I have a simple theory to explain why health reform legislation has stalled -- it is an echo of why the Clinton plan failed -- most Americans are ultimately unwilling to abandon today's imperfect system for a new one that would require them to adapt to changes that ultimately could prove more uncomfortable than the status quo.
This has nothing to do with partisan bickering, timing, communications campaigns or any of the tangential issues that are so compellingly distracting to analysts. It is very basic. People are unwilling to give up anything they have in the hope that the new system will be better. They fear it will be worse.
And there's no certainty that they're wrong. So, at the end of the day, they decided, as the advice columns would say, that maintaining today's flawed relationship was more prudent than taking the leap of faith required to find a better one. At minimum, that's confirmation that America remains a fairly conservative nation that is wary of big institutional changes.
If you require insurers to cover those with pre-existing conditions, premium costs will rise. If you limit how much insurers can charge the sick, those who are relatively well in the insurance pool will have to pay more. That's one reason insurers wanted the new revenue from mandatory coverage to offset the new expense of insuring those who were ill.
Once again we have learned that there's no free lunch and that restricting forces deemed evil - ranging from insurers to malpractice lawyers - simply won't make that much of a difference in an area where costs generally grow far faster than overall inflation.
Of course, solving the problem of the uninsured is relatively simple, but not cheap or politically easy. You simply expand existing programs ranging from medicaid to cobra to give them access to the system. The only problem there is finding a revenue source.
For those who see dire health consequences from today's situation, the Clinton precedent is reassuring. In fact, in the years since the last reform effort failed, Americans seem to have become healthier and it doesn't seem that the insurance climate has deteriorated if you tease out the current bad economic weather.
I accept the basic political logic, often ascribed to Nixon aide Herb Stein, that intolerable situations don't last very long. Which means that situations that continue over extended periods of time aren't truly intolerable, political rhetoric notwithstanding.
These days there's a lot of revisionist rhetoric afloat about Lyndon Johnson and his twin wins on health and civil rights legislation. Johnson's new-found fans say he would have prevailed where Obama seems to be failing. I'm unconvinced.
Johnson confronted a situation where a majority of Americans - not just the oppressed minority - had come to see old attitudes toward race intolerable. Johnson deserves credit. He identified a change in public attitudes and created an environment where legislative change was possible.
Similarly he responded to public concern that most seniors lacked health insurance - arguably a far greater problem than those we confront today - to create an effective legislative response.
But public complaints about America's health system today are nowhere near the levels Johnson experienced. Until they are, there will be little appetite for big changes irrespective of who's in the White House.