Politics seldom surprises. It has been described, with a measure of idealism and hope, as the art of the possible. But most often it is the art of the compromise. And the more desperate one side is to pass a bill, the less the actual substance of the bill really matters.
The Senate now is poised to pass a mammoth, expensive health care reform bill on Christmas Eve. The timing is desperate. Next year is an election year for every member of the House and many in the Senate. Compromises are difficult when votes from regular people are on the line. The Senate and House versions of the bill still have to be reconciled, and that will require a lot more compromises early next year.
But as for substance — forget about it.
The Senate bill is particularly nice if you happen to live in Nebraska. That's where Ben Nelson is a senator. He wavered in his support for the bill, and so his vote came with a provision to pay for full federal aid for Nebraska's expanded Medicaid population — forever. Every other state gets federal help for three years only. Louisiana also got between $100 million and $300 million in additional aid for its Medicaid population, all in an effort to get the vote of Sen. Mary Landrieu. Even Utah got something — higher reimbursement rates for Medicare patients. But that's only because Utah falls under the same definition as other "frontier" states where important Democratic votes reside.
What the Senate will pass this week is a brilliant political document. But it is a pathetic health care bill. Often, people conclude that a measure must be good if it makes people on both sides of the aisle unhappy. But the nation's health is far too important for such a compromise. Liberals didn't get the public option or abortion provisions they wanted. Conservatives didn't get any type of tort reform. Instead, the nation gets expensive insurance reform, along with a lot of political favors in certain parts of the country.
More than anything, this bill is a stark reminder of how inefficient governments are at making decisions that best belong to the marketplace. Following the announcement of a compromise last weekend, liberal columnist Eugene Robinson hailed it as, at long last, signaling that America no longer will "ration health according to wealth." He's wrong. Health care always will be rationed according to wealth. The difference now is it will be rationed according to the government's wealth as decided by detached bureaucrats.
America does have a health care crisis. Costs are spiraling out of control, and too many people can't afford coverage. Insurance should not be so closely attached to employment. Legal costs should be brought down and the entire system should be made more transparent. For the most part, states are the best places to handle such problems. The 2,000-page-plus thing expected to emerge from the Senate this week won't solve these problems, no matter what politicians tell you.