Health Reform "Heavy on Health and Light on Reform"

Democrats are now accusing the White House of tolerating a bill that is all health subsidies and no cost reform. Unfortunately, I think they're right about the bill. But this is strange accusation. The White House isn't writing this legislation. It's setting guidelines. House and Senate Democrats are angry about the failure of bills written by the House and Senate Democrats. It's a bit like having your mother tell you to clean your room, then coming home from school to see your room isn't clean, and accusing your mother of tolerating a dirty room.

I like Rahm Emanuel's line a lot:

"Let's be honest," Rahm Emanuel said in a recent interview. "The goal isn't to see whether I can pass this through the executive board of the Brookings Institution. I'm passing it through the United States Congress with people who represent constituents."

Let's consider Medicare reimbursement rates as an example. A "robust" public option that tied reimbursement rates to Medicare would really help bring down medical costs for enrolled families. But that's out of the question politically, because rural doctors think they're paid less than urban doctors for similar procedures within Medicare already, and rural electeds will say, "No way are you building universal insurance on the back of my constituent doctors."

Thing is, the real "game changers" are inherently speculative, but many of them are in the Senate Finance bill -- an independent Medicare commission, an Innovation Center, pilot programs, comparative research investment, electronic records. Democrats understand how hard it will be to make cuts to Medicare. They understand constituent demands put a straitjacket on cost control mechanisms. What exactly do they want, or think they can achieve?