As has been mentioned many times, what we’ve learned in the health care debate is that our government is currently hapless to really engage with the huge problems our country faces. First, let’s look at the magnitude of the health care crisis. Andrew Sullivan links to a chart from National Geographic that illustrates the problem in stark terms. Americans spend a whole lot more on health care than any other country, have ultimate outcomes in the mediocre to poor range, and don’t even go to the doctor very much. We’re spending an awful lot of money and not getting a lot for it. And the second order effect is that our future obligations to continue spending ever increasing amounts of money on health care are going to bankrupt the federal government and eat away at wage growth indefinitely, unless things change in a pretty radical fashion.
As has been mentioned any number of times, this is just one of our really big problems. We also have structural deficits in the federal budget that must be addressed at some point, we have climate change to deal with, and we have any number of other smaller, but still important problems that are also going to require attention.
What we have seen this year is a federal government that is unequipped to grapple with any of these problems in a serious way. Republicans refuse to attempt to solve any of these problems at all. Not only have the Republicans declined to work with the Democrats in moving any bills through the Senate or House this year, but in the six years where they were in charge (not counting 2007 and 2008 where Democrats ran Congress), they opted not to address any of these problems at all. They continue to deny that global warming is even an issue, and the only thing they did on the health care front was work with Democrats to pass an unfunded prescription drug benefit for seniors. And the only thing they did while they were running things was expand the budget deficit to a massive degree through tax cuts without offsetting spending cuts, new programs (like the Medicare drug benefit), and of course, multiple wars that they chose not to fund through revenue, either.
When President Bush was in charge, it was pretty obvious that the most acute problem facing the country was his administration. Now that he’s out of office, it’s clear that we can zero in on the de facto supermajority requirement in the Senate as the largest obstacle to progress. Liberals are angry with President Obama (for some good reasons and some bad ones), but it’s clear that the Senate is the biggest problem. President Obama could be twice as committed to the progressive agenda as he is, and Harry Reid would still need every member of his caucus plus both independents to vote for every bill to make progress. Ezra Klein has an op-ed today that explains just what a liability this is for effective government.
So the health care reform bill that the Senate passed will, I think, be good for the country, but it’s almost devoid of ambition. Beyond expanding coverage, it doesn’t take on any of the biggest problems we face going forward. And it seems clear it was the best bill we could possibly get from the Senate given the rules it operates under. Had Al Franken lost the recount battle in Minnesota, we would probably have nothing. It’s hard not to be pessimistic about the future of the country when one political party has as much power as any has had in decades, and it’s still unable to make real progress on its agenda.