The Treatment

The Starter Home

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At Saturday’s press conference announcing that Democrats had the sixty votes necessary to pass health reform legislation, Majority Leader Harry Reid was flanked by three of his colleagues: Max Baucus, Chris Dodd, and Tom Harkin. But Harkin was, in a sense, the odd man out.

Unlike Baucus and Dodd, who managed health care legislation through their respective committees, Harkin assumed a leadership role only after taking over chairmanship of the HELP Committee in September. And, even then, he tended to defer to his colleagues, who were more familiar with the legislation than he was.

But at the press conference, at least, it was Harkin who may have captured the legislation’s essence better than anybody. This is not “a mansion,” he explained. It’s a “starter home”--with a solid foundation, a strong roof, and room for expansion.

A lot has been said about the flaws of the Senate health care bill, in this blog among other places. And that is because the flaws are many. From the protection against out-of-pocket costs, which could stand to be stronger, to the implementation timeline, which could stand to be quicker, it’s easy to find things in this bill that could be better.

At Saturday’s press conference announcing that Democrats had the sixty votes necessary to pass health reform legislation, Majority Leader Harry Reid was flanked by three of his colleagues: Max Baucus, Chris Dodd, and Tom Harkin. But Harkin was, in a sense, the odd man out.

Unlike Baucus and Dodd, who managed health care legislation through their respective committees, Harkin assumed a leadership role only after taking over chairmanship of the HELP Committee in September. And, even then, he tended to defer to his colleagues, who were more familiar with the legislation than he was.

But at the press conference, at least, it was Harkin who may have captured the legislation’s essence better than anybody. This is not “a mansion,” he explained. It’s a “starter home”--with a solid foundation, a strong roof, and room for expansion.

A lot has been said about the flaws of the Senate health care bill, in this blog among other places. And that is because the flaws are many. From the protection against out-of-pocket costs, which could stand to be stronger, to the implementation timeline, which could stand to be quicker, it’s easy to find things in this bill that could be better.

The next few weeks will offer some opportunities to fix those flaws. If the Senate does pass this bill--and the odds are overwhelming that it will--it must negotiate with the House over the final version. The House bill is strong where the Senate bill is weak--on the financial protection against medical bills, on the structure of the insurance exchanges, and the treatment of the drug industry. With any luck, the House will prevail on these matters, even as the Senate prevails on others.

But let’s not kid ourselves: If and when a bill goes to President Obama for signing, it’s not going to look radically different than the measure Reid put forth today. Ben Nelson, the sixtieth vote, made that clear when he warned that he was prepared to change his vote if the bill came back from conference looking radically different.

That's frustrating. But it shouldn't take away from what a huge accomplishment this is. As Dodd reminded people in his remarks, this measure is going to make life better not just for millions, but tens of millions of people. Those without insurance will get it; those with it will have guarantees of financial security they never had before. The government will begin creating an infrastructure for making our health care system focus on better quality care, even as it tries to make the system less expensive.

And that's not the end of the story. There will be opportunities to improve this law even after it becomes law. Social Security evolved that way. Medicare too. Health care reform can too.

No, this legislation is not everything it could be. But Harkin is right: It’s also not everything it will be.

Follow Jonathan Cohn on Twitter: @jcohntnr

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