I find it nearly impossible to keep my head straight about the health care bill(s). By the time it (if it ever) reaches a final vote, I know it will continue dozens of provisions that I find seriously objectionable, mostly in the category of giveaways to the big interests in order to buy down their opposition.
When all is said and done, the U.S. will still have, by far, the most expensive health care system in the world and far from the best outcomes. It bothers me a lot that no one even dares to suggest that if we are paying the most of any nation for health care we ought to rank somewhere among the healthiest nations.
White House Chief of Staff Rahm Emmanuel never tires of reminding the idealists that this isn’t about finding the best possible health care bill, it’s about finding the best bill that can pass. It’s an unpleasant reality bite, but reality will bite nonetheless.
I accept, not as a proven fact but as a likely one, that if nothing passes on this round, we will be looking at several more years of the status quo system with continuing steady increases in overall costs and numbers of uninsured Americans. So, if I was a member of Congress I would vote every amendment that I believed would make the bill better, knowing my side will lose many or most of those votes, and in the end try to judge whether the overall bill represents an improvement from the status quo, and it if the answer is yes, vote for it.
Among the problems with thinking clearly about the bill is trying to decide what are the most basic issues. David Leonhardt, NY Times economics columnist, took a shot at it yesterday and, without getting too deep into the weeds, did a fine job, methinks. Here’s his stab.