Monday, December 21, 2009

After the health care reform bill passes: what next?

One of the best episodes of the final season of the NBC television series "The West Wing" was a special live (though probably scripted) debate between the Democratic candidate Matt Santos, played by Jimmy Smits, and the Republican candidate Arnold Vinick, played by Alan Alda. At one point, responding to a question about health care, Santos makes a policitically astonishing admission: "I don't like my health plan. I don't think it goes far enough. But it's my plan because I think it's what I can get through the Congress."

It's not hard to imagine that President Obama feels much the same way about the watered-down Senate version of the real-life health reform bill, which cleared a major procedural hurdle last night with no votes to spare and is expected to pass before Christmas. Even administration officials interviewed on yesterday's talk shows expressed only muted praise for a bill that, far from being a "government takeover" of health care, creates no new public insurance option, would still leave 23 million uninsured in 2019, prohibits importing inexpensive medications from Canada, and most critically, does little to control costs. It's a classic compromise solution that pleases neither end of the political spectrum, and, perhaps as a result, is opposed by a majority of the American public.

In spite of all that, this bill is apparently what can get through the Congress, so when the New Year arrives, it will be time to think carefully about next steps - to think about how to turn a bloated $1 trillion insurance subsidy and consumer-protection statute into true "health reform" that provides reliable access to (rather than just coverage for) quality primary care for all and bends the cost curve that threatens our and our children's generations with a staggering national debts as far as the eye can see. I have some ideas, of course, but I'd like to hear what you think the next steps should be.