Baseball's legendary wit Yogi Berra might has well been talking about health care reform when he uttered "it ain't over until it's over."
Though many Americans have grown weary of the health care debate as Congress prepares to vote this weekend on one of President Barack Obama's highest legislative priorities, experts point out that this is only one battle in a very long war. It ain't gonna be over for a long time. Even the most ardent backers acknowledge that the savings from $940 billion health care bill may not accrue as planned because they're based on long-term theoretical assumptions that could be incorrect.
Of course, members of Congress threw everything but the kitchen sink -- and maybe that, too -- into the more-than-2,000-page bill, which is bigger than Leo Tolstoy's 1,296-page classic "War and Peace" and the Bible, which has about 1,567 pages. Still, the final product has managed to disappoint just about everybody.
"I cannot promise this can produce breathtaking results in decades ahead," says Paul N. Van de Water, senior fellow at the Center on Budget and Policy Priorities, in an interview. "We don't know exactly what is going to work. To the extent that cost savings may be insufficient, it is not through lack of trying."
Complicated and Controversial
As the Brookings Institution notes, the legislative process for health care reform won't resemble the civics lesson taught to generations of American children. On Sunday, the House will consider two measures -- the Senate health care bill and a series of amendments that are going through the "budget reconciliation process." It's as complicated as it is controversial. But the stakes couldn't be higher.
President Barack Obama reportedly is delaying a trip to Asia to rally House Dems to back the bill. Some undecideds, such as Rep. Dennis Kucinich (D-Ohio) now back the plan. My congressman, Rep. John Adler (D-N.J.), said yesterday that he would vote against it. Adler is the first Democrat to represent New Jersey's Third District since 1882, and he faces a tough reelection bid. MoveOn.Org urged supporters to picket his legislative offices in Marlton, N.J. And Tea Party activists are urging that Adler keep his pledge to oppose Obama's plan.
Clearly, today's political fights hint at things to come.
In the coming years, the battles over health care reform won't fade regardless of how this weekend's vote turns out. Should the bill pass, Republicans will try to get it declared unconstitutional. Movements are likely to be formed calling for its repeal. Some states are already vowing to ignore aspects of the law they don't like, even though the Constitution forbids such actions.
Dr. John Geyman of Physicians for National Health Care, an advocacy group backing a single-payer national health care system, says it does little to control costs for drugs and medical devices. "I would vote against it myself," Geyman says. "It's like giving aspirin to treat cancer. . . . It's a politically motivated bill."
Republicans, business groups and others opposed to the overhaul cite the expense of revamping a major component of the economy as reason enough to fight back against what they've labeled a "government takeover" of health care. Democrats have rejected these criticisms and have vowed to use a controversial parliamentary tactic called reconciliation to get the legislation passed while avoiding a threatened blockage by Republicans.
"It's a shame that the process has become so politicized," says Kansas Insurance Commissioner Sandy Praeger, a Republican who's a past president of the National Association of Insurance Commissioners and backs the bill. "We are the richest nation on the globe, and it's a shame that people don't have access to health care."
Whenever Congress undertakes big topics such as health care or telecommunications or banking or civil rights, the process is never pretty to look at. It can take years -- sometimes decades -- to get anything accomplished. In the case of health care reform, Obama will need to complete a decathlon instead of the usual marathon. That's on top of the challenges of rescuing the economy and fighting two wars in distant lands.
Too Big for One Bill
Much as Obama would like to put this fight behind him and focus on other things, he can't. Medical bills contributed to nearly two-thirds of personal bankruptcies in 2007, a 50% increase since 2001, according to a study in The Journal of Medicine. The health care system has been screwed up for so long that no bill -- no matter how hefty -- can solve all of its problems in one shot.
"Health care is not something you can put on auto pilot and forget." Van de Water says. "No one should think now the end game is becoming clear."
Even If Health Care Reform Passes, the Fights Won't Stop