Jon Rauch, a pragmatic libertarian, looks at the Senate insurance bill sanely and argues that
the reform contains a pathway to sanity. No one can say that about the status quo.
As usual, it's such a smart, fair, balanced and thoroughly researched piece it's very hard to find an area of disagreement. Read the whole thing. I found this among the more telling passages:
The expansion of insurance coverage to tens of millions more Americans and the abolition of the "pre-existing conditions" insurance exclusion are changes for the better. A friend of mine made a full recovery from prostate cancer, only to find that he could not get health insurance at any price. Stories like his are common — too common to be politically sustainable, let alone morally acceptable.
On paper, Congress might have found better ways of making insurance available to high-risk individuals than by requiring insurers to cover them and by creating government-regulated markets ("exchanges") where these individuals can buy insurance; the alternatives, however, are complicated, lack political support, and in the end might make government even bigger.
(Indeed, one striking feature of the reform bill, given its all-Democratic provenance, is the extent to which it leaves the existing infrastructure of private health insurance intact. In a few years, the public might be less willing to do that.)
Second, the bill is probably as close to paying for itself as the political system is likely to manage. It would be great if Congress made up-front reductions in other programs, rather than counting on, for example, Medicare savings that may or may not materialize. But, given the political unacceptability of horror stories like my friend's, the real-world alternative to plausible-maybe-almost-sort-of fiscal neutrality is something more like the Republicans' 2003 Medicare prescription drug bill, which made no attempt at all to pay for itself.
Although long-term budget projections are squishy, the Congressional Budget Office's are the best we have to go on. Notably, CBO scored the Senate bill as deficit-neutral (actually, it would slightly reduce the deficit) over the reform's second decade after enactment, which is well beyond the window of cost-shifting and timing gimmicks. We could do worse, and possibly will do worse next time around.
The notion that this is some government take-over – while 60 percent of healthcare in this country is already paid for by the government – is pure ideology and hysteria. This is a centrist, practical, worthwhile start on a very difficult public policy problem. The Democrats would be insane to drop it; and the president really must fight for it.
The Dish 