As the debate over the Senate health care bill goes forward, it seems like we really need to find someone who will have a grown-up conversation about the issues involved.  First, it would be good to decide if there is common agreement that the government has a role in providing health insurance of some type for everyone.  It might be Medicare, Medicaid, or some other vehicle which means that whoever you are, you can get a health insurance product and cannot be rejected.  This seems to be accepted by all, although to listen to the rhetoric you would never know it.

If I am correct, this represents a significant move forward from the past and, in effect, assures Obama’s legacy regarding heath care.  Thus, we can focus not on what we call it, but rather on what the tradeoffs are and what we want for all Americans.

If you cannot afford a policy of any type, to say it is available is untrue.  If you are ineligible for comprehensive coverage because of a pre-existing condition, we are not being honest with each other. On the other hand, to revise what all policies must cover from current law is a legitimate area for debate.  It is also important to recognize when the Court allowed states to not expand Medicaid, it created inequities regarding subsidies and the basic architecture of the ACA on providing assistance became unfair to many people.  Therefore, reexamining the whole subsidy model is also legitimate.

What is not legitimate is pretending that high risk pools for people with pre-existing conditions have worked.  While there are a few states that recently have attempted to create them, there is not any long-term experience that would give any serious person the confidence that is exuded by proponents of this solution.  For example, if you look at Florida, you would not have great faith in this as a solution.  Rather, the only way people with serious illnesses can afford to be treated by the insurance mechanism is if everyone is insured.  This is the price and we have to have an honest debate about what we think is the right answer.  There is no magic solution and to pretend otherwise is disingenuous at best.

Now the Democrats have decided evidently to spend their time and capital attacking the Republican plan.  Instead of crafting changes to cure some of the problems of the ACA, they have ceded the field to Bernie Sanders and his single payer trope which, while worth examining, is not going to be considered.  If all you want to do is criticize the other side, that works very well.

If I sound disgusted with everyone at this point, it is because I am.  The President has no idea what he wants except a win, the Republicans have decided that since they mindlessly attacked “Obamacare” for 7 years, they have to repeal it even though it is working for millions of Americans.  Democrats have decided that instead of putting forth changes, going to some Senate Republicans and working to create a credible alternative, it is better for their electoral prospects to simply attack Republicans.  The losers in this scenario are the people these elected officials are supposed to care about.  Maybe it is finally time for a real third way in this country.  Don’t think it can’t happen here?  Look who is living in the White House.