Tuesday :: Mar 16, 2010

A Bill Barely Worth Passing, A Process Well Worth Deploring


by Turkana

Ezra Klein often is quoted by supporters of the health insurance bill. He's the type of safe, left-centrist that in the Beltway comfortably passes for a liberal. In the past year, he hasn't been much of a fan of a public option, and he's often been found rationalizing the compromises that have whittled the bill down to where its value is so hotly debated. It's instructive, therefore, to review his description of the bill, from just a few weeks ago:

The Senate bill is almost identical to the legislation supported by moderate Republicans in 1993.

Got that?

He then draws contrasts with the "far, far more conservative (and useless)" Boehner plan, and admits that the current bill "doesn't look anything like" the 1993 Clinton plan or more liberal efforts such as Medicare for all. And we should be celebrating this?

A year ago, we had a Democratic president elected by the largest majority in a generation. No Democratic president had been elected by such a large majority in a couple generations. We had large Democratic majorities in both Houses of Congress, and by summer we had sixty members of the Democratic Caucus in the Senate. We also had a nation still politically shellshocked from the worst administration in history, and yearning for transformational change. And the result, on the most important item on the domestic agenda, is, essentially, a 1993 plan put forth by moderate Republicans. And we should be celebrating this?

To this observer, the bill is barely worth passing, primarily because of the community health centers, which were inserted into the bill by the great Independent, and sometime real life Socialist, Senator Bernie Sanders. But don't call this bill health care reform. It is, primarily, a health insurance bill. You know the drill. Mandates. No public option. An excise tax. An antitrust exemption legalizing collusion on the exchange. No repeal of ERISA Section 514, ensuring continued denial of expensive treatments. Illusory enforcement mechanisms. No word, yet, on the final Nelson/Stupak wording. And we should be celebrating this?

The process of crafting this flustercluck has been ridiculous and embarrassing. The Republicans went teabagger and birther and death panel, as is their birthright, and never should have been taken seriously as a serious political party. So many compromises were floated, and argued over, and then discarded, until the only thing that had been compromised was the integrity of the bill. Remember the Blue State public option? Opt-out? Triggers? Remember the Medicare expansion? Reimportation of medicines? HHS negotiating better bulk pharmaceutical prices? Didn't think so. As Klein says, apparently approvingly:

...Democrats have massively compromised their vision...

As many have noted, this process was undermined, from the start, when single payer wasn't made the goal. Not that it would have passed, but from a negotiating standpoint, it would have redefined the target, and it would have redefined the meaning of compromise. Which is what the public option was. It never was the "perfect," it was a unilateral compromise, from the start. Had that unilateral compromise not been made, from the start, perhaps we could have negotiated down to a public option rather than negotiating down from it.

Want to know a secret about the comparisons to Social Security? They would be more accurate if Social Security had been a mandate to invest in the stock market. Social Security created a public structure, and that public structure was then built upon. This health insurance bill does not create a new public structure. The comparisons to Social Security don't fly.

The argument that we are providing health care to 30 million people also doesn't fly. One of the great confusions of the past year has been the identification of health care with health insurance. They are not the same. Mandating that people buy health insurance is not the same as guaranteeing them health care. Particularly given denial of treatment, ERISA Section 514, legalized collusion on the exchange, and the lack of real enforcement mechanisms.

We are where we are. The president is fighting hard for this final bill. He is trying to create votes. He is doing exactly what his more ardent supporters said he couldn't do, when he was criticized for not trying to create votes for a better plan. He is trying to create votes. Imagine what might have happened if he'd tried to create votes for a public option. Imagine.

We are where we are. The bill is worth passing. Barely. On the margins. Those 1993 Republican moderates have something to celebrate. For the rest of us, the day this bill becomes law is the day we start trying to make it something truly worth celebrating. Something that will provide health care, and not just health insurance, to all Americans. There is a difference. As a lot of people soon will discover.

Turkana :: 12:36 PM :: Comments (21) :: Digg It!