Occam's Razor

Polls indicate that most Americans are not happy with the health insurance reform plan emerging from Congress. Of course, most Americans are also not fully informed about the health care reform plan either. With the Senate bill alone consisting of thousands of pages, who has time to read it? We depend on the press and policy wonks to give us the bottom line. To say the least, there is disenchantment. It’s kind of like hoping for a Lexus and instead getting a Yugo. Who would not be disappointed?

I know I am. I am in line with the majority of Americans who wanted a public government administered health plan on the assumption that it would at least be fair, provide real competition and be always available when other private plans left the market. It doesn’t look like that will happen. While anything is possible in the upcoming conference committee, it is likely the House will kowtow and it will be the Senate’s version of the bill that will become law. There is no public option in there, in large measure thanks to Senator Joe Lieberman.

Many Americans are also disappointed in President Obama’s performance to date. After all, he promised change. Where is the delivery? Our disappointment is reflected in his sagging pole numbers. In reality, given polarized politics as they currently exist in Washington, Obama is doing remarkably well. Particularly when it comes to health care reform, our disappointment is because our hopes are colliding with this messy thing called reality.

We might have actually seen the massive change that we were hoping for had we had solved a few other major problems before electing Barack Obama. Specifically, we needed meaningful campaign finance reform and limits on the influence of lobbyists in Congress. The Supreme Court in its infinite wisdom says our current corruption-laden political system is entirely constitutional. This meant, as usual, that those with the money, such as the health insurance lobbies, had a massively disproportional influence on our legislators. To me it is remarkable that in spite of the hundreds of millions of dollars spent to defeat reform we got as much reform as we did.

What we are getting is largely health insurance reform and not quite health care reform. Still, getting even health insurance reform is a remarkable achievement, given the money spent to defeat any kind of reform. Every single Republican senator lined up against reform, which meant that 58 Democratic senators and 2 independent senators had to pull together. Only of course, they did not so much pull together as kept watering down the bill until health care reform became health insurance reform. Naturally, billions of dollars in tax breaks went to appease the more recalcitrant senators. The resulting bill is a lowest common denominator bill, which is what you get when the Senate chooses to allow 41 senators to block almost any legislation.

One can complain about Senate Majority Leader Harry Reid’s tactical approach. He could have placated people like me by using a budgetary rule called reconciliation that required only a simple majority to pass. This could well have delivered a more liberal bill with more actual health care reform in it. He chose not to go that route. While I think it was a mistake, perhaps he had sound reasons for it. For example, he might have decided that disenfranchising conservative Democrats on this issue would eventually prove counterproductive with a whole host of other matters on which Democrats need to remain united.

Any major changes by Congress are excruciatingly difficult because there are so many well moneyed interests aligned for the status quo. This leaves the rest of us who are much less moneyed largely disenfranchised. Yet despite these odds, meaningful health insurance reform looks likely to become law. In that sense, President Obama is right that this package is a big deal. History suggests that even this much was a long shot. Once we get used to it, we will take it for granted and wonder why Republicans were so foolish as to block it in the first place.

Half a loaf is not as good as a full loaf, but it is still half a loaf. I do not agree with Howard Dean that we are better off without this bill. While it does little to address exploding health care costs, at least thanks to generous subsidies 30 million Americans will be able to acquire health insurance, and no one can be denied coverage for preexisting conditions. This should make our premiums less than they would be without reform. Every hospital or emergency room visit by an uninsured or indigent person means that their costs are passed on to the rest of us in the form of higher premiums. Reduce the uninsured and more of our health insurance premiums will actually go to treat us.

Count me among those who are disgruntled but still grateful for the half a loaf we are getting. It was not foolish of me to hope for more than what we got. It would have been foolish of me to actually think we would get it this time around. I never did.