Understanding Reform Doesn't Come from Handicapping It

Here's something you won't learn from reading headlines or obsessively watching text crawl across the bottom of the TV screen: Health care reform isn't a horse race.

It doesn't turn on what the latest key member of Congress said this morning or the latest poll by an influential industry group.

It moves slower than a horse race and slower than a 24-hour news cycle. Understanding it requires more than sound bites.

On Saturday, it lurched forward again when the House narrowly approved a reform bill, 220 to 215. That was a milestone, but it wasn't health care reform's make-or-break moment.

Next up is the Senate, which will move toward a debate after the nonpartisan Congressional Budget Office "scores," or estimates, the cost of the Senate reform bill.

That CBO evaluation probably will come this week. It won't be the make-or-break moment, either.

One constant thus far has been the horse race analogies — the premature declarations of success or failure. During raucous town hall meetings last summer, we learned that health care reform was dead. That report, like the influence of the town hall meetings, was greatly exaggerated.

This fall, we were told that the so-called public option is a marker of "real reform." If it weren't included, there would be no real change — even though millions more Americans might get insurance coverage.

We later learned that the public option was dead; it wasn't. A public option is included in the recently approved House bill and the soon-to-be-debated Senate bill.

Now, we're breathlessly informed that Sen. Joseph Lieberman, I-Conn., won't vote to begin debate on the Senate bill.

No wait, he's changed his mind; he'll vote to begin debate, but if a public option is included, he won't vote to prevent a filibuster.

All of this fills airtime and causes furious typing on political blogs, but it doesn't help anyone understand the complex and far-reaching issues raised by reform.

This raucous sideshow won't end anytime soon. There are important differences between the House and Senate reform bills; the differences probably will grow as still more deals are cut. Will it be the public option by a nose or state opt-outs going away?

Players in the health care industry worry greatly about such things, as well they should. Health care is a $2.5 trillion-a-year business. Slight changes in the final wording can mean millions of dollars in revenue or losses.

But all the focus on differences obscures much larger areas of agreement. Both the House and Senate have bills that would provide near-universal coverage for the first time. More than 95 percent of American citizens would be insured. Now, 17 percent of the population is uninsured; millions more face financial catastrophe if they get seriously ill.

All the bills under consideration would require that insurance benefits are sufficient to cover at least 65 percent of the cost of serious illness or injury. Health coverage couldn't be canceled if people got sick. It couldn't be capped if treatment were expensive.

All the bills would establish markets in which private companies compete for customers. All would create nonprofit plans to compete against for-profit insurance companies.

Few Americans understand complex health policy issues; few can understand implications of the breathless reports on the news. What's important is that the nation finally is seriously addressing a crisis that has been building for decades. The real winners are ordinary Americans.

REPRINTED FROM THE ST. LOUIS POST-DISPATCH.

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