Why Getting Health Care Passed Is Insanely Difficult

Picture our health care system as a spider web at the top of a tall redwood tree.

Both the public and the special interests know they can't stay in the web forever, lest they be eaten. But at the same time, no one wants to be the first one to cut up their own part of the web for fear of falling to their deaths.

And herein lies the problem with current reform efforts: While our health care system threatens to bankrupt us all, it remains enormously profitable for insurance companies, pharmaceutical companies and hospital chains. Such key special interests have banded together to kill national health insurance plans time and time again, from the progressives' proposals during the Wilson era to Truman's health care plan in the 1940s to Clinton's failed reform effort in the 1990s.

At the start of his presidency, Barack Obama thought he could succeed in reforming our health care system by essentially bribing the different factions opposed to reform by promising to keep intact the inefficient portions of the system most beneficial to them. This is why we're not going to tax employee health benefits to start weaning people off the bloated and inefficient employer-based system, why we're not looking seriously at changing incentives for how doctors get paid and even why it's increasingly unlikely that we'll end up with a publicly funded health care plan to compete with private insurers.

Even with these concessions, the special interests are working behind the scenes to make sure that Congress doesn't snip out their goodies.

The New York Times reported earlier this month that the pharmaceutical industry is fighting a provision that would fund studies to compare the effectiveness of their products for different treatments. Again, consider the implications of this: The drug companies want us to continue paying them top dollar for drugs that might not even work as well as advertised.

The hospital lobby, meanwhile, is trying to kill a proposed Medicare-oversight board that would be charged with, you guessed it, trying to weed out inefficiencies in the system. Even though everyone acknowledges that our health care system is on a fiscally ruinous course, nobody wants to make the real sacrifices that would put it on a marginally more sustainable path.

All that said, it is somewhat understandable why the Obama administration has gone down the path it has taken so far.

If the current version of health care legislation passes, it will indeed provide coverage for tens of millions of uninsured Americans, and it will cap out-of-pocket expenses to ensure that far fewer people go bankrupt trying to pay for treatment. It will also bar insurers from discriminating against people with pre-existing conditions and will stop insurance companies from rescinding coverage.

These are very important policy goals for progressives, and it can be argued that Obama's strategy of bribing the special interests, despite being unsustainable in the long run, has gotten us closer to attaining them than the strategy of any prior administration. As sad as it might be to admit, it could really be the best we can do for the time being.

Of course, that doesn't mean that anyone should become complacent if reform passes, since it's unlikely to do much to contain health care costs. Bringing about significant change to our health care system -- whether it comes in the form of a single-payer system or a system of tightly regulated private nonprofit insurers -- is going to require a long-term siege war against the status quo. And this means we need to have a liberal messaging machine that tells Americans in no uncertain terms that our current system is ripping them off and that better alternatives exist.