Now What? 11 Unanswered Questions About HCR

Last night's presidential speech seemed to mollify liberals and harden conservatives, and the main media narrative -- the narrative of the savvy, if you will -- is that Obama delivered the speech that he ought to have delivered months ago. Health insurance reform is likely to pass (how's THAT for a COTS-like prediction), but there are many enhanced interrogations to be had before "likely" turns into "will."

1. Did the President concede too much last night? By ostensibly liming the cost of the final bill to $900 billion, is he inviting Republicans to find a way to force the costs higher? Is $900 billion enough to provide coverage for all, uh, 30 million Americans who don't have access to it now? (See below.)

2. Why did Obama abandon his preferred pay-for -- a cap on the deductions that high earners can take -- for a more complicated tax on gold-plated or "Cadlilac" insurance plans? One of his main constituents, the unions, oppose this because they've negotiated top-dollar plans already. Will health care come down to a fight about whether unions get an exemption? (Pre-negotiated plans?) In practice, will insurance companies pass the cost of this new tax onto consumers?
3. There aren't too many changes to the current fee-for-service payment system for doctors. Will there be more and different incentives put into the final bills, and will this jeopardize AMA support?

4. The transition costs: when 30 million people realize that they're going to have to pay more upfront for health care coverage in 2013, will they revolt? Will Republicans help them? Will enough conservative groups run ads in enough districts to scare moderate Democrats enough to believe that the aftermath of this bill will be a rerun of the 1988-Medicare-Catastrophic-Coverage political sales fiasco?  (The basic premise is that people who aren't insured aren't paying premiums or aren't seeing their compensation garnished with money that pays for their insurance plan. Soon, the mechanism by which they pay will change, and it could seem like a pretty big tax increase up front, even though, technically, they're probably going to save money over the long term.

5. What services will insurance companies be required to offer? Will negotiators be able to limit the benefit packages in a way that keeps costs down? Or will interest groups -- say, the bariatric surgery lobby -- lard up (no pun intended, really) this portion of the bill?

6. Will the new health insurance cooperatives, if they exist, be regional or national? The answer will go along way to telling us whether they'll change the competitive matrix of the insurance industry.

7. Will public opinion against health care reform in the abstract shift a few points in favor of -- or against -- the president's direction? How does this impact lawmakers' projections of their 2010 fates?

8. Does the White House try to secure a few House Republican votes....enough to give as many House Democrats a pass as needed?

9. The delayed phase-in of many of the benefits, and the temporary catastrophic coverage net (a John McCain idea) that Obama borrowed last night: how does this work, how sticky are the changes to the law, and if reform -- before it kicks in -- proves unpopular, how hard do Republicans work to try and undo it?

10. Will the President's forceful defense of the public option result in liberals demanding that the final bill subsidize people up to 400% of the poverty level, rather than 300%? If not, will Republicans be able to argue that the mandate, without appropriate subsidies, amounts to a middle class tax increase? (Yes, it's a cynical argument, but...)

11. Will Joe Wilson's Verbal Uranium Leak come to represent the entirety of the Republican response to Obama? Will it further radicalize Republicans -- or, at least, make it seem, to independents, like Republicans are ratified?