• A good comment

    Jim Burgess wrote,

    If the cost of perfect reform is a century of suffering where the benefits don’t kick in until that happens, the discounting completely kills the benefits (especially if you use preference based discounting). That makes it even less sensical. Doing things soon is worth an incredible amount more than waiting.

    Anyone advocating waiting–or policy changes that amount to the same thing–probably doesn’t accept that expanding insurance coverage is a worthwhile goal.

    It’s not as if the ideas of the ACA were just thrown together to get the uninsured covered ASAP. This nation has been struggling with the issue of the uninsured for decades. A lot of ideas have been offered and put to a legislative test. (Notice I did not say “vote.”) None others passed. The one that did has also been tested in Massachusetts. With respect to covering the uninsured, it’s working pretty well. Kinda means something.

    • The bookend to this idea is Klein’s piece on how past attempts have failed. Every proposal in the past has been met by counter-offers from the right. The next offer by the left has then incorporated past ideas from the right, but they just move away, further to the right. Couple this with unwillingness of those on the right to spend meaningful political capital in health care reform, and you end up with the ACA. In short, democracy is messy.


    • Dr. Frakt,

      As a side note, I know a senior health policy advisor for a big-time senator. She told me a few months ago that the writers of ACA (The Speaker’s office, not the committees) actually never intended ACA to pass. They expected it to be a first draft to be weeded out. The writers (Pelosi’s people, not committee “experts”) were actually shocked it passed. Obviously, I cannot confirm her in-tell as it is insider information.

      Her insider info does match with The Speaker’s numerous statements that she just wanted to get ACA passed and then they would adjust the Bill as needed.

      Great Blog!

      • @Aaron – I’m sure there were many moments when insiders judged chance of passage as low. But I don’t believe it was crafted with failure in mind. The politics for passage were always better than some thought. I do believe many think it is not the end of reform, nor should it be.