Thoughts from Kansas

Kevin Drum is right. As sucky as the current Senate bill is, it's a marked improvement over the status quo ante and it gives a path to more reforms later. Failing to pass a bill (as advocated by some progressive leaders) is suicide. Democratic voters are already demoralized from all the compromise, and outright failure to deliver a key promise will leave a lot of marginal voters either ready to vote Republican, or to simply stay home and give up on politics. 2008 energized a lot of new voters, especially new Democratic voters, and failing to pass this bill, even after the loss of Medicare buy-in at 55 and the public option, will leave those voters feeling burned.

Drum asks:

in what universe will healthcare reform get revived anytime soon if it dies this year? 2010? With the legislative plate already jammed, healthcare reform probably polling in the mid 30s, and midterms coming up? 2011? After Republicans have gained a bunch of seats in both the House and Senate thanks to public disgust with Democratic disarray? 2012? A presidential election year? 2013? 2014?

…When big legislative efforts go down in flames, they almost never spring back onto the calendar anytime soon — and that's especially true when big healthcare bills fail. It didn't happen in 1936, it didn't happen in 1949, it didn't happen in 1974, and it didn't happen in 1995. What makes anyone think it will happen in 2010?

If healthcare reform dies this year, it dies for a good long time. Say what you will about the Democratic leadership, but Harry Reid, Barack Obama, Rahm Emanuel, Nancy Pelosi, and Steny Hoyer all know this perfectly well. So do John Boehner and Mitch McConnell. (Boy do they know it.) But if it passes, here's what we get:

•Insurers have to take all comers. They can't turn you down for a preexisting condition or cut you off after you get sick.
•Community rating. Within a few broad classes, everyone gets charged the same amount for insurance.
•Individual mandate. I know a lot of liberals hate this, but how is it different from a tax? And its purpose is sound: it keeps the insurance pool broad and insurance rates down.
•A significant expansion of Medicaid.
•Subsidies for low and middle income workers that keeps premium costs under 10% of income.
•Limits on ER charges to low-income uninsured emergency patients.
•Caps on out-of-pocket expenses.
•A broad range of cost-containment measures.
•A dedicated revenue stream to support all this.

What's more, for the first time we get a national commitment to providing healthcare coverage for everyone. It won't be universal to start, unfortunately, but it's going to be a lot easier to get there once the marker is laid down. That's how every other country has done it, and that's how we did it with Social Security and Medicare, both of which had big gaps in coverage when they were first passed.

But if we don't pass it, we don't get any of this. Not now, and not for a long time. Instead of being actual liberals, we'll just be playing ones on TV.

Precisely right. It's easier being in opposition than being in power, because when you have no chance to push an agenda, you can just oppose everything at whim. When you have power, you have to govern in prose, and that's ugly and involves compromises. Sometimes it feels like you were giving away the store.

But I look at the list of reforms above, and I would bet money that Bill Clinton would've given up his eyeteeth for those changes, and for a shot at building on those reforms. Whether a triggered public option is in the bill or not, Congress and the voters and the insurers know that a non-competitive insurance market will be met with a public option down the road, and that individual mandates will make that politically necessary if insurers fail to keep prices reasonable.

And an entitlement for insurance subsidies will be as hard to take away (and as easy to expand) as Social Security has been since it was created. The other structural reforms to health insurance are enormous, and will be of real value to people who are quite literally being murdered by the current system.

Pass this, and we have something to run on. There's a clear contrast between Democrats (health care for all!) and Republicans (everything's fine, who needs insurance reform!), and a clear path to future progress. It'd be nice to solve the world's problems with a single stroke of the pen, but real reform takes time.

I'll make this same argument when climate change legislation comes to the fore in a few months. The US emissions reduction target is anemic at best, but once you have a target set, it's a lot easier to lower it. The politically hard move is establishing a new way of doing things. Once you've rewritten the rules, it's not hard to go back and make some tweaks. Passing this bill, or passing carbon cap and trade, will change the rules dramatically, and open the door to more and better changes to come.

That's why I want this bill to pass, warts and all. It's progress, and as a progressive, that's what I want.