From a legislative perspective, it’s not over until the Presidential pen comes out at the signing ceremony.
And, yes, it is possible that Obamacare will still run into turbulence. Conservative blogs overflow with reasons why this could all fail. To review: Democrats in the Senate and the House disagree about a slew of important details from taxes to the public option; abortion is still a sticking point; and, complicating matters, Congress is unlikely to conference and vote on final legislation before February – plenty of time for plenty of problems to emerge.
But, for once, I accept the White House spin. They have the ball and it’s on the one-yard line, to paraphrase Press Secretary Robert Gibbs.
Let’s be clear: there are those in Washington who have serious reservations about the size, scope and cost of the health reforms being debated. They are called Republicans, and they are the minority in both the House and the Senate.
With today’s vote, the remaining task for the White House is relatively small: to smooth over the House-Senate policy differences and round up votes, as they have done before. The President is on his way to Hawaii; his reforms are on their way to law.
The coming political achievement is incredible. The White House gambled big – and looks likely to pass the most sweeping healthcare legislation in more than four decades. Republicans and conservatives will need to do some soul searching and attempt to answer a gut-wrenching question: how did we lose this?
But, in terms of policy, the victory is not quite so complete. For much of this year, the President spoke of health reform beginning with the 25th holder of his office. “It has now been nearly a century since Theodore Roosevelt first called for health care reform. And ever since, nearly every President and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way.”
In September, when addressing Congress, he added: “I am not the first President to take up this cause, but I am determined to be the last.”
Much work remains to be done. The Senate bill that passed today leaves many details to be filled in later. More importantly, the biggest task remains: how to bend the cost curve in the coming years. As I’ve noted before, if anything, Obamacare will worsen the problem of health-cost inflation, not tame it.
The President hopes to be the last President to take up this cause. Nonsense – the challenge of paying for a modern healthcare system with an aging population has not been fundamentally resolved today, nor will it be resolved with this presidency. The debate continues.
Let’s then return to Gibbs’ analogy. The ball is on the one-yard line, but it’s still the first quarter. Those of us who favor market reforms are on the defensive. But there is much football ahead to be played.