Welcome to American politics

Pork-barrel politics bears some resemblance to sexual adventures. Politicians who rail against the indiscretions of others seem no less challenged than the rest of us in honoring their fiscal promise rings. Self-avowed deficit hawks, as the most critical marginal votes, were neither modest nor discrete in chasing special advantages for their districts and constituencies.

Not every deal was scandalous. Sen. Bernie Sanders secured valuable funds for community health centers, for example. Still, enough of the last-minute bargaining was damaging or was straight pork to prompt this week's questions. Insurers and other privileged constituencies were able to evade stringent regulatory and cost control measures. Some progressive measures were left off. For those looking to see special interests brought to heel, this was pretty depressing.

Yet we have to keep our eyes on the ball. You don't alter a $2.4 trillion medical care economy without ladling a little gravy for selected constituencies and interest groups. I wish we had a public option and more stringent taxation of high-cost health plans. I wish we didn't have those insulting and harmful abortion provisions, too. It's easy to become focused on these provisions, or on whether we punish selected bad actors rather than on whether health reform achieves its central goals.

Perhaps I am reaching, but I see some parallel between the fight for health reform and the fight to reduce tobacco-related death. I hesitate to make this analogy because I regard the health insurance industry as a legitimate enterprise that requires stringent oversight. I regard the tobacco industry as a disgraceful set of firms that that knowingly sell an addictive product that has killed millions of people. (Two of those people were my in-laws, wonderful people who died far too soon from tobacco-related causes.)

Meaningful health reform cannot happen without rallying citizens against the excesses and failures of the health insurance industry. A meaningful attack on lung cancer and heart disease could not happen without an even more confrontational attack on the tobacco industry. Yet an exclusive desire to punish Philip Morris and the rest can sometimes lead us astray. To give one example, activists have proposed breaking up the industry. That would lower industry profits and hurt the shareholders, but it would also increase competition and lower cigarette prices, thereby causing great harm. Some good public health measures--such as cigarette advertising bans--have raised tobacco industry profits by reducing their expenditures and creating higher barriers for competitors.

We have to be clear-eyed about health reform, too. Reform advocates seem a little too focused on the daily upticks in health insurance stocks that accompany critical votes. The Senate has passed an imperfect, but extremely valuable bill. This bill will provide health coverage to 31 million people. It will provide key protections to Americans with chronic illnesses and disabilities. It will provide $196 billion per year in subsidies to poor and working people. (As I have noted elsewhere, $196 billion is a huge amount of money.) The bill creates a framework for more effective and economical care, and for improved public health.

We won't get every provision I would like to see. The bill includes some comical or odoriferous provisions to buy off the various senators one needed to cast that 60th vote. Welcome to American politics.

Is the bill worth passing? I think that is a very easy call.

By Harold Pollack  |  December 23, 2009; 6:14 PM ET  | Category:  Abortion , Health Care Reform Save & Share:                 
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