Hi - I've been going back and forth over whether I support the health care bill as currently constituted. My understanding is "reform" would come in the way of insurers not being able to deny folks insurance for pre-existing conditions, removal of lifetime caps, restrictions on kicking people out of a policy when they actually get sick, providing an "exchange" where insurers are supposed to compete on price and quality, requirements on minimum amounts insurers must provide in coverage, and so on. The bill would result in health care coverage for millions of people who do not have (or are unable to procure) insurance now.
There are three big things that give me pause. 1) The method of expanding coverage comes in the form of mandates instead of a public option; while premiums are subsidized for low income folks, we don't know if this is sufficient - I've not seen anything about premiums being regulated. Since people will be fined for not buying insurance, the perverse possibility exists that it would be cheaper to pay the fine than buy insurance. (As a side note, if we force insurers to take everyone, a mandate must exist if there is no public option so healthy people will pay into the system to offset costs incurred by the sick). 2) Undocumented aliens are not able to purchase coverage, even with their own money. I find this both economically stupid and inhumane. 3) The prohibition on denial of pre-existing conditions doesn't kick in until 2014 (although I think the fines for the mandates don't kick in until then either, and the prohibition applies immediately for children). This last one, however, can be defended as needed time to let the system ramp up into place. Also, there are some tax increases - which will be invariably funneled to private insurers, which will already receive a huge expansion of customers from the bill.
I should say that much of my information has been cobbled together from various places, so I'm not entirely sure I've got it right.
Despite these and other flaws, I think the bill should pass. it opens the door to the possibility of expanding the scope of health care coverage, and fixing problems that arise. It gives legitimacy and momentum to regulating the area. It also provides benefits that do eventually kick in, and is an effort to correct some of the shortcomings, problems and disparities that exist in health care today. Doing nothing guarantees that costs continue to escalate, tens of millions of people would remain without coverage, insurers would be free to deny coverage to whomever they so choose, and so on. While I would say this is more "regulation" than "reform", as it seems to merely provide parameters within the status quo infrastructure to operate in, is is a start -- the journey of a thousand miles begins with the first step.