Our colleagues Joanne Kenen and Sarah Axeen have a front-page story up at The American Prospect explaining how the the cost of doing nothing on health care is even greater now than during the time of Clinton reform effort, making the prospect of real change even more imperative. Building on recent research from the New America Foundation they write:

In 1993-94 we had "fanfare and promise." But proponents of health reform massively bungled the politics, the process and the policy. Foes of reform, expensively and expansively, exploited their errors. The upshot was that we, as a nation, rejected comprehensive health reform. We didn't understand it. We didn't like it. We certainly didn't want to pay for it. We decided that the status quo, however flawed, was better than change.

What we didn't recognize in the 1990s was that the status quo was an illusion. Imperceptibly to most of us, dramatic changes were underway in how we pay for care, how we access care, and in the quality of our care. For the most part, they were not changes for the better.

The number of uninsured spiked in the late 1980s, and when Bill Clinton was elected in 1992, there were 38.6 million uninsured. By the time his health plan died in 1994, another 1.1 million had lost coverage. Now, we're at 46 million, and it's likely soaring as jobs vanish and businesses cut benefits in a sinking economy.

Health care spending in 1992 was $849 billion. Now it's $2.2 trillion—slightly less, actually, than pessimists had forecast back in the 1990s, because of the cost-savings blip brought to us during the short-lived era of HMO ascendency. But premiums in the early 1990s ate up 7 percent of family income. Today, it's 17 percent, and growing, a trend that is aggravated by rising deductibles and co-pays. Employers' burden has also grown. The average employer paid about $3,700 toward a family plan in 1996; it's approaching $10,000 today. [...]

Our health system today—and it's become a cliché to wonder whether we should even call it a "system"—is different and more challenging than in 1992. Then we had a coverage crisis. Now we have a coverage, cost and quality crisis. We have an aging population with multiple chronic illnesses being treated inefficiently by numerous doctors who are paid to pile on tests and procedures, but who have no incentive to coordinate care. Research by the Rand Corporation has found that when we do see a doctor, we only have a 50-50 chance of getting the right care. Assuming we can find a doctor in a world where specialties like dermatology and radiology bring more cash and cachet than primary care. We may not get our diabetes controlled, but if we've got the money we can have our body parts scanned and erase our wrinkles. [...]

Throw in the quality challenges, the errors and infections, the lack of care coordination, the vast and unjustifiable variations in how medicine is practiced from one place to another, an emergency system so strained that an ambulance is diverted from an overcrowded ER at least once every minute. It's bleak.

So bleak that it might change the conventional wisdom. In short, we need to understand that just like in 1992, we're on a trajectory. And the status quo is not an option.