Signs of the big fight over how to control health care costs are already appearing. This will be a long, hard, politically wrought battle. Nobody likes to be paid less. Nobody likes to be penalized financially. Even pushing the pain off into the future for shorter-term political practicalities is not so easy. There are critics at every turn. And when policymakers try to do that, it doesn’t even help the ten-year budget projections much.
But if you think that the administration will simply give up on the excise tax — which does them virtually no good in the first 10 years anyway — why is it in there at all? It’s unpopular with their allies and wins them no friends among their enemies. Indeed, it’s easy to see why so few presidents attempt cost control: You get hammered by the people who usually like you and dismissed by the people who usually like cost controls but don’t fundamentally trust you. That leaves you with, well, virtually no one.
When everybody is in favor of more for them and less for everyone else it is hard to assemble a coalition to do what is in everyone’s best interest. What’s a plausibly successful strategy for running this gauntlet? Beats me. I’m impressed by anyone willing to try.