By Donald B. Ardell – January 17, 2010
Not far from the invention of fire must rank the invention of doubt.
Thomas Henry Huxley (1825-1895)
I have been an enthusiast for health care (i.e., medical system) reform since I was toilet trained, or so it seems. Well, OK, that's a slight exaggeration - since my days as a health planner in the late sixties with a health system think tank and then as director of regional health planning agencies in both Minnesota and California. Since 1973 to the present, I have been functioning independent of any organizations, urging medical system reform via newsletters, books, speeches and near-daily essays posted at varied websites. 
Not surprisingly, I have been enthusiastic about prospects for changes to the dysfunctional non-system as soon as candidate Barack Obama emerged as a leading Democrat committed to health care reform. Reform prospects looked good throughout the 2007-2008 Democratic primaries and the presidential campaign. After Obama's election with a solid Congressional majority, it was easy to look on the bright side of life - while anticipating significant reshaping of the medical system in due course.
And then the wheeling and dealing began. Compromises and deals are part of our system - no surprises there and people do have widely varying perceptions about what's fair, what's needed, who is responsible for what and so on. That's how our system works. Everyone knows that.
However, sometimes the train of democracy does not move along in a way that one expected and occasionally it appears to come off the tracks.
In my view, reform legislation as proposed raises these kinds of questions. I don't know if I'm for it or against it. However, by the end of this essay, I think I'll know.
My big worries concern all the special treats for some states, the removal of the public option at the insistence of the odious Joe Lieberman and the abortion restrictions to mollify religious interests. I have been left to wonder: Will what's left of health care reform do more good than harm? Or, vice-versa?
I'm going to list what seem the most positive features of the bill, and then review what appear to be truly negative features - and make a call.
I hope senators and representatives of both parties shake in their boots or nervously finger their special interest campaign contributions (i.e., payoffs) while I ponder this go/no go decision.
THE GOOD
Here's what seems to be good about the bill.
* Republicans don't like it.
* About 31 million more Americans will have some medical insurance.
* Insurance companies won't be allowed to deny coverage any longer because of pre-existing conditions.
* A rebate program will require insurance companies to limit spending on administrative costs to ten percent of total revenues. (Because of high salaries, lavish spending and profit-taking, current rates are 25 to 30 percent. Source: Richard A. Epstein, Harry Reid Turns Insurance Into A Public Utility, WSJ, December 23, 2009, p.A21.)
* It establishes a principle that all citizens are entitled to basic medical care (without fully funding this right for everyone).
* To an extent, it reins in the insurance industry - a little.
THE BAD
Here's what's not so good about the bill, as I see it.
* It jeopardizes access to abortion services for tens of millions of women.
* There is no public option. This means too little competition for the insurance industry, which gets hundreds of billions in taxpayer subsidies.
* Price controls are lacking, despite a history of double-digit increases for decades that have contributed to the demise of auto industry and other firms that locked into untenable payment plans to insure employees. Such costs will continue to rise with a reform plan lacking strong price controls. Naturally, premiums will follow.
* There is little in the way of incentives for better lifestyle choices, which would promote well-being while reducing the need for expensive and dangerous medical interventions. Of course, this kind of reform was never expected, given the absence of empirical data showing that significant behavior changes would follow such investments, so this deficiency should not be held against any proposed plan.
* It contains provisions for mandatory coverage - everyone must pay up to eight percent of income to private insurance corporations. No choice. In effect, this is a new tax as well as a great gift to the insurance companies. The alternative - citizens can pay a penalty of up to two percent of annual income to the IRS.
* Many of the taxes to pay for the bill start immediately upon passage, but many Americans won't see benefits - like an end to discrimination against those with preexisting conditions -- until 2014 when key program features kick in. A chunk of the un-insured will not gain coverage for several years - about 20 million must wait until 2019, if indeed they will be covered then.
* High costs will add to deficits passed to future generations and further weaken the currency. There are cheaper and more effective ways to cover more people.
* Those with company-sponsored health insurance will pay more in deductibles, higher co-pays and premiums.
* There are insufficient cost controls - and added costs will make two other national priorities - job creation and deficit reduction, more difficult to accomplish.
* Mass advertising of prescription drugs is still permitted. Only two other countries permit that. The Senate bill also grants monopolies to drug companies.
AN EPIC DILEMMA - SO MANY DOUBTS
Maybe this is not the best time for a medical system overhaul. Given the obstructionist nature of Republicans, the most consequential reforms evidently are not possible at this time. But, perhaps a foot-in-the-door approach is better than nothing at all. It could be a matter of, If not now, it might never be.
(Image: The Deadly Sins Dominated by Death by James Ensor, 1904)
This bill does seem to reflect a sad reality - the American people are unready for genuine, much needed reforms along progressive lines. A recent Wall Street Journal-NBC News poll showed 41 percent of voters in favor of the bill; 44 percent opposed. The most recent Quinnipiac University poll reported opposition at 53 to 36 percent; a CNN-Gallup poll came in at 56 percent opposed, 42 percent in favor. It does appear that support for even this watered-down, flawed plan is weak.
House Speaker Nancy Pelosi pledged a final bill founded on core principles, including affordability for the middle class, security for seniors, responsibility to children (deficit reduction) and accountability for the insurance industry. The bill in conference can't deliver on these principles. The kind of reform we can expect from this bill might make things even worse, which I believe the Republicans would welcome.
The last thing this faltering nation needs in 2010 is the election of more Republicans, who every day become a greater menace to a free, rational and tolerant secular Republic than the deficit, the housing crisis, climate change, the Taliban, swine flu and the aging process - combined.
DECISION TIME - HOLD YOUR NOSE AND GO FOR IT
On the other hand, maybe the longer-term consequences of defeat of this health care reform, despite its flaws, will be more damaging than the bill is disappointing. Do we really want to see Republicans claiming victory for killing reforms? Imagine the glee of the demigods, like the vapid Sarah Palin.They will create further civic strife in boasting about their success in preventing what they will paint as government overreach.
I think it best to pass, then get to work in reforming, the reform bill.
In the meantime, the rules of the Senate should be changed, eliminating the non-Constitutional requirement for a 60-vote plurality to break filibusters. Maybe, as AWR adviser Bob Ludlow suggests, it really is best to pass the damn thing and then work like hell to get more progressives elected to House and Senate seats. Real reforms will almost surely have to wait at least one more election cycle when, just maybe if the enemy within can be rebuffed and replaced, the votes for a needed sweeping are in place.
So, I give the bill, hopefully with the negatives identified above improved somewhat in conference, my thumbs up while hoping my fellow Americans start electing better (more progressive) people to high office.
Good luck and to paraphrase President Obama, may the gods, if there are any, help Americans to think better in the coming decade than they did in this one coming to an end.
Don Ardell is the Well Infidel. He favors evidence over faith, reason over revelation and meaning and purpose over spirituality. His enthusiasm for reason, exuberance and liberty are reflected in his books (14), newsletter (511 editions of a weekly report) and lectures across North America and a dozen other countries. 