Today's debate: S-CHIP debate becomes an inconvenient truth

There comes a point in every debate where the argument moves from whether to do something, toward how to do something.

An Inconvenient Truth accomplished this in the global warming debate. It's possible the S-CHIP veto is doing this in health care.

Republicans initially thought they would win this debate easily and in the short term they will.

But just calling a program "socialism" doesn't resonate any more, even with Republicans, thanks in large part to the example of Graeme Frost, whom Democrats convinced to speak out for the program. Subsequent efforts to smear the 12-year old kid seem to have changed the tone of the debate profoundly..

With even Republicans now supporting S-CHIP expansion by 2-1, debate has shifted from whether Americans should get basic health care to how. Republicans will go into the 2008 election supporting private insurance with some subsidies. Democrats support mandating coverage and offering Medicare to those the private system won't handle.

Ironically, Canada is moving toward a similar solution, a hybrid system in which basic needs are taken care of by government, with insurable needs handled by the private sector. There it's not the poor who are complaining of ill treatment, but the wealthy, and they are being heard.

How will this impact American doctors and hospitals? Profoundly. A two-tier health care system, in which costs are controlled for basic services while the sky is the limit in a private market, seems the most likely outcome here. Every market player will have to deal with it.