The work isn’t done. You might call this health care bill the third or fourth act of a five-act play. For those of us who remember dramatics (or those of us who can fake it, i.e. me), the climatic act is the fifth one.
There’s been some triumphalism on the left (e.g. Matt Yglesias here and here) equating this bill to the end of big government liberalism in tones reminiscent of “the end of history,” as if the left winning its primary goal somehow forces—all Hegelian-like—the end of the ideology. This, of course, is false because health care reform isn’t really done.
The one thing we know for certain that health care reform will do is coverage. We can be pretty sure that coverage will expand, and dramatically, and obviously this a great achievement. But to a certain extent that means putting everyone under the shelter of a leaky roof. It’s better to be under the roof than out in the rain, and it’s better that we’ve effectively guaranteed that people can always be under the roof, but we haven’t yet fixed the roof.
The big argument that remains about health care could be summed up by saying “cost control” but that misses the point somewhat. You could control costs by methods similar to Paul Ryan’s, i.e. cap payments and ration, but that doesn’t really fix the roof (to extend the analogy). It just says we’re not going to fix the roof because we don’t have the money. Which is one way of looking at it, I suppose, and that’s why it’s an argument, and why it’s going to be a heated one. The other way is to figure out how to fix the roof. The health care reform bill has funded some studies on the issue, and it’s definitely important to know how to do something before you try to do it, but at some point you have to do it. The fifth act is doing it.