Why 2014?

| Sun Dec. 20, 2009 5:11 PM EST

Josh Marshall mentions something about the healthcare bill that bugs me too: why wait to implement it until 2014?

2010 doesn't worry me that much....But why go into 2012 without many of the benefits of the legislation actually going into effect? I tend to think that even a resurgent GOP will probably have a harder time repealing this stuff than people might think. But you could certainly have health care reform repealed in 2013 before much of it even goes into effect.

....I know stuff like this can't just be done on a few months notice. Health care is a huge part of the nation's economy. And you need frameworks of predictability, planning and transition to put such big changes into place. But four or five years seems way, waaay too long.

My impression is that some of the delays are there because it makes the budgetary accounting work better in terms of deficit neutrality. And I know the Dems would likely lose critical support without being able to show that the overall bill actually lowers the deficit. But if that's the main reason, I suspect the legislative authors may be too clever by half since they may be slitting the bill's and perhaps their own throats in the process.

I'm pretty sure the 2014 date is mostly due to budget finagling.  This stuff can't be done overnight, but I'll bet most of it could be implemented within 12 months, and it could certainly be implemented within 24.

So how big a problem is it that nothing is going to happen until 2014 instead?  My first order guess is: not much.  In fact, I think everyone will be surprised at just how fast healthcare reform fades from the public discourse once it's passed.  Climate legislation will takes its place as conservative enemy #1, new celebrity scandals will distract the apolitical, and within a few months everyone not intimately associated with it will barely even remember it happened.  After all, the plain fact is that as important as it is, healthcare reform affects a pretty small chunk of the population either for good (better coverage) or ill (higher taxes).  Around 15-20% tops.

Still, sooner would be better.  It's easier to demagogue healthcare reform as long as the supposed disasters to come are still speculative, and it's easier to keep around the longer it's had to work.  I'm more interested in 2016 than I am in 2010 or 2012, and it would be nice if healthcare reform had had a nice long time by then to start working and really become part of the legislative fabric.  Three years is a short enough time that it could still be in some danger of repeal (or semi-repeal) when1 Republicans regain control of the presidency in 2016.

Overall, though, it's probably not too big a worry.  Conservatives are right about one thing: entitlement programs virtually never get eliminated once they've become law. Plus the last paragraph of this post is pretty compelling.  I'd prefer 2012 to 2014, but I imagine that healthcare reform is pretty safe regardless.2

1Yes, I think they'll win in 2016.

2Assuming it actually passes in the first place, of course.

UPDATE: More here from Austin Frakt on the potential pitfalls awaiting healthcare reform after it passes.