Aside from Democratic cheers, there was no immediate sign that the passage of healthcare reform last night will have a major impact. (No, the socialist utopia has not yet begun.) But, while the bill is moderate in ambition and scope, it will have far-reaching, and, if you believe non-partisan economists, ultimately beneficial effects on the economy, in both the public and the private sector.
Perhaps most important in Washington is the budget picture. Democrats wanted to expand healthcare coverage to as much of the population as they could, but insisted on making sure the bill was deficit neutral. In fact, according to the Congressional Budget Office, the bill will reduce the deficit $143bn over 10 years, and could reduce the budget deficit by one-half percent of gross domestic product – a little over a trillion dollars – in the next decade. Further, the CBO has a history of underestimating healthcare cost savings, so the numbers could improve from there.
The bill will also act to lower the overall cost of healthcare through a series of public policy mechanisms within Medicare and Medicaid, ranging from commissions to determine how best to reimburse doctors to funding for research to find the cheapest, most effective medical procedures.
It also helps shape the private market with insurance exchanges that improve competition, taxes some expensive health plans to force insurers and employers to negotiate better care, along with other, more prosaic measures – investments in information technology and prevention – to "bend the cost curve" down. CBO believes that the plan will "substantially reduce the growth of Medicare's payment rates for most services" and "substantially reduce the cost of purchasing [health coverage]" for families.
The bill will also have an effect on the labour market. If it helps cut costs and reduce premiums, we could see growth in wages for working people. A variety of academic studies have identified a connection between stagnant wages and increasing insurance premiums; reversing that trend could help drive up salaries. Further, and crucially, the White House Council of Economic Advisers believes the bill can create some 320,000 new jobs, increase GDP growth by 4% over the next 20 years, and increase average family income by $6,800 in the same period. Healthcare economists David Cutler and Neeraj Sood think the bill could create between 250,000 and 400,000 jobs a year over the next decade.
The bill's proponents also point out that it will help small businesses with tax credits that will ease the costs of providing health insurance, and will spur entrepreneurialism by eliminating "job lock" – when a person avoids pursuing new opportunities in order to protect their employer-sponsored healthcare coverage.
These are the arguments that reformers have been making about the bill for ages. While some of the Republican criticism is sheer demagoguery, and other critiques mostly procedural hand-waving, some have made points about concern that Congress won't follow through on necessary future steps to preserve the savings in the bill. However, as the Centre on Budget and Policy Priorities has demonstrated, Congress has historically demonstrated a willingness to impose these savings in deficit reduction legislation from 1990, 1993, 1997 and in 2005.
Now that the bill is passed, we'll have the empirical evidence to see whose claims about the bill turn out to be true. Much like President Obama's other signature legislative victory, last year's stimulus package, we'll likely find that the data supports reformers' promises.
And did I mention, the bill covers some 31 million Americans who didn't have health insurance before? It's not all dollars and cents, you know.