This week's story was the faltering momentum of health reform, tending to contradict the argument I advanced on Monday. Despite the ongoing Congressional tussles, which are exactly what one should expect, I stand by my prediction that health reform will pass this year. There might not be a measure by the August recess--a phony deadline if ever I saw one--but there will be by the end of the year. I have three main reasons for thinking this. 1. So far as substance goes, the differences between the various bills are pretty small, and the financing gaps are bridgeable. A House-Senate deadlock is easily avoidable. 2. Obama has come close to staking his presidency on this. On Friday, reacting to a couple of perceived setbacks, of which more in a moment, he doubled down on that commitment in an unscheduled press conference. 3. Most important, Obama has said he is willing to sign more or less anything and declare victory. If a Democratic Congress cannot oblige him even to the extent of giving him some bill, any bill, to sign, when failing to might sink his presidency, I will be astonished.
Whether it's a good bill is of course an entirely different question, and I would say the odds on that are now slim. We will get a substantial increase in coverage, which is good, but without meaningful action on cost control, and the necessary revenue will be raised, if at all, in stupid ways.
One thing that surprised me about Obama's statement today was that he continues to emphasize cost control, as opposed to wider access, as the principal driver of reform. It is obvious by now that Congress has no stomach at all for cost control, and is arguing mainly over how to raise the taxes necessary to pay for wider coverage. Obama's selling proposition, so to speak, is therefore beside the point; moreover this rhetorical defect is obvious, which is not like him at all.