The Choice

| Wed Jan. 20, 2010 2:57 PM EST

After reading stuff like this and this, it's looking increasingly clear that jittery Dems aren't willing to do the obvious thing now that they've lost their 60-vote supermajority: Pass the Senate healthcare bill intact along with promises to make changes later this year via reconciliation (which requires only 51 votes in the Senate). Partly this is because the Senate bill delays implementation of its major structural changes for years, which means that anyone running for reelection this November will take plenty of potshots from Republicans but have nothing substantive to brag about in return.

That's the theory, anyway, but Jon Cohn provides a laundry list of immediate tangible changes that would make good campaign fodder:

Seniors will see the Medicare “donut hole” start to shrink.

Families will get to keep kids on their policies past high school, until the kids are 26.

Preventative services will have "first-dollar" coverage, meaning you'll pay nothing out-of-pocket — that's right, nada, zilch — when you get a regular checkup.

People who are uninsurable because of high medical risks will get access to catastrophic policies, as a stopgap until full coverage becomes available in a few years.

The government will set up a website with information about different insurance plans, letting people compare benefits in standardized, plain English terms.

It will also make investments in the health care workforce — spending money to train or hire new primary care doctors, nurses, and direct care workers.

Insurers will have to fess up about how much money they divert from patient care to overhead and profits — and to set up systems for appealing coverage denials.

People will have the right to go to the emergency room — and women the right to see an obstetrician/gynecologist — without prior approval.

The list goes on.

I'll add one other thing: the idea of going back to the drawing board and trying to pass a few little piecemeal reforms is suicidal. It's one of the worst ideas I've ever heard. One of the big problems with healthcare reform is that the public is sick of the process. The last thing they want is for Congress to spend several more months flailing around on it. What's more, does anyone seriously believe that Democrats would get any Republican votes for a smaller bill? That's just a fantasy. Oh, they'll happily negotiate and delay, since that not only makes Dems look hapless and craven, but prevents them from getting anything else done in the meantime. It's a twofer. But when it comes time to vote? Every single one of them will invent some reason that the smaller bill is still fatally flawed. The final vote will be 59-41 and months will have been lost for nothing.

Realistically, there are only two choices now: either pass the Senate bill or else wait another 15 years for any kind of serious healthcare reform. That's it. That's the choice.

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