We don't yet know what the final bill will look like.

The current model is to subsidize inefficient private insurance companies (and most of the rest of the system as well), so I don't understand how we can move toward that if we are already there. The politically realist approach was to propose as much of Jacob Hacker's recommendation as possible, then shepherd the bill through the system. This the Democrats have done, proposing an ambitious, popular and surprisingly bulletproof bill which leaves no room for an opposing argument that is both substantive and popular. That has led to the current noisy dynamic in which Republicans refuse to argue the merits and prove daily that they represent only about 35% of the population, with a platform that can only accommodate 45% of the population. The GOP is demonstrating in detail to the people and to Washington politicians that responsible leadership should ignore them. This is irritating right now, but good for the future of the Democratic Party. Meanwhile the Democrats have the votes to pass nearly the entire bill, including all of the most popular measures and some less-popular ones (like the employer "mandate") which could have taken a lot of heat had an actual substantive debate taken place.

Of course I want the public plan and the exchanges in place right now. But if there is a delay in implementation of those, the legislation will also have to delay or remove the individual mandate (since, obviously, including the mandate without offering new options is political suicide). So it seems to me that the worst case for the Democrats is if there is no exchange and no public plan for a sustained period of time, while the insurers and the private sector adapt to the new regulations. Costs would rise and employers would start modifying or dropping coverage, both of which are politically scary. But the Democrats can navigate through this by hanging the problems around the necks of the Republicans who fought to kill reform.

I think we are in a century that will feature moderation away from conservative economic ideas, simply by virtue of the huge raft of unavoidable collective-action problems we face. But there is a long way to go. Moving away from government that primarily serves the wealthy to a more equitable policy approach is a shift that, despite all the new enthusiasm over the last two years, liberal politicians and voters have not yet earned by convincing the country of its value. The best policy options are off the table this year because the interested corporate sectors are more politically powerful than those advocating the policies. That's simply a fact, one which all the organizing and communication about reform haven't removed from the picture. On the other hand, many corporate interests who are facing unsustainable compensation structures seem motivated to help make this legislation work to control costs.

We already have a system in which, by virtue of Medicare/Medicaid and the personal income tax exemption for employer-paid premiums, government pays for nearly half of all provider bills. Even in weakened form, the reform bill will make it unambiguously and obviously true that government is footing well over half of the cost, while erecting a structure that will be hard to eliminate and relatively easy to improve in later Congresses. In the future the exposure of the American taxpayer to the American health care system will be far more visible and quantifiable, and the resulting debate will shift to different ground. It will be more like Medicare or Social Security, where the debate is over how to sustain the program rather than whether the program should exist. So while I'm disappointed that the bill may get watered down, I'm very enthusiastic about its upcoming passage.

If so, Pelosi owns that mere hours after she backed away from her previous commitment to a public option, an invitation was sent out for a fundraiser for her hosted by UnitedHealth, etc.

http://www.openleft.com/diary/15066/unitedhealth-lobbyist-announces-big-fundraiser-for-pelosi-as-she-backs-off-public-option

Yes, I agree.