The Senate has been all over the place these last couple days. It sure looked like they weren’t going to get anything done before the Christmas recess, with the Republicans invoking the weird Senate rules to require that the clerks read all 2,000 pages of the HR 3590 and the thousands more pages of amendments out loud to delay everything and block a vote on cloture. They've gone through two of the three procedural votes needed to vote on the bill, hopefully on Christmas Eve. The third procedural vote is scheduled for tomorrow. It looks like the Senate health reform bill is going to happen.

That said, the Washington pundits are loudly emphasizing the fact that 61 percent of Americans in the most recent polls are leery of the Senate’s proposal, and more and more observers are concerned about the costs in view of a likely lingering large number of uninsured persons that would result from the holes in their measure. Even Howard Dean has come out against the bill

There’s a lot not to like and to be concerned about in what they’re doing, but I personally believe that the nation will be better off if we achieve a clumsy commitment to universal access, to improving quality and coordination of care, and to successfully reducing the slope of cost increases in health care. If we don’t, we will soon bankrupt Medicare and the federal budget and make health insurance premiums unaffordable for most families and businesses. Doing nothing isn’t much of a responsible action, even with the goofy elements of the Senate and House bills. Since the House version doesn’t kick in until 2013, and the Senate is likely to delay implementation another year to 2014, I think that whatever messy, 2,000-page bill is passed can be amended and fixed over the next three years.

I fully understand the views of those who want to reboot and start over. But, we’ve been saying that we will do that for 30 years. Just having a sense of direction is important. Just think about how dysfunctional the current Medicare payment formulas are, for example. We need to embark upon a process to reduce the administrative waste in our system, fix the Wall Street-based insurance injustices and design a more coordinated delivery system. It doesn’t have to be one that impoverishes physicians and nurses — in fact, a truly reformed system is going to need to empower health professionals to be effective. So, while I fully understand and empathize with the physicians, the professional societies and the members of the public who would rather do nothing and reboot the process, I honestly believe a little momentum — even with the severely flawed proposals before us — is needed. And, there will be time to try to get tort reform inserted in the process in January I suspect, and we are poised to attempt that. What else are we going to do for the next three years?