Remember the principles at stake in reform debate
The debate roiling Congress this week is hardly about health care insurance. It's about procedure and posturing and partisanship. It seems like it was ages ago that we had any sort of substantive negotiations on things like insurance pools, portability or incentives for doctors to work in underserved areas. Instead, these days we bat around the arcane minutiae of parliamentary rules and the shallow precedence of "deem and pass."
As Congress steers closer to this historic vote, it bears noting that certain health-care principles, once widely supported, still make sense. The sausage-making nature of this legislative ordeal has obscured that reality -- but the fact remains, our health-care system does not work for millions of Americans.
We must bar private insurers from denying coverage based on pre-existing conditions. We must ensure people's ability to transfer their coverage when they move from job to job. We must put an end to medical bankruptcies, a national embarrassment virtually unheard of in other industrialized countries.
We must address private insurance companies' ability to deny care even as their profits skyrocket. We must take steps to minimize the number of people who rely on emergency departments as their first, last and only options for care. We must educate and integrate new doctors, nurses and other health care professionals.
The cumbersome, highly imperfect Senate bill presently before Congress -- the final step in a torturously long process -- manages to address it all. Does it cover the issues to the satisfaction of all? Certainly not. But passage doesn't end the debate. In many ways, it only starts it. There will be much more to refine in the years ahead.
Rolling out reform in incremental steps, as some have suggested, is both unrealistic and ineffective: unrealistic, because opponents of this bill aren't likely to support any meaningful change if they successfully derail what's already on the table; and ineffective because so many parts of the reform machinery are designed to work in sync with other parts.
Yes, we have concerns. The $875 billion price tag is staggering, and though efforts are ongoing to chip away at it, the bill will be breathtakingly expensive.
We've been told this bill won't make the already-gargantuan budget deficit any bigger, but that's based on the fact the bill would accumulate funding for years before significant program costs begin.
And we're troubled that meaningful tort reform came off the table almost before the debate began.
But, for all its flaws, this bill achieves things Americans have sought, and deserved, for decades. President Nixon, hardly a pillar of progressive thought, understood that. "Without adequate health care, no one can make full use of his or her talents and opportunities," he said in February 1974.
Imperfect as this bill might be, defeat might set back health-care reform by a generation. Imagine the last wave of baby boomers living out those golden years with private-insurance bean counters watching every doddering move, weighing profit and loss.
Like so much of politics today, the debate is all or nothing -- and though "all" leaves much to be desired, "nothing" does not serve the nation's needs. In fact, it abrogates a nation's responsibility to its people.
