It’s not too surprising that I occasionally (okay, frequently) am asked my opinion about the health care push, what I think, and so forth. So, in an effort to cover all bases at once, and cut down a bit on repeating myself til I’m blue in the face:

Is this an ideal health care reform bill? No, of course not. Anyone who thought we were going to wake up and be Just Like Canada or England after a single bill was, and I say this with all kindness, delusional. There were and are intense hurdles being faced by lawmakers – and not just other lawmakers. Opposing interest groups ran out the door, and not even people most eager for health reform, like the American Medical Association, were behind the latest bill until very late in the week.

One of the good and bad things about America is the competing interests and lobbying groups and financial interests and even organized voters who can threaten their representatives with a lack of re-election for not representing their interests. With all due respect to my friends on the West Coast, this issue becomes a lot more crystal clear on the East Coast; while there are still large blocks of red and blue on this coast, there are also even larger blocks of purple, where a representative has to face the fact that they are elected into office to represent disparate and widely varied views.

But anyhow, political rant for another day. Does the fact that the health care reform bill is not ideal mean it shouldn’t happen, or that Obama/the Democrats/whomever you want to place here failed? No, it’s a step forward. These steps are important, because they are very, very hard to undue. As my friend Russ pointed out, the 1994 Clinton initiative was considered a failure by people on both sides of the isle – and yet, 16 years later, no one talks of removing SCHIP or HIPAA, because constituents have become fond of them, and familiar with them.

This is how health care reform must work, as well.

And there are other things – other bills, policies, and efforts – that a lot of people seem to be ignoring in favour of moaning over how this current bill isn’t perfect, for whatever reason you support. We’re not going to get anything close to perfect until the FDA takes back control of drug policy from Pharma – something that is being worked on. We’re not going to get close to perfect until we give our infectious disease folks over at the CDC and USDA and even FDA more power to regulate food, to track infections, to be able to order rather than suggest recalls. We need malpractice premium reforms, something that is being fought for by people on both sides of the political divide, against Very Large insurance interests.

Is it perfect? No. Does this mean Obama failed you, individually? No. Does it mean there is still more work to do, work that includes educating those who, for a variety of reasons, are terrified by the results? Yes.

Does this make me an apologist? No, it makes me a realist. Medicine is full of compromise – I learned this up close and personal in the first ethics case I sat in on, in determining the course of my own treatments, and watching my mother navigate hers. There’s a reason most of us who are involved in the medical sciences, to any degree, are pragmatists. We have to be. Idealism is nice enough, but in the end, it doesn’t get forms signed or allow for care to happen.

*No, I don’t eat babies. In case that needs to be clarified. I am, however, actively pro-choice, and have been dipping my toe in bioethics for a while now. That has led to me being labeled some really interesting things in the past. I figure, I might as well embrace the funnier ones.