Bending the proverbial curve

BENDING THE PROVERBIAL CURVE…. For some conservatives, including some center-right Democrats, the very point of tackling health care reform is to get health care costs under control. Ezra Klein has a great item today, explaining how the Senate reform bill does just that.

If this piece of the bill was passed on its own, it would be the most important cost control bill ever considered by the United States Congress. But you could never have passed it on its own. You needed the coverage to make the grand bargain work. Republicans like to call this bill a trillion-dollar experiment to expand the health-care system, and in some ways, it is. But it’s also a multitrillion-dollar experiment to cut costs in the health-care system, and it deserves credit for that, and support from fiscal conservatives. It’s easy to talk about cutting costs, but this is the chance for people to actually do it.

The “grand bargain” is an important concept that often goes overlooked in the debate. For the left, which has been clamoring for health care reform for several generations now, the point of fixing the system is the moral outrage of allowing tens of millions of Americans to go without coverage. The uninsured are one serious illness away from bankruptcy, or one layoff away from family peril, and progressives have long demanded a remedy.

For the right, the principal reason to even entertain the possibility of reform is fiscal — conservatives are worried about spiraling costs and massive deficits.

Which leads to the bargain. The left wants to expand coverage; the right wants to get costs under control. Neither side would be especially willing to entertain the other’s goal, were it not for the satisfactory resolution of their main concern. Harry Reid’s bill, warts and all, gets the bargain largely right.

Indeed, were our political landscape slightly saner, Republicans — you know, the ones who’ve invested heavily in the notion of cutting costs and shrinking deficits — would embrace this bill with both arms. For that to happen, they’d have to be serious about public policy, and willing to put national considerations above short-term political interests. I know, it’s hard to type this with a straight face, too.

But that doesn’t change the underlying truth. As Kevin Drum explained, the Senate bill is the most “ambitious” attempt to “rein in both Medicare costs, and healthcare costs generally, than anything ever done. Nothing else even comes close.” He added that Reid’s measure may be the “best prospects for healthcare cost control we’ve ever seen.”

Postscript: And speaking of Ezra, he also has a good post sketching out the kinds of positive reform changes we could expect before 2014. The fairly long list includes all kinds of consumer protections for those of us with private coverage, include a ban on lifetime limits, a ban on annual caps, the elimination of rescissions, and coverage for preventive care and immunizations.