Yes, Republicans are AWOL on the subject. Yes, lefty netroot types are consumed with rage about the fact that the public option is dead and that health-insurance companies are going to get lots of new customers. Yes, my BNET colleague Ken Terry is correct that there are lots of niggling issues left unaddressed -- or dealt with inadequately -- by the Senate legislation.
None of that matters. Pass the damn bill. (Again with the apologies: Paul Krugman got there first, and arguably better. I'll let readers decide.)
Politics being what it is, the first cut at major social-program innovation is always imperfect. Look at the 1957 civil-rights bill. Or the original implementation of Medicare. Or the initial version of Social Security. Or Bill Clinton's 1996 welfare reform. The old saw about the perfect being the enemy of the good holds in spades on each of these programs. In each case, time passed and as the reality of the previous legislation took hold, Congress amended and/or vastly expanded each of them.
Yes, I know this won't sit well some some portions of the BNET audience. No business owner wants to see the nose of the government camel under its tent. And no believer in the free-market system wants to see the government setting rules and potentially constricting business opportunities.
The problem here, though, is that the free-market system has manifestly failed in healthcare, as I've noted before. Economy-wide, we're paying too many people -- doctors, hospitals, insurance companies -- too much for care that doesn't make people healthier, and which sometimes (maybe often) leaves them worse off. The result is a bankrupt healthcare system that will inevitably try to extract more money from fewer paying customers until the whole thing collapses.
If you agree that medical problems shouldn't bankrupt ordinary Americans, and if you think that simply obtaining healthcare coverage shouldn't force people to jump through hoops for insurance-company actuaries, and if you believe that escalating healthcare costs will eventually bankrupt the U.S. -- as they well might -- then the Senate bill, flawed as it is, is the best initial step in the direction of reversing every one of these problems.
Sure, the politics are still sticky. First off, let's kill all the Republicans. No, I jest -- let's just ignore them. The GOP made itself entirely irrelevant to the reform discussion by embracing Bill Kristol's 1993 rejectionist playbook, and as result is now completely on the sidelines. Jon Chait pretty accurately described the box the Republicans created for themselves, and I'm hard pressed to argue with him. Whatever the merits of tort reform -- for the record, I think they're minor, but still worth pursuing, if only to shut up doctors on the subject -- the Party of No managed to render itself silent on the subject of how you might best introduce market-oriented elements to a sensible healthcare reform. (No support here for consumer-directed healthcare, which is essentially a massive fraud based on the notion that you can shop for a cardiac surgeon while attached to jumper cables.)
That leaves us with what we have -- even if it's still just a bill, sittin' here on Capitol Hill. It's a measure designed by the sausage factory that is the Senate, and almost wholly driven by Democrats. Hard as it will be for many of our regular readers to swallow, this is a good thing, because the healthcare industry is based on an unsustainable business model that's going to end in untold misery and death. Let the tobacco industry be your guide: A business plan that kills off your customers -- or, to be more precise in this case, renders your product unaffordable to them, which in business terms is the same thing -- is not going to stand the test of time.
Reform is going to mean wrenching change, no question. Yes, lefties like the aformentioned Jane Hamsher believe that directing any government money to insurance companies is evil, pure and simple. I take a different tack. The health-insurance business is not a healthy one, despite the bonuses its executives pay themselves. The reason you see such a rash of consolidation -- hell, the largest insurer in the country, WellPoint, is essentially a conglomeration of formerly nonprofit Blue Cross/Blue Shield plans -- is that the companies have convinced themselves and their investors that the only way to be better is to be bigger. That may be true in the narrow sense of giving insurers more leverage to beat down hospital costs, but as far as the overall national healthcare equation is concerned, it's just a matter of squashing down the balloon in one place only to see it expand in another. Or, as I've termed it before, the Whack-a-Mole school of healthcare economics.
So to break the self-perpetuating cycle in which insurance rates climb because doctors do more stuff that requires us to pay them more -- or, in wonky terms, to "bend the curve" on escalating healthcare costs -- everybody's ox needs to get gored. Every dollar spent in healthcare goes into someone's pocket, and those interests are going to fight like hell to resist any suggestion that they get paid less, even if it's manifestly in patients' interest -- and that of the country as a whole. No one yet knows the best way to make such cuts palatable, which is why the array of pilot programs in the Senate healthcare bill are worth a lot more than you might think, as Atul Gawande has argued in the New Yorker.
The simple fact, as anyone in healthcare will acknowledge if you catch them in an unguarded moment, is that the current system is unsustainable. Whatever its faults, the reform legislation that now has to votes to pass the Senate is the best any of us can expect in the short run -- and it can always be made better. Pass the damn bill.
Previously on BNET Healthcare: