The health care proposal: is it too weak?

The healthcare proposal that seems to be headed for approval doesn't very effectively deal with costs, but the measures which conceivably could have attacked the cost problem head-on don't appear to be politically possible at this time. I don't think there's any inobtrusive policy change out there that could have resulted in significant savings; the possibilities that I've heard -- binding price controls on fees for services, prohibiting fees-for-service instead of fees-for-outcome, forced standardization of practices -- all entail intervention and change into medical care vastly beyond anything that has been proposed until now.

When we try to figure out what was possible in this area, I think it is helpful to look at the political makeup of the votes backing and opposing the measure. I think it makes sense to ignore the House and concentrate on the Senate where the passing margin was a single vote. If you try to place the cost-saving proposals that I mentioned above on to an ideological spectrum left to right, they will all be considered left wing. I don't think it requires much reflection to realize that the Senate bill would not have gained any votes by moving to the left. Olympia Snowe is probably the most left-wing senator to oppose the measure, and I don't think anyone would claim that making the measure much more ambitious in terms of its intervention into the industry would have won her over.

Keeping these factors in mind, I have to wonder what those liberals who have called the current measure a step backward are thinking. Presumably they have a stronger -- i.e., more left-wing -- measure in mind that they are hoping would be enacted in the place of the current proposal. But when would this happen? It appears that the 2010 elections will bring Republican gains in both houses of Congress; surely a strong left-wing healthcare proposal will be less likely to pass after 2010 then now. So perhaps they are looking long-term -- say, after 2012? This seems like quite a gamble to me. The economic "recovery" -- if you want to call it that -- is quite fragile, to say the least, and it is easy to imagine a second leg to the economic downturn which will cause continuing Democratic losses in 2012 and beyond.

Yes, the proposal is flawed. It is very generous to the insurance companies and big Pharma. But it does establish the principle that we are going to help the working poor to have medical care, and this is a principle that the left has been trying -- and failing -- to get into place for the last 80 years. And the measure contains pilot programs for many interesting cost-cutting ideas, pilot programs which will provide us with valuable information as to their effectiveness. We are going to have to revisit the cost end of healthcare, and we may find that the information gained from the pilots is very helpful at that point.