The New Health Dialogue

Overall, it's been a pretty good week for health reform.

We know there is a ton of work to do, both for the politics (60 votes) and the policy (we need to merge the bills correctly and not just to get the votes but to make health reform work for the people who need it -- which is all of us.)

None of the five bills passed by the House or Senate committees on their own is perfect. No final bill will be "perfect" either, of course. But we're still hoping for really really good.

When we write about how far we've come, rather than how far we need still to go, it's not an effort to minimize any of the flaws or challenges that we still need to address. Trust us, we live and breathe flaws and challenges. But we do think it's important to keep in mind that this legislation will be the single biggest advance in U.S. social policy since the passage of Medicare and Medicaid in 1965. And when you think about it in those sweeping historical terms, it's pretty exciting.

It's also worth remembering that the huge social advances of the 20th century were not passed with one wave of the legislative magic wand (and moderate, liberal and conservative Democrats feuded over every one of those achievements, too. Although there were more moderate Republicans in the mix). Social Security in the mid 1930s covered only about half of adults -- left out were many farm workers, domestic workers, many people who worked for small businesses, and many blacks. That got fixed, in time. Medicare did not include disabled people or those with end stage kidney disease until the early 1970s; we didn't add a drug benefit to Medicare until 2003. So it too, was fixed, in time. Health reform will do more to improve Medicare for future generations.

Don't misunderstand. We aren't saying we would settle for an incremental bill, or a bad bill. We want a good bill, an excellent bill, and a comprehensive bill, one that takes the strongest and most effective provisions from the various pieces of legislation approved by the committees to achieve our goals of covering everybody, containing costs, and improving quality. But we understand it won't be a perfect bill. But that, too, can be fixed in time.