Winning Ugly

By Eugene Robinson

When all is said and done—and, yes, there is a bit more saying and doing to endure, which means that anything can happen—the health care reform legislation that President Barack Obama now seems likely to sign into law, while an unlovely mess, will be remembered as a landmark accomplishment.

The bill making its way through the Senate by the slimmest of margins is imperfect, to say the least. But before listing its many flaws, let’s consider the measure’s one great virtue: For the first time, we will enshrine the principle that all Americans deserve access to medical care regardless of their ability to pay. No longer will it be the policy and practice of our nation to ration health according to wealth.

When you blow away all the smoke, that’s what this fight is about. The Senate bill lacks a public health insurance option, the House bill is burdened by gratuitous abortion restrictions, and the final product of a House-Senate conference will probably have both those failings. But once the idea of universal health care is signed into law, it will be all but impossible to erase. Over time, that idea will be made into reality.

The loose ends are so many and varied, in fact, that it will probably be necessary to revisit the health care issue sooner rather than later. Even if it takes years to get it right, eventually is better than never. History suggests that major new social initiatives have to be perfected over time—and that basic entitlements, once established, are rarely taken away.

Progressives who argue for killing the Senate bill and starting over should explain their position to the 30 million Americans without health insurance who would be covered under this insufficiently progressive legislation. They should recall that when Obama and the Democratic leadership in Congress began this crusade, public opinion was solidly in favor of reform. With polls now showing widespread wariness, with Republicans having confused and frightened many voters who already have adequate health insurance, why would anyone think that beginning from scratch is likely to produce a more progressive result?

It surely wouldn’t. For anyone who believes it is shameful that the richest, most powerful nation in the world cares so little about the health and welfare of its citizens, this is the moment. It should be seized, not squandered.

Is it ridiculous that the Senate bill essentially bribes Sen. Ben Nelson with special Medicaid reimbursements for Nebraska alone? Yes. Is it galling that the public option and the idea of a Medicare buy-in fell victim to Sen. Joe Lieberman’s whims? Supremely so. But our eyes should be kept on the prize.

The bill has been described as a gift to the health insurance companies since it provides them with 30 million new customers and no competition from a public plan. I don’t believe it’s a coincidence that the stock prices of health insurers are soaring. But I also don’t believe the main point of this exercise was to stick it to the insurance companies, however satisfying that might be.

Someday, perhaps, we will deal with the perversity of having for-profit health insurance companies. Executives of those firms have a duty to maximize value for shareholders, which gives them the incentive to behave badly—rejecting those who are most in need of health care, denying reasonable claims, raising premiums whenever possible. If health care is a fundamental right and a societal good, then why should its allocation be mediated by the private sector? But this is not the debate we’ve just had.

Eventually, we probably will ask that question. While the reform package nearing completion bends the curve of rising health care costs, more bending is going to be needed. Ultimately, we’re going to have to take a more fundamental look at how the health industry is structured.

So this isn’t the end of a process that leads to a rational, sustainable, more efficient health care system. It’s the beginning. But when a reform bill passes, as now seems likely, Obama and congressional leaders will have achieved a goal that progressives have sought for decades. They will have established that quality health care should be for all, not just for those who can afford it.

We have a system now in which Americans go bankrupt trying to pay doctors and hospitals to keep them alive. When you have the opportunity to change this, you take it—even if it means winning ugly.

Eugene Robinson’s e-mail address is eugenerobinson(at)washpost.com.
   
© 2009, Washington Post Writers Group

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