Been halfheartedly following the “progress” of the health-care legislation, been reading a lot of stuff by those who think it’s a horrible bill, but others, like Nate Silver, say progressives are nuts (well, OK, he uses the term “batsh*t crazy”) to oppose the bill:

I understand that most of the liberal skepticism over the Senate bill is well intentioned. But it has become way, way off the mark. Where do you think the $800 billion goes? It goes to low-income families just like these. Where do you think it comes from? We won’t know for sure until the Senate and House produce their conference bill, but it comes substantially from corporations and high-income earners, plus some efficiency gains.

Because this is primarily a political analysis blog, I think people tend to assume that I’m lost in the political forest and not seeing the policy trees. In fact, the opposite is true. For any “progressive” who is concerned about the inequality of wealth, income and opportunity in America, this bill would be an absolutely monumental achievement. The more compelling critique, rather, is that the bill would fail to significantly “bend the cost curve”. I don’t dismiss that criticism at all, and certainly the insertion of a public option would have helped at the margins. But fundamentally, that is a critique that would traditionally be associated with the conservative side of the debate, as it ultimately goes to mounting deficits in the wake of expanded government entitlements.

But it’s a vital critique.

Look, the issue of cost is paramount. The moral issue is that all deserve to have access to affordable coverage. You can make coverage more “affordable” through massive subsidies, or you can bend the cost curve; you can allow, for example, re-importation of drugs, which would save consumers billions. But we’re not going to do that. A single-payer system would have forced insurers to compete by lowering costs. But we’re not going to do that.

So if we’re not going to bend the cost curve now, then when? Ever?

A more liberal approach might have produced a more fiscally responsible bill. If drug prices are lower - as a result of re-importation - the government, the taxpayer, saves money. Single-payer absolutely “infringes” on the insurance industry, but saves an overwhelming amount of money long-term on administrative costs. It’s a more fiscally efficient, and ultimately a more fiscally conservative, approach.