Mad Max? Or the Second Coming of Hillary?

Apparently Sen. Max Baucus (D-MT) will run a major health care reform bill whose terms are being built and discussed for an unveiling in the 2009 session. The good news is Sen. Kennedy and staffers are involved in the planning process. He's in the best position to understand the history of the fight over national health care, and also best positioned to arm-twist the myriad constituency groups that would need to be on board early in any kind of effort.

Any whiff that such a bill represents Sen. Hillary Clinton's revenge for the underhanded, corrupt and morally bankrupt spiking of her 1993 plan would grind the process to an early halt.

I can't believe there's someone who would read this blog who hasn't heard me say this, but extending health care to every American is the paramount issue of our time. It impacts our economic competitiveness, the education of our kids and the well being of our seniors. It eats something like a third of our domestic budget in its various forms and it literally determines the quality of our lives.

(Spoiler Alert: The title of this blog refers to the condition of the United States, in the two dimensions I care about, Democratic politics and health care policy. In one way I am obviously excited to see Democrats in charge. In another, the condition of the patient is something to be concerned about, where health care is concerned.)

There's no one who wants to see a health care bill succeed more than I do. But, to give away my view on the still-open poll here, I dont think this is the right time, and I think the bill should wait.

1. We're out of money. Any solution to the 47 million uninsured not to mention the laundry list of other issues that would need to be addressed, not hte least of which is the terrible rate of Medicare and Medicaid reimbursement in the Midwest including Iowa, requires real dollars. We face the biggest deficit ever, a debt we cant service, and the largest economic investment by government in the history of the free world. We need to right the ship before we take on health care, as much as it hurts to say.

2. 'Health Care Stimulus' is a non-sequitur. Lets say part of the economic stimulus (the next one, not the business bailout but the consumer one thats coming) involved an effort to invest in health care in order to crank up the economy. To do this in a meaningful way would mean putting more health care providers to work in more places in the country. Think rural Iowa, which is desperate for dentists and psychiatrists not to mention direct care workers. Getting these folks enrolled in school, educated, placed and profitable will take years. Any attempt to sell this process as short-term stimulus is bad policy and will set the system up for failure.

3. The recession will stretch resources as they are. Government is really good at robbing Peter to pay Paul. My biggest fear about a massive health care bill is that the money will come out of the existing system. With the economic downturn will come seniors losing health benefits from private pensions when their companies can no longer afford them; substance abuse issues on a scale we only see in these conditions (smoking, drinking and gambling are up in Iowa already); and tight state budgets that I fear will require cutbacks in state services like Medicaid for the poor. None of this is good for anyone.

In short, this is a trauma situation, and we have to stabilize the patient first before we can operate.