I'm not saying this bill is perfect. I do think it is good - very good even, and will leave many millions of people much better off than before. But sure, there are things in it that I would change if I were starting from a clean sheet of paper.
But we all have to understand the choice that we are making here. Our choice is not between this good but not perfect bill or another, better bill that we could pass in a year's time. It's between this or the status quo.
Remember that there isn't a single Republican in the Senate, and there is just one in the House, who is willing to vote for even this version of health care reform, let alone the stronger one that we progressives would like.
Now remember that there were nearly 40 DEMOCRATS in the house who voted against this current House bill, and there were 3 Democrats (plus Joe) who had a lot of issues voting for it. These people are not going to suddenly change their mind because progressives want something stronger. They don't LIKE PROGRESSIVES. They WANT to defeat progressives. In many cases, the best thing that they can do for their own electoral chances in their states is to be seen to anger us fighting lefties. And because health care reform doesn't exist yet, there's no constituency in their state this is benefiting from it and wants it protected. Social science proves that people are far more loathe to lose something they have than they are eager to get something better. When it comes to the conservatives in both parties who are blocking us here, we have no power over them.
Plus, we are likely to be a smaller caucus after the 2010 elections, especially if Democrats fail to achieve their single biggest domestic priority. Failing to achieve health care reform makes us look (and act!) like losers. Losers do not win the good will of voters.
But with the modified health care reform passed, a couple of things work in favor of improving and expanding it.
- The world will not end. All the Republican scare mongering about death panels and socialism will start to look even more crazy as people look around and see none of this happening. Meanwhile:
- A consituency is created for the Health Exchanges. People who are on it will want to protect and keep it. And the number who are on it will go up in time.
- Insurance industry regulation will kick in right away and will make small but relieving changes to the deals people can get from their insurers.
- All of this, plus the political bonus that comes from achieving what no other Democratic Congress or President has ever been able to accomplish before should helpt mitigate losses in the 2010 election.
The final days of a bill are, almost by definition, the hardest. Critics have had time to mobilize. Industry has had time to lobby. Supporters have endured one painful compromise after another. Enthusiasm ebbs at the exact moment opposition peaks.A bill will pass. Millions will be better off. Those who oppose the bill from the left (a large number) will realise that their cause is better off now than it was before. Those who oppose it from the right will have to find a way to live with it. Either way, by the midterms people will be judging the law, not the bill - and those aspects of it that aren't working can be fixed incrementally rather than as a once and for all take it or leave it deal.
And as those who would like to see the bill fail organize, those who would like to see the bill succeed nitpick. Joe Lieberman refused to allow Medicare buy-in. Ben Nelson worries over the abortion language. Susan Collins wants to ensure access to catastrophic plans. Progressives are concerned that insurers will game the individual mandate. Name your interest group or constituency and they will name the provision, or set of provisions, that worries them. The goals of covering the uninsured and bending the cost curve remain popular, but the means are, well, more controversial.