Everyone understands that healthcare reform is a moving target. But even by the standards of everything that has occurred over the last three years, the actions of the administration in the last few weeks are startling.
In postponing the mandate on businesses to provide health insurance — but keeping in place the individual mandate to purchase insurance — essentially what the president’s people have done is push off the primary effect of his law on businesses while pushing forward its primary effect on people and the cost to the Treasury.
Businesses on the other hand will have another year to get ready to confront the chaos and costs of the administration’s initiatives.
The stated reason for this course of action was that the administration was responding to those in business who had expressed confusion and outrage at the prospect of being thrown into this convoluted new system. That system, they argued, would have crushed the economic engines of America — small businesses — under an avalanche of new duties, rules and expenses.
Was this the real reason for the change? Those who are a bit more political tend to believe that the reprieve was granted simply to get past the midterm elections and thus avoid the retribution that congressional Democrats might otherwise have experienced at the polls.
Whatever the true reason, it is a course of action that gives new meaning to the term ironic.
First, it clearly is an attempt to rewrite and delay the implementation of the healthcare law — a law that the president once needed so urgently that the congressional Democrats found it necessary to run it through the Senate in four days with a final vote on Christmas Eve.
It is also a sweeping rejection of the terms of the law itself, which set out a timetable that was supposed to be built around a coordinated rollout of business’ obligations, the individual mandate and the health exchanges.
When the original arguments in favor of the law were being made, it was regarded as absolutely integral that it would move forward as a unit, with each part playing off the other as it headed down the road toward a self-proclaimed utopia in healthcare delivery and coverage.
Second, it sets up a scenario where the exchanges move from being somewhat funded and possibly even coherent to being totally unfunded, except through taxpayer subsidies, and most likely rather confusing.
It is possible a citizen who finds himself or herself enrolled in the exchange will be able to end up with a rather large subsidy depending on his or her income level. This is good news for those folks and bad news for the Treasury and national debt. But concern on that front has always been at best a distant murmur in this undertaking.
Independent of the question of the legal defensibility of this action, the essential effect of splitting the healthcare initiative will, far from improving the system, actually lead that system to sputter toward implosion. Its parts will simply fail to mesh and fail to function.
Of course, the truly cynical might say that this was the game plan all along. First, get a large number of people hooked on a new entitlement — the subsidized, exchange-sponsored insurance. Second, do this without highlighting the most politically explosive parts of the plan — how you pay for it and how you push people off their employer-sponsored plans and into the exchanges.
The result will be exchanges that are not sustainable but full of people getting a new government benefit. This will require the federal government to step in and save the rights of these folks to their new entitlement. Such action can only be accomplished by a complete government takeover of the exchanges and “kazam,” like magic, we are into a single-payer national system.
Thus, as inconsistent and as incoherent as the administration’s actions of the last few weeks may seem on their face, the administration may have actually stumbled into a new and even more effective path for getting to what has been its primary purpose in healthcare reform.
The goal has always been a government-run system where the issues of who is covered, what the coverage is and how the healthcare delivery system is managed all fall into the hands of the few in Washington who have selected themselves as the autocrats of healthcare in America.
If it were not such a bad deal for a nation already overburdened with a government it cannot afford and for the people who consume and deliver healthcare in the country, it would have to be called “brilliant.”
Judd Gregg is a former governor and three-term senator from New Hampshire who served as chairman and ranking member of the Senate Budget Committee. He is the CEO of SIFMA, a financial industry lobbying group.