Keuhl

Sometimes I find myself to the right of many of my fellow bloggers out here in California. Perhaps it is my East Coast roots, or my more direct experience working in politics. Health care reform is one of those issues where I diverge and stand with the political establishment.

See, I am pragmatic. I look at SB 840 (single payer bill) and SiCKO and think well gee wiz, it sure would be nice, but it just isn't politically practical right now. I see the statistics on all of the uninsured and know that we can do better than the status quo, even if it does keep in place the private insurance industry. It's why legislators like Shelia Keuhl, ever the fighter for single payer, votes for bills like AB 8 (the Nunez/Perata plan).

Similar dynamics are playing out on in the presidential campaign. The WaPo had an interesting article on the decision making that went into Edward's health care plan. He pulled in two leading academics, one who argued that our system was "so riddled with inefficiencies that it needs to be blown up and replaced by a plan in which people can buy coverage themselves." On the other side was a MIT economist, who argued for an incremental approach that would be politically viable.

A month later, when Edwards announced his health-care plan, he almost completely sided with Gruber. And he is not alone. For the first time since President Bill Clinton's plan for health-care reform, overseen by his wife, collapsed in 1994, the leading Democratic presidential candidates are campaigning in favor of universal health care. But in developing their specific plans, they are embracing the pragmatic steps advocated by the MIT professor and a group of similar-minded policy experts, many of whose ideas were shaped by their first exposure to the perils of health-care politics 13 years ago.

"Plans which minimize the disruption to the existing system are more likely to succeed than plans that rip up the existing system and start over," said Gruber, who has consulted with the three leading Democratic campaigns about their health plans. "It doesn't take a genius to see that. That's not to say that plans ripping it up wouldn't be better -- I just think they're political non-starters."

Politics is not the art of the possible, but rather the practical. That is not to say that what is a political non-starter today will be impractical a few years from now. Indeed, we have seen a great deal of shifting on the issue of reform in the last decade. Republicans are now much more willing to discuss significant changes to the system.

If a health care reform bill does make it through the legislature this year, it will not be perfect. Heck, it may not even be great, but more than likely it will be better than what we have got now. We are not talking about something abstract here. There are life and death matters at stake, not to mention quality of life issues. Millions of Californians do not have insurance and millions more are at risk of losing their coverage. Even more fight their insurance companies tooth and nail to get the coverage they paid for.

We can change this, at least partially. Something is better than nothing.