Do you want to win or do you want to be happy?

It’s a great story, and one most of you likely know by now. When Medicare was nearing passage, the AMA – which was completely opposed to it – got Ronald Reagan to tape a record describing how Medicare = Socialism. Medicare passed anyway, and years later, it’s as American as Apple Pie and not going anywhere.

But everyone knew Medicare wasn’t perfect. That’s why, over the last few decades, both Republicans and Democrats have worked to fix it. The same goes for Medicaid.  You get Medicare Part D; you get SCHIP.

No one (at least no one with any clout) talks of repeal of those programs.  They talk about modifying them all the time, or about changing their spending, but few want to abandon them entirely.

That’s what makes me concerned about what’s going on right now with respect to health care reform.

Were you paying attention the last few years?  Do you have any idea how hard it was to get something passed?  It required a supermajority in the Senate, a majority in the House, and the Presidency.  And – it roused half the country in to rage. It’s not easy.  That’s why it only comes along every so often.

And don’t believe the hype. No matter how many people tell you it’s the best health care system in the world, it’s not. We’ve got great doctors and hospitals and technology, but the quality of the system is surprisingly lacking. And that’s after we spend way more money than any other country in the world, even after accounting for our GDP. And come on.  Access here is crappy.

So let’s all agree that we need to do something.  OK?  If that’s the case, and you don’t like what PPACA did, work to change it. Don’t like the mandate?  Fix it. Don’t think it controls costs enough?  Change that. Got a beef with the CLASS program? Go ahead and propose modifications.

Especially since there’s no way that the whole thing is going to work.  Things change. People get things wrong. And we have to be willing to alter that which doesn’t work and add to the things that do. It’s common sense.

I’m not seeing that, though. So far, the only thing anyone seemed to agree on modifying was a 1099 requirement. There are few credible people offering other serious modifications.

Will no one take that route? Have we really gotten to a place where it’s more important to win by wholesale repeal than by working towards a better solution?  I’m sure that many conservatives felt that way after Medicare passed, but most sure don’t seem that way now. So why is this so different?

(And please don’t tell me it’s because of the over-reach of the mandate.  I already said you could get rid of it.)

When I wanted more robust reform than what I though I could get a year ago, I made peace. I knew that wishing wouldn’t make it 60. Right now, repeal isn’t possible either. Will anyone who wants change make that same concession and work towards a better, and possible, solution? Will anyone encourage their representatives to do so?

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