Health Care: There will be a health care bill. It just won't be anything recognizable as reform.

Dear Dr. Healthcare Reform,

I know I've been a bit disconnected lately, but what exactly IS Obama's health care plan? It seems that he would be well advised to do a little proactive sales on his plan, but does anyone know what it actually is?

-- Perplexed.

Dear Perplexed,

You haven't missed anything. It's true that the Right has been attacking "Obamacare" for months, but they don't have any better idea what it is than you do. We may find out more tomorrow when the president addresses congress, but then again, maybe not. He seems to have a problem with any kind of governing that doesn't involve an executive order or a signing statement. Still gives a hell of speech, sometimes, though.

The Obama administration, committed to "health insurance reform" by the candidate's vague promises during the campaign, knew it wanted something it could call health reform, but apparently didn't know what. They parsed the failure of the Clintons to pass health care reform, not necessarily coming away with the lessons you might have. The Clintons' massive bill was drawn up in secret without input from the legislature. That might have led to the conclusion a) that the process should include elected representatives and b) that it should be public and transparent. The White House decided that the corrective of too much control by the White House was none. The president should stay completely out of the process -- in other words, he would decline to lead at all. The part about transparency went right by them -- at the same time that they left the legislature to tack this way and that without a rudder, White House officials were holding secret meetings with drug companies, insurers and other big players in the health care industry. Instead of the promised "change," as far as secrecy goes it was business as usual in the new administration.

It's not like the Obama White House had to lay out a program in Clintonian detail, every t crossed, every i dotted. But he owed it to other leaders in his party to make clear, in general outline at least, what he expected. Since House bill HR 676 that would establish Medicare for All only takes up 13 pages, it's obvious that you can say a lot in a very few words. During the campaign, Obama stood to Hillary's right on insurance reform, so it's not as if anyone expected him to propose socialized medicine, but his supporters were not wrong to anticipate some minimal changes: even those of us with the lowest expectations thought that, at the least, health care insurance would be made more affordable, universal and portable; costs would be controlled; and no one would be denied coverage because of a pre-existing condition.

Naturally, because no one can think of any other way to control costs, many believed that Medicare for All, or single-payer health insurance, would have to be considered. But in another misreading of the Clinton health care debacle, the administration, in its only glimmer of leadership, took Medicare for All "off the table" for being too radical, even though the president himself acknowledged that it is the only way to bring down the cost of health care. It never seems to have occurred to anyone in the White House that part of the reason the Clinton plan foundered was the degree complexity that came from trying to devise a mechanism that would save the parasitic insurance industry. Like the massive bill that has emerged from the House of Representatives, Clintonian health care reform lacked the simple directness that made "Medicare for All" an easier sell.

The "public option" that has the Right so exercised is a compromise introduced in an attempt to put a brake on costs by providing a publicly financed alternative to exploitative private insurance. It probably wouldn't have worked as intended, so we shouldn't be too disappointed if the president throws it under a bus tomorrow. But it has to be understood that with out it, or Medicare for All, or the conversion of the insurance companies into not-for-profits, whatever the president conjures up tomorrow will be as a bandaid on a hemorrhaging wound. A public option that is triggered a decade from now by some vague set of circumstance is the same as no public option; probably worse, because it will leave the impression that something was done.

At the end of the day, this is what is likely to happen: every person in the United States not eligible for Medicare or other existing government programs, will be forced into a private insurance plan, with the tab for those who can't pay picked up by the taxpayer. In other words, the insurance companies will sell many millions of additional policies and get massive government subsidies for the trouble. Businesses will probably still be on the hook for huge insurance expenditures, although some industries may be excepted. Insurance may become more "portable," that is you will be more able to carry it from job to job, and to a much larger extent than now insurance companies will not be able wriggle out medical payments. There will be no significant reduction in insurance industry overhead, however, beyond the loss of a few claims adjusters.

Should this pass -- by no means a sure thing given the profoundly undemocratic nature of the U.S. Senate -- the administration will call it a victory and move on to less vexing tasks. Like bombing the crap out of Afghanistan.