Alea iacta est.  I think it very unlikely that the Democrats will be able to retreat from this now--has any major bill ever simply failed in conference?

The good is that some people who cannot now acquire insurance will get it; even if this does not make them noticeably healthier, it will make them less worried, and insulate them from catastrophic medical bills.  If our technocrats get things right, we may improve the practice of medicine--the most hope probably lies in improving IT and streamlining the bloated provider administrative processes.

The bad in my opinion, is that I'm not particularly sanguine about the ability of our technocrats to deliver unmitigated fabulousness, nor our politicians to resist the lobbying groups who will be steadily pressing them to make everything less fabulous.  I think we'll probably end up eventually with price controls that reduce innovation, providers that turn into horrid quasi-public utilities, brain drain out of the medical profession, and pretty serious rationing, which as David Cutler told me the last time I interviewed him, no other country has managed to avoid.

Oh, and there's a good chance we'll also end up with a fiscal crisis.  Those are usually pretty bad for everyone, but particularly the everyones who rely on government benefits.

Beyond that, I'm not sure how much more point there is in talking about it until the legislative particulars emerge from the final bill.  At this point, pretty much everyone is exhausted--the politicians, the CBO analysts, and the journalists who cover it.  I assume y'all are too.

So go have a merry Christmas.  Whatever you think of this bill, things will still be better than they ever have been in all of human history whether or not it passes.  So go out and sample some peace on earth and goodwill to men for a few days.  After the holiday, we can all get back to shouting at each other.

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