Here's the basic dilemma on health coverage reform: We've got an imperfect bill, but we've also got a brief fleeting window of opportunity. Given this set of choices, I'd much rather have imperfect reform to nothing.
No one is 100% happy with the bills we're seeing. Personally, if I could wave a magic wand, I'd begin with the Wyden bill and incorporate additional provisions like the public option. But for contingent historical reasons (e.g., a flawed Senate), that's not the path reform took.
But remember this -- the bills may be imperfect, but they would accomplish many important goals. It would be a great and historic success to enact reform that ends pre-existing exclusions, limits out-of-pocket pay, creates exchanges, expands Medicaid, ensures a robust baseline of benefits, mandates individual coverage, etc., etc. Those reforms would have a huge and beneficial impact on millions of Americans' lives. We should never forget the human costs of the status quo.
But that said, the bills aren't perfect -- we could draw up a better plan. The problem with waiting, though, is that the political window of opportunity isn't open for long. I'm over my quota for Wire references for the month, but I'm skeptical that our institutions are capable of passing reform anytime soon once this brief window closes.
It would be different if we were slowing things down to get a better bill. But the political reality is different. We have a finite amount of time, and (IMHO) not enough time to start over from scratch. If reform dies, it will be many many years before there's another serious effort to do it.
So that's the dilemma -- pass the imperfect bill now, or wait and pass nothing for many years. And because any of the current bills are far superior to the status quo, I say pass reform now.
Also, adopting isolated improvements in the future will be much easier than trying to pass comprehensive reform. Think about the "new" Wyden Plan -- I could easily imagine adopting this bill a few years down the road to reform the exchanges if costs are out of control. That's an isolated fix -- you wouldn't be juggling 8 million different chainsaws.
Same deal with the public option, or even reforming the employee benefits exclusion. To me, it seems infinitely easier to pass one of these provisions in isolation (maybe even through reconciliation) once the heavy lifting of reform is finished.
So let's keep perspective. Even enacting the bills we've seen would be a great day for American families. And though it would be nice to enact everyone's personal fav, the fleeting political window makes that unrealistic. Let's do the hard stuff now, with the knowledge we can fix other things down the road.