As they lick their wounds from their location in the briar patch, America's health insurers may be musing about how they could have come out in a better place. Perhaps there's still time to add a rule that would require uninsured sick people to join the public plan rather than merely relying on time-tested indirect techniques to convince them to seek insurance elsewhere.
In the absence of a public plan, a program that required the purchase of insurance would inevitably stick some private company with the responsibility of paying to care for the sick. That's not something any insurance company aspires to. The whole logic of the business rewards those with the skill to select those who won't make large claims.
An effective technique from the past, just saying no, won't be permitted in the future. In return for giving up their right to exclude the sick, the insurers won some public relations points - from those in the center who thought they'd shown some impressive public-spirited flexibility and from those on the left who saw them as being appropriately punished for their sins in the past.
Still unclear is precisely what they'll get in return for their participation in this political theatrical that's now nearing a grand finale. These are not stupid people and history suggests they're getting something in return for embracing - or at least accepting change.
Good negotiators are seldom direct or transparent. The homebuyer who loudly and overtly falls in love with the walk-in slate fireplace does not come away with a good deal. But one who obscures that preference and instead complains about the expense of removing the mirrored bedroom ceiling may win a substantial price break.
In a truly good deal, everyone gives and everyone gets. That may be the outcome of the health reform debate. Time will tell. But the current construct that identifies winners and losers provides more heat than light and does little to increase our understanding of what's actually going on.
In fact, for this to work, everyone involved has to think he's a winner. But it'll be years before we know how the law of unintended consequences intervened (although we do know that it will) and how things shake out.
Of course, the game isn't over yet and there are still many devilish details to be resolved. But it does look like we'll be making some serious - albeit inevitably incremental - progress. And while total defeat is always a possibility, that seems to be a receding threat.
For the moment, though, I'm quite confident that the insurers in the briar patch are feeling no pain.