Sometimes you get what you want... alas

The easiest thing to have done with health care would have been to simply issue a Medicare card to everybody with a Social Security card, then fund the whole thing with a payroll tax plus an equivalent tax on unearned income. We're spending the money on healthcare anyhow, it makes no sense to collect the money for healthcare in such an expensive and duplicative way as having health insurers duplicate the IRS's money collection mechanisms and Medicare's bill processing systems.

So why didn't Congress do it this way? Why did Congress create over 2,000 pages of kludges and workarounds to try to make the strange conglomeration of the Dutch, Swiss, and German systems that they came up with workable? Was it a conspiracy by insurers? Did the Trilateral Commission contact individual Congressmen and give them marching orders for how to create the New World Order? Did drug companies bend Congress into doing their bidding? Gosh, there's just so many conspiracy theories going around about why we have such an enormously complex health care bill that will only imperfectly cover most Americans, when the actual reason can be summed up in one word: Democracy.

Democracy is the notion that the common people know what they want and deserve to get it, good and hard (H.L. Mencken), and this bill gives the common people what they want, in spades. Currently over 80% of Americans have health insurance either from private or public sources, the majority of those with health insurance have it via private sources, and over 90% of Americans who have private health insurance have it through their employer. Various non-partisan public health foundations, the most prominent being the Kaiser Family Foundation, set out in the aftermath of the blowup of the Clinton health plan to perform tracking polls to see what health care proposals are most popular. What they found was that the proposals that polled the best were proposals that combined a mandate on employers with subsidies for those who could not afford insurance and restrictions on insurers to keep them from kicking people out of the system. As in, roughly 70-80% support stable over more than a decade.

The single-payer alternative has never polled at even 60% even when polled as "Medicare For All", and generally rarely cracked 50% in the tracking polls. Since democracy is the notion that the common people know what they want and deserve to get it, good and hard, our politicians then sat down to give us what we wanted, good and hard. And that, my friends, is that -- we got what we wanted, a system that largely keeps health insurance for working-age families in the hands of our employers, which thus required 2,000 pages of workarounds and kludges to sort of make it into a universal healthcare system if you squint hard enough. And which, of course, does include pieces of pork here and there on behalf of one special interest or another, but if you look carefully at the bill and at the fifteen years of tracking polls at the kff.org site, it's clear why it looks like what it looks like -- its core proposals are what polled best.

In short, there was no conspiracies involved here in the basic bones of what came out of Congress, it was very carefully crafted to include the policy proposals that polled best over the past fifteen years of tracking polls... along with a bunch of nasty kludges needed to make those proposals sort of workable (for example, the individual mandate, which is needed because otherwise the system goes into a death spiral). What happened to the simple notion of handing out a Medicare card at the same time a Social Security card is issued was something called "democracy", which is the worst of all possible forms of government save for all others that have been tried. So it goes.

- Badtux the Democracy Penguin