As Congress debates healthcare reform, we often hear that hopes for comprehensive reform -- fundamental changes, like a public plan or a radical, Netherlands-like overhaul of regulation -- simply aren't realistic. I hope to explore later why this seems so to those casting the votes. In the meantime, a couple reports make an interesting juxtaposition:

The first reorients the context of, if not the debate, then the original reasons the subject came up. The WSJ Health Blog reports briefly on some truly alarming projections of healthcare economics 10 years from now. A sampler:

• In every state, the share of population getting health care through their job would fall; in more than half the states, the decline would be greater than 10%
• Every state's spending for Medicaid and the Children's Health Insurance Program (CHIP) would rise by more than 75%
• In 45 states, the amount of uncompensated care in the health system would more than double
• In 29 states, the number of those without insurance would grow by more than 30%
• Nationally, spending by American businesses for their workers' health care would double.
• Individual and family spending on health care would jump by 46% to 68%.

(For an idea of the squeeze this puts people in, see "The Underinsurance Problem Explained".

This is the sort of train-wreck Peter Orszag has been warning about, and it'll be hell on the states, families, and businesses. There's little reason to doubt it: It's simply a continuation of the trends of the last decade. Only difference is that now we're near the breaking point, and the next decade will take us past it. Huge swaths of the middle class are being driven into debt and even bankruptcy, even as they have less and less access to care.

Maybe Congress will get it yet. But if you're doubting they will, you're not alone. From Kaiser Health News:

NPR reports: "A new poll by NPR, the Kaiser Family Foundation, and the Harvard School of Public Health finds that, so far, the public feels profoundly shut out of the current health overhaul debate."

"'Most people don't feel that they personally have a voice in this debate,' said Mollyann Brodie, director of public opinion and survey research for the Kaiser Family Foundation. 'In fact, 71 percent told us that Congress was paying too little attention to what people like them were saying.'...

Reuters reports: "Most Americans would pay higher taxes to fund healthcare reforms that provide the best quality of care, but only a minority expects Washington to deliver it, according to a survey released on Wednesday. The telephone survey of 3,003 U.S. adults conducted by Thomson Reuters found 63 percent are willing to pay for healthcare reform, though most also said they are happy with their own doctors, insurance plans and out-of-pocket costs. However, only 35 percent of those surveyed said President Barack Obama's reform agenda and the debate in Congress will lead to better health service, while 41 percent said they would expect it to lead to lower costs" (Morgan, 9/29).