I honestly don't know whether the Senate will pass a health care bill this year. On the one hand, the obstacles seem almost insuperable; on the other, there are some very smart people working very hard to make something happen. If they don't get it done before the new year, my advice would be to declare victory and get out: Pass something smaller and more targeted that would increase incentives down the road to come back to the big issues in a more constructive way.
The problem isn't just the congressional risk aversion associated with election years. Health care is probably the single hardest and trickiest problem American society faces. Economically, it involves about one-seventh of the economy, and everybody in the United States has a dog in this fight. Hospitals are the biggest and fastest-growing employers in many communities across the country. Health care jobs are some of the best paid we have.
People's expectations for health care are deeply irrational. Everybody wants to live forever, nobody wants to cut any corners on his or her own health care and nobody wants to pay through the nose for everyone else's. When my grandma is sick, I want everything possible done for her; when it's your grandma with the problem, I want the death panel to meet. Oh - and I don't want any politicians telling me that my expectations are out of line, contradictory and, on a very deep level, foolish and vain.