A HISTORIC COMPROMISE. There's little I loathe more than a useless compromise that grabs headlines while undercutting serious attempts at reform. So excuse me if this "historic" compromise between everyone from insurers to AARP to Families USA to the American Medical Association leaves me with little but an arched eyebrow and a sense of annoyance. What're Families USA doing? They're good guys! This supergroup combining legendarily malicious actors with a couple genuine do-gooders appears to think their latest pact for covering the uninsured ranks somewhere between the Yalta conference and the Treaty of Paris. I must disagree. The plan, as composed, offers three phases for coverage expansion. Phase I insures the kids, gives states some money to experiment, and offers some new tax credits. Phase II we "give the states the option to expand Medicaid eligibility to all adults...below the poverty line." Ohreallycanweplease!? Then it offers subsidies to buy private care. This is what I'll call an unacceptable plan. It uses the cover of universality -- and I'm not even sure it achieves that -- to sacrifice the necessary, more fundamental reforms needed to make our health system better, fairer, more affordable, more efficient, more humane, and less damaging to personal freedom and autonomy. It is the industry's way of pretending to be part of the reform conversation, and it signals their fear of more substantive changes. That AARP and Families USA jumped on board to offer cover is incomprehensible -- those organizations know better, and they should act better. In coming weeks, I'll talk more about what a decent health system will look like, and hopefully start a conversation over what progressives will accept, given that most already know what they want. Having those boundaries (the ideal as well as the merely worthy) clearly defined is crucial as we move forward, as this moment progresses, and as self-interested stakeholders try to preserve the status quo by calling minor tweaks "change" and labeling their nonexistent concessions "historic." Those interested in a better system need to be clear on what elements cannot be compromised. This plan, for its part, doesn't compromise a single element of the current mess. All it does is accelerate profits to those already making plenty. Dr Steve, by the way, has more. --Ezra Klein
