As you probably already know, the big battle in the world of health care reform this week is an internecine one. One group of reform proponents argues that the Senate reform bill is so compromised that it should be scrapped, and another group of reform proponents claims that scrapping the bill -- however imperfect it may be -- will cost Americans many important incremental gains.
If I'm being honest, I've been struggling to figure out which side I'd take. I vastly prefer getting things right over getting things wrong. At the same time, I wouldn't want my opinion on the matter to be privileged over the people who want to push the bill through, and who have done the hard work, put in the sweat equity in the legislature and who probably feel the loss of the public option no less keenly than I. I also have to recognize that my opinion on the matter is colored by the fact that deep down, I'm probably more of a fan of the romance of Grandiose And Ultimately Futile Gestures than I care to admit.
That said, one thing I can say declaratively, is that I am also a huge fan of Not Kidding Ourselves.
There's a lot of very elegant, intellectually-sound wonkery underpinning the case to push on with what little is left in the health care bill, none of which I'll take issue with here. But when the final chapter on this attempt at health care reform is written, I plan on evaluating the enterprise according to the principles laid out by President Barack Obama, as he set the wheels in motion.
There are three specific metrics -- if we can call them that -- that I think should be met by this bill in order to call it some kind of significant, historical achievement.
When President Obama campaigned across the nation, he sold his plan to reform the health care system by personalizing it. At various stops along the campaign trail, Obama brought up his mother's battle with cancer, and the battles she had to fight with insurance companies. In his nomination acceptance speech at Invesco Field in Denver, Colorado, Obama referenced this, saying:
Now -- now is the time to finally keep the promise of affordable, accessible health care for every single American. If you have health care -- if you have health care, my plan will lower your premiums. If you don't, you'll be able to get the same kind of coverage that members of Congress give themselves. And -- and as someone who watched my mother argue with insurance companies while she lay in bed dying of cancer, I will make certain those companies stop discriminating against those who are sick and need care the most.
At the second presidential debate at Belmont University in Nashville, Tennessee, Obama referenced his mother again, and expanded his vision for what health care in America should be:
I think it should be a right for every American. In a country as wealthy as ours, for us to have people who are going bankrupt because they can't pay their medical bills -- for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they're saying that this may be a pre-existing condition and they don't have to pay her treatment, there's something fundamentally wrong about that.
Lastly, in his speech on health care Obama made before a joint session of Congress, the president vowed:
I am not the first president to take up this cause, but I am determined to be the last.
So, beyond the policy proposals and the delivery mechanics and the existence of public plans, I'll be evaluating the bill according to three principles:
1. When this plan goes into effect, will it bring an end to the battles that health insurance consumers must wage to retain their coverage, or will the practice of rescission continue?
2. When this plan goes into effect, will it bring an end to the long-term, intractable debt that millions of hard-working Americans incur, simply because they get sick, get injured and grow old?
3. When this bill is signed into law, will Obama truly be in the position to say he'll be the last president to "take up the cause," or will it be obvious that we've only kicked the can down the road, and that more needs to be done?
In truth, the way I see things shaping up, I don't believe that the eventual reform legislation will achieve any of these things. At the same time, I think that if it makes it to Obama's desk, he's going to sign it. But, pursuant to the cause of Not Kidding Ourselves, he'd better not call it a victory. I think that anyone who believes that the enactment of legislation that fails to achieve these three key goals is some sort of astounding historical achievement, worthy of pomp and ceremony, better curb their enthusiasm.