The second reason why the health-care wave is fading is this: so far, this isn’t “reform” in any thoroughgoing sense. The original idea was to rethink the entire convoluted and overly complex system, and to find ways to truly change the way we think about health care to both improve care and save money. There ought to be ways to do that. But the three bills to emerge so far seem like more of an attempt to buy off existing constituencies than a real rethinking of the mess.

Insurance companies are a good example. Yes, they would be required to sell coverage to people with preexisting conditions, but they would get something monumental in exchange for tighter regulation: a government mandate that everyone buy their product. No wonder an industry group has released an ad praising what Congress is doing. Yes, there would be tighter regulation of hospitals, doctors, and other caregivers, and cuts in Medicare and Medicaid spending, but all of the players would stay in place in pretty much the same relation to each other that they now have. So, yes, millions of people would get subsidized coverage at taxpayer expense, but we would be sending them into a system that everyone admits is dysfunctional and unsustainable now.