As passage of health reform nears, a historic chance to help fix Washington, too

House Minority Leader John Boehner and other Republicans claim that opposition to the health-care bill runs far and wide, but as passage nears, it seems the people have kept their outrage to themselves.
House Minority Leader John Boehner and other Republicans claim that opposition to the health-care bill runs far and wide, but as passage nears, it seems the people have kept their outrage to themselves. (Melina Mara/the Washington Post)
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By Steven Pearlstein
Friday, March 19, 2010

It's shaping up to be a great weekend here in Washington.

I'm not just talking about the spectacular weather or another upset-filled NCAA basketball tournament. I'm talking about the prospect of a quasi-climactic vote in the House that would finally have the United States join the rest of the industrialized world in offering health insurance to all its citizens.

Sometimes, those of us who live here and participate in political life can get a bit cynical. We tend to focus on the process or the gamesmanship or the unsavory compromises. Which is why it is important at moments such as this to get your head out of the weeds, look at the Capitol dome in the distance and remember how lucky you are to have a front-row seat to one of the world's longest-running historical dramas.

What strikes me about the lead-up to this weekend's health-care vote in the House is how quiet things actually are.

If, as Republicans would have us believe, Americans are so up in arms about the prospect of "Obamacare," why aren't there angry hordes marching on the Mall or jamming the halls of the Rayburn Building?

If the plan really represents a wholesale government takeover of one-sixth of the economy, why are so many associations representing private doctors, hospitals and drugmakers either supporting the legislation or staying relatively neutral?

And if this Democratic version of health reform is such a threat to economic prosperity, why are stocks, bonds and the dollar all rising this week as odds of passage increase?

One of the silliest Republican talking points is that Democrats are "ramming health-care reform down the throats of the American people." In fact, we've been talking about it, on and off, for decades, ultimately winding up with a solution that is not only remarkably centrist but also not all that different from the compromise nearly reached between Ted Kennedy and the Nixon White House in the early 1970s.

Indeed, although you'd never know it from the overheated rhetoric, the remarkable thing about the final proposal is how little it would change things, at least initially, for most Americans. That's no accident -- in fact, it's by political design. This plan is more like a time-release tablet meant to reform the system slowly from the inside out rather than surgically from the outside in.

If all goes according to plan, Medicare and private insurers will begin changing the way doctors and hospitals are paid, from a system in which they are compensated on the basis of how many tests they order or procedures they perform to one that rewards doctors based on how healthy they keep their patients and how closely they adhere to proven medical practices.

Over time, those government-sponsored exchanges will be so effective at generating competition and offering good deals on a range of insurance plans that big companies that now run their own programs will want to drop theirs and simply give employees a voucher to buy insurance on the exchanges.

And over time, the cap on tax-free health benefits will force insurers to better manage the cost of care, or charge patients higher co-payments and deductibles that will turn them into more price-conscious consumers.

Although Republicans are not wrong in declaring that "Obamacare" represents a significant change in the social compact, it falls well short of the European-style socialism they fear. In a uniquely American arrangement, health care would become both a personal right and a public responsibility, one shared jointly by workers, individuals and the government.

Over the past year, anyone following the health-care drama has been tempted, at various points, to question the judgment and the leadership of President Obama, his staff and the Democratic leaders in Congress. Should they succeed this weekend, however, there is no disputing that it will be a remarkable political achievement, the result of a combination of focus, determination, flexibility and patience not seen since the early Reagan years.

Most of all, enacting health-care reform would be a desperately needed victory for a political system teetering on the verge of breakdown. Years of polarization, partisanship and stalemate have led to a widespread and cynical belief that Washington is simply incapable of solving any major problem. Passing a health-care reform bill would restore not only a measure of trust and confidence in our political process but also, more significantly, trust and confidence in ourselves.

© 2010 The Washington Post Company