As the struggle to reform healthcare goes on, it’s becoming increasingly clear that we aren’t going to get what we really need out of any legislation that could actually clear Congress. Don’t get me wrong, I like the provisions to get more people insured, prevent you being dropped for pre-existing conditions, and other attempts to make healthcare in this country a bit more humane. However, it doesn’t look like there’s even a small remaining hope of getting anything into the reform bill that will actually reduce the cost of health insurance.

The public option, while hotly debated, isn’t providing competition for any existing insurance customers. And any attempts to regulate the existing industry or remove monopolistic practices are pretty much dead on arrival. Robert Bixby, the executive director of the Concord Coalition, a bipartisan group of budget watchdogs said of the bill, “As of now, it’s basically a big entitlement expansion, plus tax increases.”

As a practical matter, the health lobby is never going to allow the Congressmen they’ve paid good money for to vote for anything that will cut into their profits. And so far, the public isn’t united enough around any particular reform policy, or even the need for reform at all, to exact their will on Congress at the polls in 2010. This leaves us with two options: leave the system as it is, or accept “reform” that pads the pockets of the companies that are already the heart of the problem.

If we can agree on one thing, it is that the current system is broken. To not do something when we are this close would be devastating to future attempts. Further, we’d be right back here next time. But passing reform without cost containment of some form seems ultimately destructive. Minimally, it would be used as a weapon by those who opposed reform to say, “I told you so.”

Yet there might be a constructive aspect of expensive reform. Perhaps things need to get worse for people to unite against the current non-competitive expensive employer based system. The only thing that will break the stranglehold the industry and their lobby has over our government is a people’s revolt that is at least somewhat unidirectional. And that kind of focus will only be achieved through some shared pain. In part, I think we are not in agreement on a cure for healthcare because it doesn’t hurt enough yet.

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