Reform, unlike a bat out of hell

President Obama keeps pushing for a health overhaul bill, even though what’s on the table now is far from what he originally envisioned.
Chris Satullo suggests, in his weekly audio essay, that passing a flawed bill might still be better than sticking with the status quo. [audio: satullo20100307.mp3]

Call it the Meatloaf principle. Back in the late 70s, the chubby singer had a hit song in which he wailed, “Two out of three ain’t bad.”

The question is, when it comes to health care reform, does the Meatloaf principle hold?

Is it, in fact, the best America can expect to do?

The long-elusive Holy Grail of health reform holds three main elements: Access. Affordability. Quality.

That’s been the mantra of would-be reformers for decades: Let’s expand access to affordable, quality care. For just as long, health care economists have said this to starry-eyed reformers:

You have to pick two. In other words, you can’t have it all or at least you can’t on any terms the notoriously tax-averse American voter will accept. The Obama team, convinced they were the smartest guys ever to be in this particular room, thought they could go three for three. They were pretty sure that, by eliminating unnecessary procedures, pushing evidence-based treatments, and cutting down on paperwork, they could sweat enough waste out of the system to pay for expanded access while improving care.

In a perfect world, they might have been right. In an imperfect world of Nancy Pelosis and Sarah Palins, they’ve been humbled. Battered by Tea Party protesters, single-payer ideologues and Massachusetts voters, they’ve given up on many of their ideas to contain costs or improve care. Now they’re looking for any kind of win they can get, however flawed.

At this point, the bill that might become law – if congressional Democrats can pick up their courage at the dry cleaners – would do a lot to improve access, a little to improve affordability and a tiny jot or two to improve quality.

Add up the fractions, and it might come two out of three. Or a little less.

It’s well below Obama’s opening bid. It’s riddled with flaws. But it will do some useful things that do poll well with Americans, no matter how sour they’ve become on the phrase “health care reform.”

Here’s the key thing: Even a little less than two out of three is far superior to the status quo. That is on a fatal trajectory can only get worse if an Obama defeat turns health reform into a new third rail of American politics.