Here’s my position. In these final days of the health care fight, progressives should work hard to improve the health reform bill in the Senate and in the conference with the (better) House bill. But we should support the passage of the best bill we can get – and then keep fighting for more and better reform.
We always knew that winning health care for all Americans would not be easy. Yes, the health care crisis is hitting more and more Americans, but the special interests that now control America’s health-industrial complex would fight fiercely to stop reform (as they did against Bill Clinton) or to shape change to their own ends.
Unless the mechanism of reconciliation can be brought into play, it appears that those special interests have succeeded in stopping the public option – and the very good alternative of allowing people older than 55 to buy into Medicare. As one of the earliest promoters of Jacob Hacker’s version of the public option, I share the progressive anger at the way special interests have exploited the disunity among Democratic Senators to achieve their ends. But I am gratified by the way the idea of non-profit competition for the insurance industry caught the imagination and support of not only the activist left but also of strong majorities of the general public. If the public perceives this reform bill as falling short, we should make sure they blame the conservatives and the insurance industry — and pressure should trigger support for a “robust” public option.
We built a strong movement for health reform – and a movement that challenged the insurance and drug industries at every turn. That movement can’t disappear because passing legislation this year is just the beginning of a long struggle to cover all Americans, control health costs, and to break the power of the special interests over our health care system.
Obama is determined to get a bill that 60 senators will support. It will be disappointing as to public option. And it will have other serious flaws. But it will be a major step forward, covering lots of people and beginning the long battle to regulate the insurance companies. And that is what we should say: this is a major step forward, but we will build a vigilant democratic majority to monitor its flaws, to improve the bill, and to tame the insurance industry.
What Howard Dean is doing now is infuriating the White House, but it is creating some leverage on the Congress and the White House to improve the bill in conference, so the liberals won’t be so furious – and so working Americans won’t discover that an excise tax on so called “Cadillac plans” ends up undermining the coverage of people with Chevy incomes. This last push to improve the bill in conference should focus on getting rid of the excise tax on working people, requiring corporations to cover their employees, improving subsidies so people can afford the insurance they will be required to buy. In other words, we should work to make sure that the bill that passes will be seen as a step forward and won’t harm working people and generate a backlash against reform – and against Obama and the Democratic Congress.
We should say what I say above — elaborating the good steps forward. And we need to convince the White House that, while they claim success and momentum, they should not describe this victory as anything but a step forward in a longer struggle with the health insurance industry. There will be things about this bill that voters will discover they don’t like — and Obama needs to say he’s going to monitor how it works and improve it when problems emerge. And if the insurance industry doesn’t perform, we will give them real competition or replace them.
