Government Healthcare or Bust
In Sen. Reid's bill as in the House bill, Priority 1 is the creation of some kind of government-run plan. The Dems are willing to accept that the plan won't be offered in all states. They are willing to allow private insurance to coexist alongside the government-plan for many years to come. They are willing for the government-plan to retain many features of private insurance - premiums will be based on the allowed risk factors, not on "ability to pay." They know that all those concessions will gradually erode. The key thing: establish the government-run plan now. Drive private insurers out of the market gradually. Shift only slowly from insurance-like finance to tax finance.
On that line, the debate is joined. Democrats now must worry: how many of their own senators will they lose in the final march to a state plan? How rough will their tactics have to be? How real is the risk of backlash?
If the bill does fail, future historians will wonder this:
What if President Obama had chosen a different path? What if he had told Congress in his 9/9 healthcare speech:
"I continue to support the public option personally and will work for it to be established later. For now, my priorities are (1) insurance reform, to outlaw the practices that most offend Americans, and (2) to create exchanges like those created by Gov. Romney in Massachusetts so that individuals and small businesses can buy insurance at the same favorable prices paid by large employers. We're going to have an individual mandate to buy insurance - and subsidies to help those who can't. We're going to shift regulation of health insurance from the states to the federal government, so that we can write a single, predictable set of rules, rather than 50 different rules that allow lobbyists in places like New Jersey to push insurance prices up and up and up."
Republicans could never have said no to that. He would have pushed his program through in a week. He would not have the cost problem, but then the current problem does not solve the cost problem either. What he would have done is open the door to market-driven change in the existing American system ... to a gradual shift from employer-provided healthcare to individual purchase from a menu of regulated choices ... without creating a new government entity. If further regulations were needed, they could be added later.
Such an approach would not have satisfied the desire of Democrats for a great 1964 or 1935 style messianic moment: "We've created healthcare!" But it would have expressed a broad national consensus, solved problems that people actually cared about, and put the country ahead of ideology.
And it would have been law by now.