By Evan Falchuk

So the President gave a speech yesterday in which he said he would push, with Democrats in Congress, to pass a major health care bill through a process called “reconciliation.”

I don’t think most of us know what that is, exactly.  The meaning of it is simple, though: they can pass a bill with a simple majority vote.  They can eliminate a Republican filibuster in the Senate.  It’s been called the “nuclear” option, well, at least since Republican Trent Lott dubbed it that some years ago.

Some people are appalled that this could happen.  Should they be?

I don’t think so.

When the President said yesterday that “everything there is to say about health care has been said, and just about everybody has said it,” he may not be factually correct.  But in terms of the legislative process, he and the leadership in Congress have the power to decide that, in fact, it is true.  If they have the votes, that is.

So, at this point, it’s not about whether the plan is good or bad.  It’s about whether the President can get the votes to pass it.  There’s nothing illegal or immoral or unethical about that – it’s just democracy.  And it’s the worst system in the world….except for all the others.

Now, you can have a perfectly good discussion about whether reconciliation makes good political sense.  I suppose people who are prone to be angry about such things will be angry about it, and strong supporters of the President will like it.  But I don’t think this is the biggest problem, and I leave those politics to others.

The biggest problem is that it just isn’t going to deliver the transformative changes that you might expect given the huge commitment that’s been made to it, and the controversy surrounding it.  In spite of all of the soaring rhetoric, most Americans aren’t going to experience much change at all.  The problem will be that, after the dust settles,  people will be left asking “where’s the beef?”

Why will they ask this?  Because health care costs will continue to rise, and there will still be many millions of uninsured.  It’s because the fundamental problems that drive health care costs in America will remain essentially unaddressed.

We will still have an uncompetitive insurance market, and an increasingly concentrated hospital market.  We will still have an aging population that need increasing amounts of care.  We will still have all of the unhealthy lifestyles Americans live.  We will still have an extraordinary pace of new medical technologies and treatments that add new expense.  And we will still suffer with quality problems because we don’t let doctors have enough time with their patients.

This is the larger point.  We face major structural problems in health care, that can’t be “fixed” by a bill, no matter how long or how short it is, and no matter how many people vote for it or against it.  They can only be fixed in the way many other things get fixed in America, by the efforts of individuals and companies, charities and governments to chip away, bit by bit, to build a better future.  It won’t be easy or quick.  But no one should believe, even if a bill becomes law and a political battle won, that American health care has been somehow “reformed.”