Ezra's got a critical post in understanding the bad news we've gotten on health care reform recently. Essentially, the plans that the Senators Kennedy and Dodd wanted to pass are judged to be too expensive. That's because they didn't include enough reform. So we could be in trouble.
But there's another path. This CBO estimate could be the first step towards making health reform better rather than worse. Rather than capping the employer tax exclusion, the Finance Committee could end it entirely and convert it, as Ron Wyden does, to a progressive standard deduction. Wyden's plan, incidentally, was scored by CBO as being revenue neutral in two years and revenue positive in four. Rather than protecting the private insurance system, the Finance Committee could include a public plan with the ability to bargain to Medicare rates, thus saving, according to the Commonwealth Fund, 20 percent to 30 percent against traditional private insurance. Ezekiel Emmanuel, brother to Rahm and health-care adviser to Peter Orszag, has a proposal for a universal voucher system funded by a value-added tax. All these ideas would make health reform better, cheaper, and more sustainable. None of them, so far as I know, are under serious consideration.
So, as Ezra says, the more reform you put into health care reform, the more affordable it will be. And that's a political problem. But progressive priorities — quality of care and universal coverage — should not bear the brunt of making a law affordable. Rather, we should operate under the assumption that the public demands health care reform; and it's the drivers of cost in the medical-industrial complex that have to justify their existence.
It ain't no how impossible. Failure will be because of timidity, not a fundamentally unworkable problem. Politics and organization now become very, very important.