But there's a reason they didn't: Health care reform is politically difficult, particularly given the setup of American government. (The U.S. Senate, with its overrepresentation of small states and use of the filibuster, make it hard to pass anything.) It’s easy to forget, but the reform scheme Bill Clinton tried to pass in 1994 would have come pretty close to achieving most of the goals reformers now seek: It would have given generous insurance to just about everybody, by radically reorganizing the way medical care is doled out. That ambition was also a major factor in its demise.
Maybe that means those of us on the left should dwell a bit more on what reform still would achieve--even if it's not everything we hoped. The bills that passed the House committees might not mean every single American would have insurance. But they would mean that every single American could get insurance if he or she wanted it. Insurance companies couldn’t deny coverage to somebody because of pre-existing medical conditions--nor could they cancel a policy retroactively, after a large claim, as insurers have been known to do. In fact, that change--an end to the practice of "rescission"--would happen right away.
The insurance people get under reform would be relatively good insurance, too: The House bills, for example, would limit out-of-pocket expenses to $5,000 for an individual or $10,000 for a family. That's still more than people in other countries pay, yes, but it’s a far less than what many Americans end up paying today once they get a chronic or catastrophic illness. And keep in mind the exposure would be a lot less for lower-income people.
Besides, it's not as if it will be impossible to scale up these reforms later on. If Congress passes and the president signs a bill putting in place the key institutional elements of reform now, they can always revisit, and strengthen, the measure later. During the 1980s, Henry Waxman almost single-handedly expanded Medicaid to its current levels by gradually making more people eligible and securing the funding to pay for them. All he needed was the institutional structure--the program, the rules, and the basic funding stream--on which to build the new coverage. The fact that Waxman is a chief architect for this year's program ought to give liberals confidence that, once again, these reforms needn’t represent the upper limit of what might be achieved over the next few years. They are a start, and a very good start, but not a finish.