All or nothing at all? If US health reform doesn't change coverage, costs, and quality, will it matter?

Abstract

As I write this, two health reform bills are moving through the US Senate and three in the House of Representatives. Senate leadership is meeting to combine their two bills into something that will have a chance of getting through the more conservative of the two bodies. This is looking more and more likely to succeed. The House has a similar blending task for their more liberal bills, which probably shouldn’t prove too difficult.

Then the bills go to the floors of the respective chambers for passage. Finally, if they make it that far, comes the conference of all conferences: an attempt to craft a bill both houses can agree on.
Most observers feel that we are pretty close to a historic change. The question is, what would a final law look like? What reforms will remain and what will get compromised away? And will the new regulations make a difference? As Frank Sinatra famously sang, should it be all or nothing at all—or is …