Reform is dead. Long live refrom

They're whipping out one of Ted Kennedy's favorite sayings a lot lately: Don't let the perfect become the enemy of the good. And so it was that we have danced this dance with a pretty good idea of how it was going to turn out.

There will be no public option. There will be no Medicare expansion. We await Congressional Budget Office figures on the creation of a national, nonprofit plan administered by the Office of Personnel Management, to approximate the state employee plan. We also wait numbers to see if Medicaid will be expanded beyond 133 percent of the federal poverty level, to 150 percent.

We can look at this as a loss. It is a lost opportunity, for sure, that won't come again for a long time. Those of us who are intimately acquainted with health insurance know that we have lost the opportunity to control cost, and that's a big problem. There will be subsidies for people up to 400 percent of the federal poverty level (almost $40,000 for an individual and $80,000 for a family of four), so for them, the cost will be more bearable. But for those of us who earn more than that, we can still expect to pay in the neighborhood of $600-1000 per month. Without a public option, there's nothing to change that.

However, people with pre-existing conditions will have more choices because all insurers will have to cover them. And we will be able to research our choices on the Exchange. There will be no lifetime caps, and although there is an obnoxious loophole in the Senate bill that would allow "reasonable" annual caps, I am hopeful that those kinds of small tweaks will be taken care of in the Conference Committee. There will be out-of-pocket caps at about $5000 for individuals and $10,000 for families, virtually eliminating medical bankruptcies -- EXCEPT that no reform proposal has even tried to address denials of coverage, which will continue unabated. Indeed, I suspect, as insurers try to find new ways to profit, that we will see MORE coverage denials under a reformed system.

Is there anything to be happy about here? Yes. Millions of people who don't have insurance now will get it. People with pre-existing conditions will be able to chose their insurance. Do we accomplish all that we set out to do? In particular, did we curb insurance company abuse? No -- the insurance companies will have gotten exactly what they wanted -- pretty close to the status quo. They knew they had to give on pre-existing conditions and so they did. In exchange, they get an individual mandate requiring young, healthy people to buy insurance; they get a whole lot of new enrollees with no controls on premium prices -- they're even walking away with their antitrust exemption in place (although I'm really hoping this will go in Conference).

Still, our primary goal was universal coverage. We will get something close to that. It's not perfect, but it's too much to walk away from.

If Ted Kennedy were here, I suspect Joe Lieberman might not have gotten away with what he did, killing the public option and then Medicare expansion. But right now, he would be telling us not to let the perfect be the enemy of the good. What we're getting is far from perfect. But it's still good. Jennifer