The health care reform law was signed 10 months ago, and what’s striking now is how vulnerable it looks. Several threats have emerged — some of them scarcely discussed before passage — that together or alone could seriously endanger the new system.
My initial response is that when talking about health care reform, especially, it's important to remain grounded in reality. And the reality is that the status quo in health care was not working. (I don't think any reasonable person would argue with that.) Given that reality, it was important to pass not some mythical perfect health care legislation, but rather the best health care bill possible, which in this case was the ACA (based mostly on Republican ideas, by the way).
Liberals would have been thrilled to enact a single-payer system, like Medicare for all. Conservatives, on the other hand, wanted to bring more market-based solutions to the problem. But -- and this is important -- neither could have gotten passed in this, or any, Congress. Brooks, like many policy wonks, favored the Wyden-Bennett health care bill. But as many observers at the time noted, it had virtually no chance of getting passed. (The bill was so controversial, in fact, that it may have cost Robert Bennett the Republican nomination for his Senate seat.)
So the reality is that Congress had a choice between an unsustainable status quo and a 2,700-page bill that almost no one liked. Reality can be messy that way. (At the time, Warren Buffett said that, given the choice, he'd take the ACA.) So rather than tear it up, as many conservatives would like, the bill will probably be tweaked in order to keep up with reality. In fact, reality being the moving target that it is, the bill will be forever getting tweaked.
But, like I said, reality is messy.
(For Ezra Klein's reaction, click here.)
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