The Senate isn’t yet finished deciding what rights patients will have, and already it is difficult not to feel despair like a damp breeze creeping into a half-closed medical gown. The lack of coverage is embarrassing enough for a nation that is supposed to lead the world in heath care; that senators this week heard case after case of dangerous indifference by HMOs to the health of their patients shows this issue will return before Election Day.

Certainly, health-maintenance organizations are in the terribly difficult position of having to say no to certain kinds of health coverage in certain cases. Saying no is their primary justification for existing. But the complexity of medicine demands that the money counters make choices that do more than neatly balance cost and care. Among other things, it requires them to ensure that patients retain some control over their health.

Republicans, who hold the cards in Congress, argue government regulations aren’t the answer — their view of government being not the collective authority of the people but the feckless mandates of bureaucrats. Their plan is supposed to let states and HMOs keep their greater say; with the assumption that bureaucrats in these places do not suffer from the same fecklessness. But for all the arguing in Congress over who should control what, the difference between the Republican and Democratic plans are slight, outside the Dems’ insistence that patients deserve a right to turn to the judicial system if they have been harmed by a denial of care.

Both plans are wholly inadequate to restore the doctor-patient relationship that has suffered in recent years or to do anything about the 43 million Americans who lack coverage entirely. And neither gets to the troubling lack of coverage for mental health. At least the Republicans have a provision that would allow the self-employed to deduct the full cost of health insurance. That may allow a relative few to afford coverage but it is unlikely to help the majority of uninsured. As that population continues to grow, Congress is certain to return to this topic.

That means more congressional theatrics and more dramatic claims, more horrifying anecdotes and more frenzied lobbying from both sides. The number of uninsured continues to rise (up from 34 million when the Clinton plan failed in ’93), costs keep going up ahead of inflation, particularly in the last few years, and Congress continues to fiddle with small proposals and incremental repairs to a system headed for crisis.