Half a Loaf

Like many of you, I'm sick to death of the slow-motion evisceration of the healthcare 'reform' bill winding its way through the Senate. As we inch toward the decade's end, it seems that each day brings a new Senator out of the woodwork to take his or her rightful fifteen minutes of infamy. As each dim Senatorial light insists on stripping out another element of reform, in order either to please a lobbyist or to insure against anyone who might later claim they were a progressive for voting "Yes," I have to wonder whether what's left in this legislation is worth fighting for.

But there is a wealth of experience out there, starting with the missed health insurance opportunity offered during the Nixon years, to remind us that passing on significant reform in order to drive home our revulsion at the way Washington works will delay any healthcare progress, however slight, for at least another presidential administration. That's at least four more years of millions of uninsured Americans staying outside the system, getting sicker and dying faster.

It's true, as Howard Dean says, that this bill is worse for all the insurance company goodies being stuck in it. The fact that insurers are allowed to charge individuals more for covering pre-existing conditions and that they've killed off all competition offered through a public option or a Medicare buy-in is lamentable. Really, worse; it's inexcusable. The way the Senate cloture rules have been abused to allow a small group to demand these changes— and the lack of chutzpah shown by the President to fight these skirmishes both irritate my last nerve.

But in the end, the passage of a bill, an amazingly imperfect reform, will be better than no reform at all. Here's why. Once we have near-universal coverage in the United States, the question will no longer be how to cover everyone. The question will turn to how best to pay for all our coverage. That's when the insurance companies' defense will begin to break apart.

The insurance companies have attempted to cherry-pick their demographic, in order to exclude anyone who might actually file an individual claim— and to lop off coverage options for small companies in which claims run higher than expected. This bait and switch of rescission will now be less possible under the legislation left in the bill in the Senate and in the already-passed House bill. So, the only profiteering option left to the insurers is to raise rates. This will no doubt be a tactic the insurers turn to quickly. It's in their nature. They won't be satisfied with less per-insured profit, even in a larger pool.

And that's when the private market will be challenged again by the people. There will need to be more strict regulation or added public insurance options offered as competition. Depending on how the insurance companies react to public pressure, perhaps they'll even make a single-payer system more politically enticing than it currently is. But the major shift will be that we'll have everyone as a stakeholder, not just those now insured under the present free-for-all system. That demographic and political shift will be a change of significant proportions.

So, I'm with columnist Gail Collins on this. I'd rather take the gain that all Americans will be insured as a major victory, with all the warts now on it, than cross my fingers and wait for a "better day." That day might come, but it might not come until many more people have suffered and died because they lack decent health care. Let's make our next healthcare battle over improving the system, rather than starting over to fight against the one we're stuck with now.

UPDATE- I see that Reggie Kennedy has reached much the same conclusions in a persuasive and well-crafted reminder in today's WaPo: that the current bill, however flawed, is what her husband Ted Kennedy fought for during most of his long Senate career. He would have taken the changes this bill secures and run with them. Later, he'd have been back on the Senate floor, demanding improvements to make healthcare better for all.