To add onto Uwe Reinhardt's points: One of the real sicknesses -- pun unintended -- in the health care debate is that the comparison tends to be between the reform legislation proposed and the reform plan imagined. The relevant comparison, as Reinhardt argues, is between the reform legislation proposed and the status quo. That, of course, requires a phase shift at some point in the discussion. During the period in which the reform legislation is being shaped, you probably want to compare it to a much better plan in order to push it in that direction. The problem, however, is that those battles are bitter, and can bias the losers against a plan that, in fact, they'd have happily supported against the status quo months before. It's here that process becomes important. Players who feel that they won some and lost some but were nevertheless respected and heard are more invested in the final bill than players who feel they were marginalized or dismissed.
