealing it is even less popular. But this is a pretty worthless comparison. Reform is already in place in Massachusetts. People can see who it helps and who it hurts. They know how it works, and can make an informed decision about it.
If this Senate bill is passed into law, it will do very little until 2014. For the 2010 and 2012 elections, the health care reform bill will mainly be a far away promise (or impending threat). Votes in 2010 and 2012 will not be anywhere nearly as informed as the people in Massachusetts are. Even if it is impossible for Republicans to get the seats necessary and summon the desire to spend the political capital needed to actually repeal the whole reform package, that does not mean it will be a bad campaign issue. I can picture many Republicans in 2010 and 2012 pointing to high premiums and people still uninsured as proof that Democrats “failed.” If you expect Republicans to be honest about reform during a campaign, you have not been paying attention.
I think about the fate of Ben Nelson in Nebraska. Recent polling shows his vote for health care has hurt him in Nebraska, but he is not up for re-election until 2012. Now, it is possible that by 2012, health care will have dropped off everyone's radar, but it will definitely not be something Nelson will want to campaign on. He will have made a big vote three years prior for a bill that will still have almost no tangible benefits (but some tangible pain in the form of taxes and Medicare advantage reforms) to show for it.
If Democrats were a sensible political party, they would have started reform as soon as possible (probably about 6-12 months from now for most of it). That way senators like Ben Nelson would have the program in place serving people for a full two years before his election. If it succeed he could run on it. If it failed, well politicians deserve to lose for passing bad legislation.
I don't know if Democrats primarily delayed the start of reform until after the 2012 presidential elections because they know it would not be popular to implement, or because of a terrible political calculation based on their insane fetish with the CBO. I still have not decided which scenario would give me a less negative impression of the party.