There are two major issues fighting their way through Congress right now that have the potential to substantially reshape American society. The first is Heath Care Reform, which has become Health Insurance Reform, with the almost solitary metric being number of people covered. The second is climate legislation, which is being predictably watered down.
Many bemoan the perceived loss of the opportunity to engage in truly wholesale reforms. Certainly, no one would design our current health care system from scratch. It's hard to see how anyone could defend a distribution network that forces people to stay with employers for fear of bankruptcy if/when something goes wrong. Especially when that system is pretty likely to bankrupt people anyway. Unless, of course, they are over 65 and happen to fall ill in the ways that are backed by the full faith and credit of the United States of America. Of course, one of the fastest growing industries in the US and Japan involves producing more health care options for this lucrative set. Necessity may be the mother of invention, but her father is profit.
Clearly, it would be in society's interest to change the incentives. Pay doctors salaries, instead of fees, and award bonuses for the number of days their patients are healthy and able to work. Ban, or at least heavily restrict, prescription drug advertising to help funnel drug company profits into research, not television. Set prices for medical procedures so insurance companies have to compete on quality and efficiency, not hospital networks. Set malpractice limits so that doctors and hospital administrators have an incentive to do autopsies and further develop best practices.
However, one man's waste is another's income. The "fee for service" model employs legions of billing clerks, and I dare anyone to push for reforms that reduce employment today. Prescription drug adverts pay for a lot of what's left of today's new television programming, and if you think newsrooms are shrinking now, just wait until they don't have Merck and Pfizer as sponsors. The struggles between hospital networks and insurers has generated a market which the established players can easily dominate. And seriously, find a Democrat who will stand up for actual tort reform.
On the climate side, the story is much the same. The current system digging up and burning our fuel has an impact similar to wrapping a refrigerator in cellophane while someone else plays with the thermostat. It's hard to say how big the effect is, especially over short time scales, but it's noticeable in the long run. Ocean acidification, on the other hand, is a very real and easily measured problem. So are the health impacts of mountaintop removal, smog and the odd coal ash flow in a river. Never mind that entire civilizations are built on a set of resources that might last another couple hundred years if we don't need too much more of them.
Alternatives exist, but no one will pay their capital costs until there is a clear and consistent policy that makes it worthwhile. This is not hard, a simple $.01/ton carbon tax on fossil fuels, especially one that was indexed to inflation, would be enough to get things started. But in the US especially we try to cajole good behavior without directly imposing costs, mostly through building codes and the CAFE standards. It does look as though the current bill before the Senate might start to change that. Maybe.
The point here is to remember that big changes happen slowly. We're dealing as a country with a few systems that developed mostly accidentally over the last century. We've finally begun to face them in a serious way, but that century for habits, beliefs and interests to become ingrained will not change overnight. Today's legislation is the tee shot on a long par 5. A hole in one would be nice, but aim for the fairway. Make sure the next debate is about how to finish out, not whether or not to play.
