As others have noted, Democrats are on the brink of enacting an imperfect but historic bill that will cover 30 million people and correct egregious defects in our current health insurance system. Fully implemented, the bill would provide about $200 billion per year down the income scale in subsidies to poor, near-poor, and working Americans.
$200 billion is a big number. It exceeds the combined total of federal spending on Food Stamps and all nutrition assistance programs, the Earned Income Tax Credit, Head Start, TANF cash payments to single mothers and their children, the Department of Housing and Urban Development, and the National Institutes of Health.
Harold Pollack is clearly pleased that a lot of money is being directed to help people (even if it is in a very wasteful way). On the other hand, I see this large number, and it fills me with terror. First, even as large as this number is, it is nowhere near sufficient to make quality health insurance universally affordable. Because they did not truly reform our broken health care system, the cost of expanding coverage is extremely high.
What I see when I look at that $200 billion number is a huge target for Republicans and conservative Democratic “entitlement cutters.” The subsidies only go to a small fraction of Americans who are not politically connected. I can easily imagine the already low-quality insurance on the exchange slowly being scaled back to basically nothing. I fear the Republican solution to the high cost of the program will be their same solution to all programs; Deregulation.
What progressives should really want to see is a smaller number attained by using much more cost-effective public insurance programs to expand coverage. The Senate bill is an extremely expensive expansion of very-low-quality insurance to a small group of low income Americans. That does not sound like a recipe for a workable, long-term reform program. This big number is something that should fill progressives with fear; not joy. It will only enrich the enemies of reform and be a huge target for “deficit reduction.”