“Let’s be honest, the goal isn’t to see whether I can pass this through the executive board of the Brookings Institution. I’m passing it through the United States Congress with people who represent constituents.”The bill we get is not going to be perfect. In fact, it will be far from perfect. The key issue, it seems, is whether doing something imperfectly is preferable to doing nothing. On this point, the essential question is, Will the situation worsen, improve, or stay the same if flawed reforms are enacted?
He went on: “I’m sure there are a lot of people sitting in the shade at the Aspen Institute — my brother being one of them — who will tell you what the ideal plan is. Great, fascinating. You have the art of the possible measured against the ideal.”
Harvard Medical School's Marcia Angell has argued that the bill is not better than nothing, emphasizing that health care costs will continue to rise and insurance coverage will not improve for many Americans:
It simply throws more money into a dysfunctional and unsustainable system, with only a few improvements at the edges, and it augments the central role of the investor-owned insurance industry. The danger is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we've tried health reform and it didn't work. But the real problem will be that we didn't really try it. I would rather see us do nothing now, and have a better chance of trying again later and then doing it right.John Cohn, writing at for The New Republic, takes issue with Angell and other liberals and progressives who are dissatisfied with the present reforms, arguing that, in fact, a number of good things will come from this bill:
According to the Congressional Budget Office, the House bill would mean about 36 million people get health insurance, reducing the number of uninsured by around two-thirds. People who had pre-existing medical conditions would, finally, have the ability to get insurance just like the employees of large companies do. The insurance would not always be as generous as it should be, but the government would prohibit lifetime caps, place some limits on out-of-pocket spending, and establish a basic benefits package that makes sure all policies cover a broad range of services.
The studies--which, I know, Angell has seen--suggests tens of thousands of people* die or go bankrupt every year because they can't afford to pay their medical bills. Countless more suffer. The House bill wouldn't stop such hardship altogether. But it would reduce it significantly--arguably, by as much as any single piece of domestic legislation since the Great Society. Surely that qualifies as something more than "a few improvements around the edges."
The House bill would do many other things, too, familiar to the readers of this space--from the creation of a public plan to the creation of pilot programs that would begin to change the way we deliver medical care. And while it wouldn't do nearly enough to make health care less expensive--the drug industry, among others, remains a source of untapped savings--the House bill certainly wouldn't cause the cost of medicine to go up even more quickly. If anything, it'll cause the cost to go up a bit more slowly.Besides, says Cohn, reform can be revisited and adjusted down the road:
As I've argued repeatedly, the House bill is not close to perfect. Neither is its Senate counterpart. But we don't pass perfect laws in the U.S. We pass imperfect ones and then do our very best to improve them over time.Ezra Klein piles on with more historical perspective:
It happened that way with Social Security and Medicare. It can happen that way with comprehensive health care reform, too. But only if we do something, rather than nothing.
As any scientist will tell you, it's much easier to encourage something to evolve in a certain direction than it is to create it anew. The idea that a high-profile failure in a moment where a liberal Democrat occupies the White House and Democrats hold 60 seats in the Senate for the first time since the 1970s will encourage a more ambitious success later does not track with the history of this issue, nor with the political incentives that future actors are likely to face. If even Obama's modest effort proves too ambitious for the political system, the result is likely to be a retreat towards even more modest efforts in the future, as has happened in the past.I'm with Cohn and Klein on this one.
Sure, the present House bill is flawed. One of the most significant problems that goes largely unadressed here is the fee-for-service system that we presently have, which creates perverse incentives for doctors to "over-treat" their patients. The public option will offer insurance to people who might otherwise be unable to find a reasonable plan, but this option could potentially turn into a dumping ground for applicants who would make poor clients for private insurers. Another concern I have (and one I am not altogether clear on) is the fine structure for non-compliance with any mandate provisions; very low fines could incentivize employers and individuals to pay the fine and cut insurance, and very high fines might allow insurers to jack up their prices. I'm not sure how one goes about determining the optimal fine to produce the desired behavior on the part of individuals, employers, and insurers. Finally, none of the reform efforts have done anything to address how the personal choices people make - in their diet, exercise, and lifestyle habits - affect the cost of health care and health insurance. The system we have at present fails to address this issue. Greater transparency in terms of the cost of care might help here, but I don't know that much the issue to come down firmly in favor of specific solutions.
That said, I still think it is better to pass a flawed bill than to do nothing at all. First and foremost, there will be tangible benefits to a reformed system that will outweigh the corresponding costs, some of which Cohn outlined. Also, B's suspicion that "Democrats want to pass a bill simply to say they have 'passed health care reform'" is not without some justification, for Democrats may benefit from being a party that "gets things done" (of course, they may also suffer from some backlash for being "big-government liberals"); however, this does not mean that this is the primary or sole reason for acting on this issue. Many liberals and progressives believe that this is a human rights issue, and that as a nation we have a moral obligation to make sure that everyone has access to quality health care.
I wouldn't call it a "right," but I would say that it is in our national interest to pursue such a goal. B and his conservative allies might disagree, or say that it is pie-in-the-sky idealism to believe that our nation is even capable of achieving anything near universal, quality coverage. Indeed, there is a certain element of fatalism and determinism to the conservative philosophy, just as there is more than a shred of idealism and, at times, naivete, in progressive liberalism. I'm no utopian, but I think there are reasonable things we can do to achieve more universal coverage and lower costs. In the real world of political maneuvering and congressional logrolling, people like me will take what we can get on this issue. This bill is not perfect, it's a start.
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