Let's say all goes well and we manage to reform our health care system so that the number of uninsured Americans falls close to zero. Given the political constraints facing the Obama administration, assume we do this through some slapdash approach that temporarily preserves job-based coverage while subsidizing coverage for millions of poor and near-poor families who do not currently receive coverage through their employers. To placate private insurers, assume that an individual mandate also goes into effect. How long might this new health care settlement last? I'd give it about five years.

The French universal health system is the envy of the world. After an exhaustive study that measured health outcomes in 191 countries, the World Health Organization concluded that French medical care delivers the best combination of quality and fairness. And as T.R. Reid explains in his excellent new book The Healing of America, the French regularly riot over its shortcomings. The United States, in contrast, ranked 37th in the WHO ranking, in large part because of the extreme contrast between the well-being of America's insured and uninsured populations.

What's more galling is that France manages to achieve better outcomes, as measured by healthy life expectancy, at far lower cost: While 16% of GDP is dedicated to health care in the U.S., only the French spend 11%. It's hardly surprising that Americans, on the right and the left, are clamoring for a drastic overhaul. But like the French, Americans will never be satisfied with any reform package.

The French are in a panic over rising health costs, and for many of the same reasons that we are: Unlike Britain's National Health Service, which places tremendous emphasis on cost-effectiveness, the French system gives tremendous discretion to doctors and patients to choose treatments regardless of cost.

Yet as in the British system, French taxpayers ultimately foot the bill for this outsized generosity. The French have nevertheless managed to keep costs well below American levels by spreading risks over the country's large and diverse population and, more to the point, by squeezing medical providers: Incomes for physicians are sharply lower in France than in the United States, though physicians enjoy a variety of public subsidies that their American counterparts do not. Can you imagine American doctors and nurses accepting steep pay cuts, even if they received free tuition and malpractice insurance in return?

As the health care debate has evolved, we've gone from President Obama's early focus on rampaging cost growth and the ways in which it undermines our economic well-being to a new focus on improving the quality of coverage for the currently insured. The first argument was the right one to make: It is the undeniable root cause of health care woes in the United States and in all advanced market democracies.

Yet the Obama administration was incapable of crafting an effective message on how to deliver lower costs and higher quality without terrifying voters. Talk of an independent commission with the power to revamp Medicare, one of the president's more promising proposals, proved frightening to the elderly. Meanwhile, coverage expansion would inevitably prove extremely expensive at a time when tax revenues are collapsing. The only way to pay for such coverage expansion would be a broad-based tax--exactly the kind Democrats and Republicans alike have pledged never to enact.

Then there was the notion that a public insurance program would compete with the private sector to drive down costs. Republicans effectively framed this "public option" as the beginning of the end of private medical care.

What's essentially happened is that, in classic fashion, Democrats and Republicans have both focused on short-term political gains at the expense of creating a sustainable package of reforms. Democrats and Republicans both recognize that the vast majority of Americans like their job-based coverage. So while the more honest and far-sighted legislators from both parties know that job-based coverage is doomed, they can't say so without getting politically punished. The White House has thus crafted a compromise based on their fear of tough conservative opposition.

Republicans are spending less time thinking about how to fix a broken health system and more about how to deliver the Obama administration a crushing blow. This is despite the fact that conservatives have many of the right answers, particularly when it comes to cost-sharing.

My bold prediction is that some kind of health reform legislation will pass. Costs will balloon, just as they have in Massachusetts, a state that was unusually well-placed to afford universal coverage. We'll eventually be forced to abandon fee-for-service medicine in favor of a more efficient system based around integrated networks of providers. After a long and wrenching process, people will live longer and pay less for medical care. And we'll still be extremely angry about it.