There were lots of reasons why I wanted to see Affordable Care (née healthcare reform) pass. Ending the tyranny of “pre-existing conditions,” of cruel recissions, and insuring more than 30 million uninsured Americans were big reasons. But it wasn’t a perfect bill, and there was a vocal group of Democrats on the leftward fringes of the blogosphere who wanted to “kill the bill” and take a fresh stab at it down the road. Doing so, they insisted, would supply us with a better reform of healthcare in the end.

I rejected that argument for several reasons, all of which continue to be vindicated by current events.

First, they were suggesting killing a bill narrowly passed by a Senate with 60 Democrats, and starting over with a Senate that had only 59 Democrats. I could see no mechanism by which this more conservative Senate would pass a more liberal bill. It just never made sense. Second, the bill on the table had too much good stuff and was too much of a sure thing to toss it and gamble on maybe getting something some day down the road. I saw no clear argument why we shouldn’t bank the good in the bill at the time and come back to make it better.

And this relates to my third reason, that the bill contains the seeds of its own future reform. An individual mandate, however unpopular it may be, was necessary to make the other reforms work without destroying the entire industry. And anyone who thinks private insurers won’t continue to game the system is nuts. So people will, in time, come to demand that the government step in and create some alternative to those private insurers, some sort of option created by and for the public, run by publicly elected agents. Some sort of “public option,” if you will. So you get the public option in the end. And if you run that public option efficiently, and don’t tie its hands behind its back, it’ll force private insurers to be lean and mean. They’ll provide better care at lower cost, or people will switch to the public option. If the private insurers can’t compete, they go under, and we get a single-payer system. If they can compete, then we get a competitive, cheap, efficient, market-based insurance system that covers everyone. Win!

But the fourth and fifth reasons the “kill the bill” crew was wrong relate to the politics. Fourth, it’d be nigh-impossible to take up health care again if the bill died. There were too many nasty votes already, the bill passed as the 2010 electoral cycle started heating up, and the appetite for those tough votes was evaporating quickly by late March, when the bill finally passed. It’s gone, now, and no one will want to relive the 18 bloody months they’d just been through. The fifth reason to pass the bill was that doing so would force anyone who voted for it to defend the thing, thus building a political consensus to retain and expand it.

And that’s what we’re seeing now. People took the hard votes to pass this bill, put their reputations on the line for it multiple times in some cases, and now they have to explain why it matters. For instance, TPM reports: Senate Majority Leader Reid Doubles Down On Health Care As He Fights To Keep His Seat:

Senate Majority Leader Harry Reid, battling for his political life against bad odds, has doubled down on his role in health care reform even though Nevadans aren’t fans of the new law. Reid is up on statewide television with ads that champion health care reform, speaking to the camera and showcasing three residents who would be helped under the changes in the measure.

If the bill died, Democrats in tough races could have turned on the bill, insisting that it was never what they would have liked it to be, and insisting that they’d pass a perfect bill the next time around. And if the next time never came, so much the easier for them. But the bill passed. The only choice is to defend the bill they passed, or to open themselves to charges of flip-flopping. And unlike August of 2009, there’s an actual bill to defend, not a dozen drafts floating around the Hill. That makes it harder to stir up bogus charges against it. We can have a serious debate about the merits of the bill that actually passed, and Republicans can contrast Affordable Care with their own cockamamie ideas about trading chickens for healthcare. If the election centers on whether people like what’s actually in this bill, or if they’d rather have the Republican alternative (no change, worse insurance, and a return to subsistence farming) I think we’ll see a real shift in public opinion toward the bill.

Comments

  1. #1 andrewo
    April 30, 2010

    I just do whatever Ezra Klein says.

    (That’s a joke.)

    (I’ll say it twice: JOKE.)

  2. #2 Pen
    May 1, 2010

    Myes, that’s what I’ve been thinking. Better a step in the right direction, than high-falutin talk about climbing Mount Everest.

  3. #3 Deepak Shetty
    May 3, 2010

    I’m not sure how Americans are able to accept the fact that it now needs 60 votes to pass anything instead of 51. It seems to be taken for granted.

  4. #4 jacksmith
    May 5, 2010

    I want to commend all of you for working so hard and being so strong at helping the whitehouse and congress begin to address our U.S. and Global healthcare crisis. You have been AWESOME! my fellow Americans and peoples of the World. America and the World is better and safer for it. My greatest pride is the knowledge that I am one of you. And that you really get it. You really understand the importance of it all.

    There are some potentially very good things in the healthcare legislation. Especially with the reconciliation fix’s. The Democrats, Bernie Sanders and the Whitehouse did a GREAT! job of fighting to produce the best healthcare legislation that they could. They have earned all our strong support. And we should give it to them.

    But it was your relentless pressure and hard work that made the difference. Whatever good comes from this healthcare legislation, America and the peoples of the World will have each of you to thank. You were smart, creative, courageous and relentless. You fought together for the best legislation possible. And when you had to, you fought alone. No matter who stumbled and fell you continued to push and forge ahead. Fighting for the lives and health of the American people and the World. YOU SHOULD BE PROUD OF YOUR-SELVES :-)

    It may come to pass that future generations will look back on us and say that we were ALL Americas Greatest Generations. And that healthcare reform was our finest hour. You should be proud of our leaders President Obama, Speaker Pelosi, Majority Leader Reid and the many other Democratic and independent fighters for the people in congress. They proved them-self worthy of the leadership of a GREAT! PEOPLE.

    But we are not done yet. This was just the beginning of healthcare reform, not the end. WE THE PEOPLE OF THE UNITED STATES, ARE NOT! divided on healthcare legislation. The vast majority of you have been consistently crystal clear that this legislation does not go far enough. You want a strong Government-run Public Option CHOICE!! available to everyone on day one. And you want it NOW! YOU MUST NOT ALLOW AN INDIVIDUAL MANDATE TO STAND WITHOUT A STRONG GOVERNMENT-RUN PUBLIC OPTION CHOICE! AVAILABLE TO EVERYONE.

    WE THE PEOPLE have been crystal clear that we want an end to dependence on for-profit healthcare and the for-profit proxies called private for non-profit healthcare. The American people want the CHOICE! of a strong Government-run Public Option to replace their need or dependence on healthcare providers whose primary motivation is profit. Rather than providing the highest quality, easiest accessible and most affordable medically necessary healthcare possible. This is what the rest of the developed World has. And the American people want it too. They want healthcare ASSURANCE! Not, for-profit health insurance. And they want it NOW!

    Now is the time to continue the push for a strong Government-run Public Option CHOICE! available to everyone that wants it on day one. Rationally it’s clear what we have to do to get this done. SUPPORT THE DEMOCRATS that supported you with a Public Option, and REMOVE as many republicans as you can. Not one republican in congress was willing to step across the isle to support a strong Government-run Public Option CHOICE!! available to everyone on day one. NOT ONE! Let no candidate prevail this November that does not support a Strong Government-run Public Option.

    47,000 AMERICANS die each year from lack of healthcare. 120,000 die from treatable illness that don’t die in other developed countries. Hundreds of thousands of you are dieing from medical accidents in a rush to profit. And Millions are injured. Millions are driven into bankruptcy. All for the privilege of paying two to three times as much as any other people in the developed world for healthcare. HOGWASH!

    Additionally, tens of thousands of you and your children were killed and millions sickened and injured from a terror attack with H1N1 (swine flu). Released on the American people and the World by the for-profit healthcare industry. All in an attempt to panic and frighten you into accepting the oxymoronic criminal enterprise of private for-profit healthcare (The most costly, deadly, dangerous, and disgraceful product sold in America). H1N1 is still sickening people and killing them. Especially children, the young and the middle aged. And there will be a third wave. These are the terrorist you need to worry about the most. Even the so-called international terrorist would not do something so INSANE! But greed driven medical profiteers would and did.

    Apparently as far as republicans in GOVERNMENT are concerned, YOU! my fellow Americans – CAN JUST DROP DEAD! Including their own family members. Fools! Hundreds of thousands of you, and possibly millions of you will die from the long-term effects of your infection and poisoning with H1N1.

    So my fellow Human Beings. Rest-up, Take good care of the basics (Balanced nutrition, hydration, exercise, rest and POSITIVE emotional supports). Then wade back into the FIGHT! for a strong Government-run Public Option CHOICE! available to everyone on day one. Drug re-importation, Abolishment or strong restrictions on patents for biologic and prescription drugs. And government controlled and negotiated drug and medical cost, NOW! You must take back control of your healthcare system from the Medical Industrial Complex. This is a matter of National and Global security. There can be NO MORE EXCUSES.

    God Bless You My Fellow Human Beings. I’m glad to know of you. And proud to be one of you.

    See you on the battle field.

    Sincerely

    jacksmith – WorkingClass :-)

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