As published for Critical Condition on nationalreview.com on March 11th, 2010:

I have a new piece online from the April Commentary, which argues that contrary to the conventional wisdom, health care has been a poor political issue for the Democrats, and that a measured approach has tended to work better. Given this two-decade history, Democrats should be very wary of the politics of voting yes on their trillion-dollar overhaul.

In addition to the historical politics of the issue, the short-term politics are problematic for the Democrats as well. Today’s CBO score should not be very reassuring to the Democrats on a number of fronts:

1. More Costs — CBO states that we should expect as much as $70 billion in additional discretionary costs that they did not score. This includes $5 to $10 billion for the IRS, “at least” an additional $5 to $10 billion for HHS, and “at least $50 billion in specified and estimated authorizations of future discretionary spending for a number of grant programs and other provisions of the legislation.” That $5 to $10 billion to the IRS, in particular, should worry lawmakers and citizens alike.

2. Continued Access Problems — At great cost, the bill will cover 31 million people by 2019, but that will still leave 24 million people uncovered. In addition, over half — 16 million — of the newly covered people will be covered throughMedicaid, and not through private coverage. This is both a fiscal challenge, as Medicaid’s long-term finances are extremely shaky, but also a political challenge, as many doctors refuse to take Medicaid patients. Putting more people on Medicaid will not solve the access problem if doctors refuse to see them.

Read the full post here