I highly doubt any major healthcare or energy reforms will get passed in the next few years. Obama will probably still get reelected though since he'll get the credit for the improving economy. And then maybe we'll see actual reforms getting passed in the second term.
That's just not how it works. It's much harder for a president to push through major legislation in their second term. Look at FDR, LBJ, Reagan and Dubya. Realistically, it's the next couple years or bust.
I said it during the main election, UHC is merely a pipe dream among the left. It shipwrecked the Clinton presidency and looks to be doing the same to the Obama one.
Obama gave it a good try, but he (or future people) would be better off implementing reform in small bites. Trying this approach only invites big disappointment.
That being said, they can still salvage something out of this.
That would be nice if that were true, but the nature of health insurance makes "small bites" problematic.
It's not like environmental public health issues, for example. Lead in the water, smoke in the air, mercury in the food chain. You pass a bill dealing with all of it, or pass several narrower bills, and it will basically have the same effect. Failure to clean up one thing won't undermine your efforts to clean up something else.
Ditto pilot programs dealing with education/crime/drug. A needle exchange in Baltimore will work or fail regardless of what the policy is in Oakland.
Health care, not so much.
The way the system is, you can't even somewhat effectively address either of the big problems (exploding costs and uninsured Americans) without either 1) a massive expansion of government or 2) a bill with a
lot of moving parts to keep people from cheating the system so badly it collapses.
Say you want to make it so people don't worry about losing their coverage if they lose their job. That was a goal of both Obama and McCain's plans during the campaign, is a wildly popular idea, and certainly sounds less ambitious than a revamp of the entire system.
If you do it by replacing the employee healthcare subsidy with individual vouchers, employers will offer coverage to fewer workers. These workers then use the vouchers to buy plans on the market. But if they're over 40 or have been in the hospital the last year, they probably won't be able to afford a plan on the individual market. So the government has to step in and regulate insurance companies so they use community rating and ignore pre-existing conditions. But if someone knows a pre-existing condition won't disqualify them from coverage, their best bet is to not spend any money on insurance (getting only what the voucher will pay for), they'll wait until they or a loved one gets sick, then sign up for the nice, low-deductible comprehensive plan. So then you need to implement either a surtax or a mandate on people with little or no coverage to keep them from gaming the system. But that would mean taking money from poor people who can't afford coverage, which you could get around by either helping pay for their costs or waiving the surtax/mandate. Also, you'd need to implement some system for tracking and enforcing compliance with these rules for both the insurers and customers.
Which gets us *long inhale* in the neighborhood of the current plan.
Basically, any tweak to the system that's not completely insignificant needs to be packaged with another billion rule changes to keep it from being exploited.
