Health Care Reform Starts Looking Like an Established Fact

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I now put the chances of a substantial health care bill passing at 75%, and the chances of the Democrats losing the house in 2010 at about 66%.

Replacing Ted Kennedy is major, of course, but the real game changer is that the CBO is willing to score health care savings on the grounds that the bill contains automatic spending cuts. 

Conservatives are filled with rage and anguish.  The spending cuts, they argue, mostly will not be done, which means that this bill is going to cost hundreds of billions more than its proponents claim.  They are absolutely right:  the savings cuts will not be made, and I doubt that many in the Democratic party leadership, or the liberal wonkosphere believe that they will.

But I'm not sure what good it does to protest this.  That's the way the system works.  The fact that the CBO has minimal discretion and uses roughly the same standards for every analysis is, despite its problems, a feature rather than a bug.  We may not like the fact that the CBO scores what's in the law, rather than what is most likely to happen.  But the alternative is what?  An agency that can give the thumbs up or thumbs down according to how it feels about the legislators?

I assume that the CBO is going to score all these largely imaginary savings, and that this will make it very hard to keep the bill from passing, because legislators are, natch, more concerned about the appearance of fiscal rectitude than actual conservative budgeting.  Conservatives can, and should, raise the reasons to believe that htis bill will cost more than its CBO score allows.  But frankly, the public is probably going to accept the CBO numbers.

I think that ramming through the bill on a party line vote makes it very likely that the Democrats will lose the house in 2010; the American public doesn't like uniparty votes, especially on something this controversial.  A lot of liberals have gotten angry at me for saying this, but it's not a normative statement; it's an observation.  IF the Republicans had been willing to push forward on a controversial bill with no Democratic cover, we'd have private social security accounts right now.  But they weren't, for a reason. 

But if I were a Democrat, I'd take that bet.  What's the point of electing Democrats if you can't get national health care passed?  If Republicans were smart, they'd find a couple of Democratic senators from swing states and pound the Teddy Kennedy rule change until they forced one of them to sit out the cloture vote.  But I'm not exactly holding my breath on a resurgence of Republican strategic brilliance.

No, I think that for those of us who were opposed to this bill, it's game--almost--over.  This isn't exactly surprising; Democrats have a commanding lead in the house and the Senate, and now they have the presidency too.  If public opinion on this thing craters again, I'll reassess.  But for now it looks like it's time to start preparing for an ambitious health care reform, and all the dislocations, and the budget crisis that we now have even less ability to aver.

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Megan McArdle is a columnist at Bloomberg View and a former senior editor at The Atlantic. Her new book is The Up Side of Down.

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