After virtually a century of struggle for a national healthcare plan, it finally appeared that the stars were finally aligning in just the right way:

• The public wants maximum-strength reform. Business Week reported a poll (5/16/05) showing that "67% of Americans think it's a good idea to guarantee healthcare for all U.S. citizens, as Canada and Britain do, with just 27 percent dissenting. Numerous polls since then have yielded similar results.

• *The public recognizes for-profit insurers' motives* of maximizing profits while minimizing actual care: Health insurers have ranked below tobacco companies in terms of favorability ratings. A recent USA Today poll showed that just 4% of Americans trusted them to reform healthcare.

• Huge momentum from election: President Barack Obama was elected with health reform as a part of his appeal, and the Democrats accumulated a filibuster-proof 60-vote majority in the Senate. The Wall Street meltdown only underscored the need for reform, with 14,000 Americans losing insurance daily.

• Unity behind strong public option: The public's preferred healthcare reform, a Canadian-style single-payer reform, has been ruled "off the table" by Sen. Max Baucus, President Obama, and a large liberal coalition. Nonetheless, 90 percent of Democratic voters favor a strong version of the "public option" in any reform plan, notes Vermont Sen. Bernie Sanders.

While even the best model of the public option is a very far cry from single-payer and forfeits enormous savings, under the best circumstance it might create a potential incubator for a single-payer plan covering all Americans.

So what is emerging from all this? At President Obama's news conference July 22, he notably neglected to commit himself to a vigorous "public option" that would expand Medicare.

Meanwhile, both the House and Senate health bills have so enfeebled the public option that it represents no threat, as Kip Sullivan insightfully points out.
The public option was supposed to serve as a measuring stick by which to judge and discipline the for-profit insurance industry's cost increases.

While consultants predicted up to 130 million clamoring to sign up for the public option, both the House and Senate bills permit no more than 10 million people to join the public option before 2019. Workers for large corporations will be ineligible now—and perhaps forever.

The insurance industry, on the other hand, gets an enormous boost with a mandate for all citizens to buy insurance, and government subsidies to pay whatever the insurers charge.

In exchange, insurers must only promise not to formally exclude people with pre-existing conditions or use patients' medical histories to deny current claims. But the insurers know how to easily evade these rules while claiming to comply.

At the same time, the drug companies have just won bans on importing cheaper drugs from Canada and the federal government negotiating drug prices for all citizens, along with a 12-year exclusivity deal for biotech drugs.

While it is too early to reach a conclusive judgment on the Dems' health plans, the signs are distressing. We can try comforting ourselves with the hope that any reform enacted is better than nothing and can be improved upon in the future.

But I ultimately can't convince myself. The current House and Senate bills—carefully tailored to specifically avoid insurance and drug industry opposition because they are currently seen as omnipotent on Capitol Hill—will vastly expand their already-overwhelming political power.

So perhaps a decade from now, if the stars line up again for reforming the 2008 reform plan, we will be facing an infinitely taller, thicker wall between us and genuine health reform.