Another Milestone for Health Care Reform

I haven't posted often enough lately to keep up with the pace of change in the health care reform struggle. Last time I wrote anything I was happy that a key compromise appeared to trade a "public option" for expanded eligibility for Medicare. Not long after, Sen. Joe Lieberman scuttled that deal. Now we're closer to the end, and while it's a far cry from what I think we should have as a health care system, the bill contains substantial improvements in health care. More importantly, if a bill like this one becomes law, it will be the first time that the vast, diverse bundle of things called "health care" is encompassed by a comprehensive national policy or approach. I don't think this is appreciated enough, except maybe by Republicans. I think a lot of their opposition is precisely because they see that any health care bill that looks anything like this will set a precedent. One way or another, if this bill passes, health care will never again be just another "industry". Lefties like me don't want it to be an industry at all. We'd like it to be more like a public utility, while this bill would appear to make health care more like ... well, I can't think of a parallel. Let's just say that health care and health insurance will still be nominally for-profit industries, but ones that are highly regulated and circumscribed. I suppose the closest resemblance would be to health care in Switzerland or maybe Germany ... private insurers operating in a highly regulated marketplace. I can live with that. And, since "highly regulated" is a subjective description, there will be room to tighten the reins later on, if necessary.

Here are some good articles on the subject:

- Matthew Yglesias: Health Care Woo

- 538.com: Senate Passes Historic Health Care Reform Bill on Party Line Vote

- Ezra Klein, Washington Post: Winning ugly, but winning

- Jonathan Chait, The New Republic: And the Rest Is Just Noise

- Daily Kos: After tomorrow's Senate vote, what next?

Everyone's trying to understand why liberals and lefties are angry about this bill. Personally, I think it has less to do with how and why the public option failed, and more fundamentally a frustration with the whole terms of the debate. Essentially, to participate meaningfully in the debate, you have to rule out a whole menu of health care models that most of the rest of the world finds perfectly satisfactory and sustainable. For some reason, we have to just accept that there's something different about the United States, such that health care systems that work for Canada, the UK, Germany, Japan, and dozens of other developed, complex, democratic and industrial countries are regarded as radical and impractical here. Why? Nobody seems to know. At least there are no substantial technical reasons ... only political ones. So, it's hard to stay usefully engaged in fighting for this or that detail of some sort of hybrid reform, when perfectly usable systems are ruled out from the get-go, for no other apparent reason than leftover fear of the Red Menace.

Put another way, the debate as it has played out has good and bad arguments, and is a logical, sensible, quantifiable discourse within it's own defined terms, but the logic kind of drops out if you just look up and see the workable solutions out there we're not even allowed to consider.

Which I agree, doesn't mean we shouldn't be glad that some substantial improvements are probably about to happen. But it also means we should spare some understanding for those who ae disappointed that once again, our choices were curtailed before the discussion even began.

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P.S.: Here's a good illustration of the limited utility of the argument from the left that the current health care reform bill is a giveaway to big insurance companies.