Are the defenders of the Democratic party’s approach to healthcare reform irrepressible optimists, or self-deluding fantasists? I declare a personal stake in the issue, as one such defender myself. In that capacity, I only wish I could be more confident of the answer.
As the search for votes to pass a bill continues, the line taken by defenders of comprehensive healthcare reform goes like this. Yes, the public opposes the Democrats’ proposals, but it is the process more than the product that voters question. And though nobody would say the product was perfect, it is basically good.
According to this argument, pieces of the reform – rules to force insurers to ignore pre-existing conditions, subsidies to help the less well-off, and so on – are popular. But the past year’s wrangling has sown confusion. Voters are bored and bewildered. Once a bill is passed, they will come around to liking it.
And the bill is a big advance, defenders insist. Broadening healthcare coverage and making it more secure are ethical imperatives. The measure takes tentative but useful steps towards better control of costs: not enough, but better than nothing. If the effort stalls, the likely result is no reform at all. Just as in the 1990s, a grand attempt at healthcare reform will have been crushed. It might be 20 years before anybody tries again.
These arguments are correct, but there is a problem. The process, not the product, has indeed caused the failure. The trouble is, the process just keeps getting worse.
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