By Evan Falchuk

Since the 2000 Presidential election- and most especially since the world-changing events of October 17, 2004, I’ve known this: don’t assume anything is over until it’s over.

Still, I’m going to bed so I’m going to give you my six quick reactions to the reform plan, based on the assumption it’s about to get voted in.

UPDATE: I stayed up, and it passed.

1.  It’s Historic. It is, but mostly because people keep saying that it is.  I mean the President of the United States has gambled most of what he’s got on this, so it’s one for the history books in that sense.  Still, a health care program that was truly historic would be something like taking all of the uninsured and just enrolling them immediately in Medicare.  This plan doesn’t come anywhere close to doing that.  Much of what is meant to deal with the serious problem of the uninsured doesn’t start for years, and is going to be handled through a complicated mechanism that may not even work.  I suspect the history-making part of this will have to do more with the political fortunes of the Democrats and President than American health care.

2. Talk to Benefits People Who Have Messed Up. You know who the President really ought to talk to now?  It’s private-sector executives who have presided over botched implementations of new employee benefit plans.  Because their experience at how to repair damaged relationships with people are what he needs.

Why?  Because what happens is that management decides to put in some new benefits plan that will save the company money and which they just know employees will like once they understand it.  So they don’t spend a lot of time worrying about how the changes are going to play with employees.  The trouble is people take their health benefits very seriously.  Anything they think will affect them creates a lot of anxiety, and failing to communicate well makes it much worse.  Sound familiar?  It’s very much what’s happened here.

3.  It’s Not Over. That’s right, it’s not.  Congress is going to be taking up the so-called “doc fix,” which is another multi-hundred billion dollar federal health care expenditure.  The same issues we’ve been talking about for a year are going to get dredged up again.  And again.  And again.  Plus we’ve got an election coming up.  Barring some major international catastrophe, we’ll be stewing in the juices of health care reform for many more months to come.  And you know, if the Republicans somehow manage to take Congress, this could go on right until 2012.  I wonder if President Obama really wanted things to go this way.

4.  It’s Not a Left-Right Thing. It’s not.  Sure, the existing infrastructure of the culture war has grabbed hold of reform and is riding it.  But Republicans opposing the plan should learn from Massachusetts.  Don’t confuse the fact that you are saying things people like for a shift in support for your culture war causes.  There is a glimpse of this in the last minute wrangling over abortion.  While that’s an important issue for a lot of people, it’s not what public anxiety over reform is about.  So if, for example, Republicans decide to make abortion a big part of their strategy going forward, they shouldn’t be surprised when they find there aren’t as many people behind them as they expect.

5.  Health insurance regulation is now federal territory. Little-noticed (well, except by me) is the fact that Congress has repealed the anti-trust exemption for health insurance and that the reform plan sets up the basics of a federal infrastructure for insurance regulation.  The federal government doesn’t just drop by and visit, they move in.  Memo to state insurance regulators: the feds are outside, and they have a HUGE moving van.

One day we’ll all be able to tell our kids we lived in a quaint time when we used to regulate health insurance in the states.  Our kids will laugh.  Actually, strike that.  They’ll wonder why we thought it was interesting to tell them that.

UPDATE 2: Some state attorneys general say (on Facebook no less) they’re going to mount some kind of (sure to fail) challenge to the bill.  Too little, too late.

6.  Elections matter. I don’t think the reform plan is a good idea, but we live in a democracy and the other side won.  Good for them.  Now, once the President signs it, the reform plan is law – not Democratic or Republican law, but American law.  For those who don’t vote, or who do;  for those who don’t get involved in politics, or who do;  the success of the reform plan is a tremendous lesson: elections matter.