Some have likened the legislative process to making sausage. Understand this analogy was not meant to be flattering, but sometimes this process works better than you think...and people do like sausage. I think this is what is happening on Capitol Hill this week.
After leaving an intense, hastily called, late-night meeting (before its 2:30AM conclusion), I had a sleepless night before returning for another meeting with the same cast Saturday morning.
It was but one of many dramas occurring around the Capitol - in offices, in restaurants, in nooks and crannies - throughout most of the last 48 hours. It is ironic that my 15 months of intense work on health care, along with so many of my colleagues, comes down to this.
As I write this, despite the late meetings and sleepless nights, I am actually feeling good about where we are and what's going to happen.
I know that it is very hard for people outside of the Capitol to keep track of the developments that have occurred over these last few days, much less make sense of them. The fact is that the process here, for all of its frustrations and inefficiencies, is in fact working like it was designed to do. After more than a year of being in the middle of this drama, I am satisfied that a clear outline for fundamental reform for America's flawed health system is emerging. There is greater understanding inside and outside of government.
While we have the greatest health care in the world, the "greatness" is only available for some: those who can afford and navigate the system. For most Americans, however, our health care system is too expensive, the results uneven, too many are denied access, and the results for average Americans are mediocre. We get sick more often and longer, die sooner and pay far more for the privilege than most other countries that I hear opponents of reform vilify.
Our bill will expand access to over 30 million who currently do not have coverage. The insurance that everybody has will be better, eliminating some of the artificial dollar limits. Americans will no longer go bankrupt from medical costs. Over the next few years, insurance protections will be even stronger, the tyranny of being denied coverage for pre-existing conditions or being chained to a job for fear of losing your coverage will be eliminated.
Perhaps most important, we are on a path to save Medicare from collapse by empowering the government to study and then implement a system that rewards value, not just volume with tests and procedures. There will be new tools for the federal government to ensure equity and innovation that will put us on a path to save over a trillion dollars in the next 20 years. It puts us on a path to prevent Medicare from collapsing and eliminates the biggest fiscal threat to America's stability.
There is a certain amount of irony that the uniform Republican opposition actually made the bill worse. By following leader Boehner's admonition in March of '09 that his party should not be legislators, but communicators, they took themselves out of the game in the House and the Senate. True bipartisan legislation has a cushion that enables it to resist efforts from a small minority - and even a single member - to extract their pound of flesh and be granted special treatment. Across the board Republican opposition empowered every single member, for a bill that has come down to one or two votes, to have a moment in the sun. It gave them maximum leverage, and it would be surprising to not see people try and exercise it. On balance the fact that the legislation does so much good - controls cost, creates a new path and creates instant benefits for the American public - is remarkable.
It is also striking how the legislation, despite all the heated rhetoric from opponents (most of it wildly inaccurate), is quite moderate. It relies heavily on the private sector and existing insurance industry. While it does not make progress as fast or at a level as ambitious as I have fought for this year, it does have the key elements: access, cost containment, and insurance reform, which will put us on a path critical to our physical and economic health in the years ahead.
Tomorrow I will be voting on a bill that will be the fundamental foundation for health care results that are as good as what other countries have, and will put us miles ahead of what we have today. It will give Americans more coverage and rescue Medicare from collapse. At a time when the federal government provides $.50 of every dollar for health care, it's time that we exercise our full ability to make that money and that authority work for all Americans.