So what happens now?

The insurance contracts that went into force this month replace the old PPO-HMO choice with a more defined benefit structure, where wellness costs are paid for but strict limits placed on illness payouts.

The expected election of a Palin-ezoic Republican to Ted Kennedy's Senate seat marks a turning point in the national debate on health care.

(To the right, Republican Scott Brown as a Cosmopolitan model in 1982.)

It's great fun for the pundits, but the stark reality remains obscured.

American businesses pay more for less health care than their trading rivals. This subsidizes giant, powerful industries, but it leaves tens of millions facing a neo-Haitian situation, unable to insure against immense risks, and subject to bankruptcy in the event of accident or disease.

Last year's Harvard study, showing we suffer a 9-11 nearly 15 times each year from premature death due to a lack of coverage, was merely another Inconvenient Truth in the Fox-o-sphere.

Rather than spur compromise, it sparked angry rejectionism, with Democrats unable to cobble together the super-majority needed to overcome it.

This, in turn, is bringing out the inner Tea Partier in Democratic activists. The middle ground is now seen as the yellow line on a country road, a political deadline for whoever stands there.

This is either the beginning of the end for President Obama and the Democrats or the end of the beginning. They can face the reality and full responsibility for failure or they can raise high the standard of political war, becoming just as unyielding as those on the other side.

But what happens now for health care? Some elements of reform, like meaningful use of health IT and efforts to treat the insured not as risks but as a bundle of defined services, are baked in.

The insurance contracts that went into force this month replace the old PPO-HMO choice with a more defined benefit structure, where wellness costs are paid for but strict limits are placed on illness payouts.

The result is that the financial risk of dire illness is being transferred from the insurers to the insured.

  • There are no guarantees that, if you get sick in an expensive way, your costs will be covered.
  • There remains no control over risk rating, meaning you may be unable to get coverage if you have a preexisting condition.
  • There remain no incentives for hospitals and clinics to control costs.
  • There remains no way for individuals and small businesses to get the kinds of deals large businesses get from the insurance industry.
  • Decisions on what must be covered remain in the hands of state bureaucrats.
  • Even rich people may have trouble getting emergency care as services are cut due to a flood of poor uninsured.

It's a bad deal and there is no compromise coming. Industries primed to face a new reality find instead the old one.

So don't get sick, and if you do die quickly. The can is getting kicked down the road while players on all sides, and at all levels, point fingers.

This post was originally published on Smartplanet.com