If it is not yet apparent, perhaps it is time for the last holdouts among us to accept the fact that the American healthcare system is never going to undergo any meaningful reform. Whatever comes out of this Congress and ends up on the desk of the suddenly-not-so-bold President will be watered down, ineffective, costly, and of little use to people who really need it – the working uninsured who are too "rich" for Medicaid and too poor to pay out-of-pocket. I believe there are three main reasons for the impending and perpetual failure of reform.

First, insurance industry shills and more importantly their ideological allies now have too prominent a pulpit for spreading disinformation. ClintonCare in 1994 represented the last, best shot at reform because it was the last pre-Fox News effort. Fifteen years ago the industry lobby had to engage in a very expensive anti-reform PR campaign, most memorably the "Harry and Louise" TV ads which showed a respect for the truth on par with that of an Alabama used car salesman. Now? They don't even have to spend a dime. The right wing media does the hatchet job for them. Why bother with PR campaigns when people from national celebrities like Limbaugh down to dopey 7th-string imitations on bad websites and local AM stations will rail against it for hours gratis?

Second, the timing is just spectacularly inept. Even the d-bag the NY Times hired to replace Bill Kristol understands this:

But in a crisis, all the public tends to care about are jobs and economic growth. It’s not the ideal time to pass costly social legislation that promises to reap dividends only in the long term, if at all. That’s why Franklin Roosevelt waited until 1935, when the Great Depression seemed to be waning, to push Social Security through Congress. It’s why Lyndon Johnson established Medicare at the peak of the long post-World War II expansion. And it’s why Massachusetts’s health care plan and California’s cap on greenhouse-gas emissions both passed at the height of the recent boom, rather than the bottom.

This might have worked after a prolonged period – 12 to 18 months – of sustained positive economic news. Maybe in late 2011, just in time for the 2012 election. But now? It might not even get to a floor vote. This is an unqualified fuck-up on the White House's part and the first serious misjudgment by a President who suddenly sounds a lot more like Eisenhower than the election year FDR comparisons would lead us to believe.

Third, I have serious doubts about the American public's ability to meaningfully process this issue. It is universally (see what I did there?) recognized as a complex problem with correspondingly complex solutions. They are being pitched to an electorate in which 14% of adults – one out of every seven people sitting on the bus with you – are functionally illiterate. They can't read this blog or the instructions on their Easy Mac let alone understand what a single-payer system would entail and how it would affect them personally. I feel like the public listens up to the point at which they can no longer understand it – which doesn't take long, sadly – and then the shields go up. After that, they either decide that they fear change or that they should hide their lack of comprehension behind some slogans they heard on Glenn Beck's show. There is a reason elected officials spend so much time talking about what political scientists call easy issues – those for which citizens need no information whatsoever to form valid-sounding opinions (i.e. "moral" issues like gay marriage or abortion, which anyone can declare Right or Wrong).

Until any of these things change, and I'm certainly not holding my breath, it is pointless to even propose a serious overhaul of the status quo let alone expect one to pass.