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.