There are two weeks left in 2009, and there will be lots of holiday interruptions so the huge efforts to get agreement on a formula for national health reform, and push it through the Congress will surely go over into the New Year.
Each day seems to bring additional twists and turns to the tale one day our hopes are dashed, then the next day we learn of a new proposal which seems to have merit and support, then someone shoots it down.
With all of this I continue to believe that we will ultimately get large scale legislation passed and signed, and that it will overhaul our national health care system in substantial ways. And to be sure, we badly need to do this as a nation.
For months, one of the sticking points has been whether the legislation would establish a new public plan for health insurance that would give real competition to private health insurance. The theory has been that this would lower overall health care spending over time. The proponents of the public plan have criticized private health insurance loudly, and have heralded the public plan as the right idea for the future. Supporters of the public plan have tended to be from the left side of the political spectrum progressives as they are often called. But the notion of an effective alternative to private health insurance has been a popular notion with a broad array of citizens private insurers don't poll well these days.
But this fall the criticism of the public plan has centered on the idea it will simply add cost to an already very expensive health system, without really restraining spending much at all. And the Senate seems to lack the 60 votes needed to break a filibuster and pass the public plan.
Last week Senate Majority Leader Harry Reid came up with a new idea dropping the public plan altogether, and substituting for it a new idea (which has been around for decades). This new / old idea is to allow younger Americans to buy into the Medicare program so that people who are age 55 to 65 could join Medicare, with subsidies for those who cannot afford it on their own.
For a day or two it seemed that this might be a way around the impasse, but now some moderate Democrats have criticized this as being even more liberal than the public plan.
Who knows how this will turn out? We have many more twists and turns to navigate.
My prediction remains this will happen, meaning major health reform legislation will pass, in the early part of 2010.
For the first time, in addition, it seems that a growing number of legislators, policy wonks and pundits want actually to overhaul the health care system in some fundamental ways.
In this spirit, I recommend an article in last week's New Yorker magazine by Atul Gawande.
I believe he describes well the challenges we face in actually improving America's dysfunctional health care system.