Speaking at a Politico panel, Peter Baker of The New York Times said that “you’re not going to see universal health care, I don’t think, this year." And he may be right. But if you're not going to see comprehensive health reform this year, you're probably not going to see it next year. Or the year after that. Or even, really, the year after that. There's a very good chance that health care happens in 2009. But if it doesn't, there's a very good chance that health care doesn't happen at all. The mantra of the past few months has been that deficits don't matter. That's not quite accurate: Rather, they don't matter right now. Right now, the job market matters. If we need to run deficits to ease unemployment, then we run deficits. But if the laws of budgetary gravity have lifted for the next year or so, that only means they're going to crash back with twice the force two years from now. Having spent $750 billion on TARP and $825 billion on stimulus and who knows how many other billion on who knows what else, deficits are likely to matter quite a lot when the immediate fiscal emergency passes. And that will constrain the opportunity on health reform rather substantially. Great feats don't happen during hangovers. I had lunch yesterday with a longtime Hill and administration health care adviser who argued, persuasively, that health care happens in 2009 or it doesn't happen at all. For the next year or so, Congress is going to be prepared for major action. It will be willing to spend money. It will be far from the next election. A year from now, all that crashes down. The midterms will loom. The recognition of how much we've spent will dawn. The public pressure for dramatic action will ease. The aversion to risk will return. It's not impossible to imagine health care happening late in the administration's first term. But it's very difficult. The money won't be there. The budget hawks will be reempowered. The boom-bust cycle of elections will reemerge, and with it, the natural caution of Congress. The good news is that there's evidence the administration understands this. Following Orszag's statement that health care was now the top priority, behind stimulus. I made some calls to Folks In The Know. No one would confirm that the priorities had changed. But they were pointed in refusing to deny that priorities had changed. And the guy building the budget, they reminded me, had just said that priorities had changed. And Tom Daschle knows all this, and almost certainly has brought it up with Obama. When I interviewed Daschle for my article on the mistakes of 1994, he made much of the timing. "For understandable but unfortunate reasons," he told me, "the President and the Congress diverted from the focus we had on health care for quite a period of time and that hiatus allowed the opposition to organize and begin turning public opinion against health." Meanwhile, in Congress, both Kennedy and Baucus want to see this as a "year one" priority, and they're running a legislative schedule meant to accomplish that goal. I've heard some say that legislation could emerge as early as January. And for good reason: Everyone remembers watching Clinton's momentum and popularity flag while they waited for him to release a health care plan. They remember receiving the bill in November of 1993, when the recession that was powering public attention to health reform had ended, when the Whitewater investigation was sapping Clinton's strength, when it was already too late.
