Ezra Klein on the Real Health Care Debate

Ezra Klein of The Washington Post details the disconnect between the overheated public shouting match on health care reform and the actual discussion in Congress.

The Democrats conceded so much up-front that the actual range of debate is strikingly slim. The public option attracts most of the attention, but the reality of the policy, even in the liberal House bill, is that it's limited to the insurance exchanges and isn't expected to serve more than 12 million people by 2019. In part, that's why the debate has had to move toward fear-mongering and lies: There just aren't that many scary elements in the bills, because the legislation is oriented toward preserving the existing system and avoiding points of controversy. You can make an argument that the policy is worse because of its modesty. A more ambitious approach could save more money and do more to fix the system. But that's the way it is.

Insofar as there are real debates remaining, they are not about the policy. They are about whether people trust the Obama administration, and the government more generally, to do anything at all. They are about whether Republicans want some sort of bill, or whether they see more political upside in handing the president his "waterloo" on health-care reform. They are about whether people will fall to fear and retrench to the relative predictability of the status quo when faced with the chaos and polarization present in our political system. But beneath all that is a health-care bill that is not necessarily finished, and that is not necessarily agreed-upon, but is a lot closer to done than most people think.

The disconnect between what is being shouted about and the actual discussion in Congress strongly suggests that the shouting is really about broader issues regarding to overall role of government rather than specific policy. The more honest and insightful protesters have acknowledged that their concerns are "bigger than health care."

The town hall protests also take on a kabuki theater quality because the reality is that the Democrats have the votes to get a reform bill passed. The public option is an important bone of contention. However, observers on all sides agree that there will be broad reform passed. Klein's point that the details on a few issues are all that is left to decide is valid.

--Ballard Burgher