Improving the Health Care Bill After It Passes Will Not Be Easy

There have been so many distractions around the health care bill this year, that it is hard to evaluate it on its merits. Health care reform has been something of a holy grail for progressives for more than half a century, so the debate was not likely to be simple or unemotional, but the last few months have exceeded even these expectations. Opponents of health care reform launched protest movements which warned of death panels, raised the specter of Nazi Germany and portrayed the bill as a major step down the road to Communism. The administration negotiated, if that is the right word, away most of the key hopes which many progressives had for the bill including a single payer system, public option and an expansion of medicare. Lastly, the reemergence of an increasingly petulant and egotistical Joe Lieberman as a key player in the negotiations was particularly unpleasant.

Nonetheless, it remains important to look at the bill itself rather than the debate and news stories surrounding its passage. The biggest reason health care reform is so urgent is because there are more than 40 million Americans without health care today. For these people, a serious injury or illness can result not just in not receiving timely and adequate health care, but in devastating financial burdens as well. People without health insurance, of course, always had the option of buying health insurance from a private insurance company, but telling somebody without a lot of money to spend thousands of dollars on health insurance was something of a "let them eat cake" solution to the problem. The uninsured tended to be unemployed or concentrated in low paying jobs and could scarcely afford this option.

The new bill addressed the issue of getting insurance for the uninsured, but it does it in a cynical and insulting way. It tells people who formerly had the option, but not the means, to buy health insurance, that now they will be required by law to buy health insurance. This policy sounds like a cross between Alice in Wonderland and Catch 22, or more mundanely, what one might expect from a Republican administration and congress. Coming from a Democratic administration and congress it is disappointing and infuriating.

Several supporters of the bill, notably Paul Krugman of the New York Times have suggested that, while the bill is far from perfect, the bill can be improved after its initial passage. It would be nice if this would happen, but Krugman's reading of history notwithstanding, this in unlikely to happen-and in fact has rarely occurred with social policy in the U.S. Because of the requirement that the uninsured buy health insurance from private insurance companies, the insurance companies will almost certainly grow more powerful as they add tens of millions of people onto their rolls, employ more people and increase their profits and lobbying power. Health insurance companies will be even better poised to combat any proposed modifications to this bill, other than those they want.

The bill, while failing to solve the biggest health care related problem, also seeks to reform the health insurance industry. For example, the bill makes it somewhat more difficult for health care companies to abuse people, seemingly arbitrarily deny coverage to people, and bars health insurance companies from refusing to offer coverage for preexisting conditions. These reforms are laudable, but do not inspire great confidence. It seems likely that health insurance companies, particularly as their influence continues to grow, will find new ways to harass their customers and try to deny them coverage, just as they do now.

For these reasons, if this bill passes, the chances of getting meaningful health care reform will be slightly worse than they were before Obama got elected because it will require not only a Democratic president and congress, but one willing to admit that a previous Democratic congress and president got it wrong.

Progressives who oppose this bill are not being obstructionist, making the perfect the enemy of the good, or sabotaging their president. They are taking the position that history has shown us that opportunities to reform health care do not come along very often, making it essential to get it right when those opportunities arise. Pushing this bill through because the White House needs a victory before the New Year is a much bigger mistake, which will likely backfire for the president, but more significantly potentially make our health care system worse.