Writing this diary has been on my mind for a number of weeks as the "healthcare reform" debacle staggers towards its unfortunate conclusion. So much animosity and venom has been exchanged between the pro and anti factions recently I think many have lost sight of the bigger picture of what's at stake. Give me just a minute of your time and I will make a reasonable argument that there are a number of major problems with the proposed reform bill, enough I believe that passing the reform bill will set back the progressive agenda for a generation (or more).
How did we get to this point? From the outset, expectations on healthcare reform were sky high, and for good reason. Obama campaigned on the public option; for many (myself included) this was a major milestone in the progressive agenda. Think Progress's excellent research on Obama's endorsement of the public option here. After the long, dark night of the Bush presidency progressives saw the light at the end of the tunnel.
If that's the case, where did the public option go? The answer lies in the modus operandi of the modern Democratic party. As the nominally liberal wing of our two party system the Democratic party pays homage to progressive goals as a means of generating enthusiasm in the base. However, words are but wind as the saying goes. When the time for action comes votes are never to be found as Glenn Greenwald states more eloquently than I.
Why should you care about whether the public option is dropped from the reform bill? Because it's the right policy. One of the most discouraging aspects of the last year is the total disengagement of the public in any serious discussion about the merits of different proposals. For so many reasons (which would require a lengthy diary of its own to explore) the public at large is uninformed about and at the same time uninterested in analysis of one of the most daunting challenges facing our nation. Death panels! No one wants that socialist healthcare crap they have up in Canada! Discussion of market failure in the health insurance industry? I have a better chance of waking up on Mars in the morning.
The structure of the current health industry is leading to healthcare costs that are growing at a significantly faster rate than GDP. What do we get for this expenditure? Not much! Government run healthcare systems in other countries spend less, achieve better outcomes, and have higher general satisfaction levels. This is all old news and more than well documented, so let's continue on.
As I alluded to at the beginning of the diary expectations for Obama we high not only because of the campaign he ran but also due to the path taken to get to that point. Obama was replacing a president who was literally, a war criminal. The fruits of the previous eight years included two unnecessary wars, tax cuts for the rich and to finish it off with a bang the worst recession in generations. Democrats had taken significant majorities in both the house and the senate. The world was our oyster.
Therein lies the problem with HR 3590. If, after taking control of the white house from a war criminal, during the worst recession in generations, with an estimated 46,000 people dying per year directly attributable to our healthcare system, and with significant majorities in both the house and senate, we can't get the public option even in the limited form as proposed, we certainly won't ever get it after passing HR 3590. HR 3590 does address some of the short-comings of our current system. After time, more people would be covered and less would die. Some limits would be placed on the health insurance industry most horrific policies. But these are not ironclad solutions like what could be achieved with government run healthcare. Rescission's would still be allowed for fraud, anyone want to hazard a guess as to how long it takes a pre-existing condition auditor to be re-trained to become a fraud auditor? The most significant parts of HR 3590 don't even start until 2014, do you think the health insurance lobbyists that have fought tooth and nail to scrap the public option will simply go on vacation and twiddle their thumbs for the next four years? They have four years to muscle in as many loopholes as possible after the public's limited attention span has grown tired of healthcare reform.
If HR 3590 is passed all momentum, all urgency is lost. Worse than that, the healthcare system will be improved only to the point where conditions are bad, but not bad enough to risk the expansion of the role of government in healthcare. The Captains Of Industry running health insurers may be terrible people but they aren't stupid. They certainly won't repeat the same mistakes and push the limits of acceptable practices again; they've peered over the edge of the cliff and did not like what they saw.
HR 3590 is essentially a blueprint for any private industry threatened in the future by necessary reform. Allow for non-material changes at the margins, bonus points for avoiding key reforms that damage your core profitability (double bonus points if the marginal reform actually increases profitability). Passing HR 3590 and declaring it a success sends the following message to all future representatives and senators: Feel free to ignore popular opinion and the public interest when considering legislative initiatives, the corporate interests that fund your campaigns and bribe you (delayed-payment style) are what matter. Who's going to be concerned with the consequences of supporting industry when on the healthcare issue an obvious, popular and effective solution was thrown under the bus with no consequences for those involved?
On the flip side of the previous paragraph, think of the outcome if congress passed the public option. The public option would be wildly popular, essentially everyone would try to get on the plan. How do I know this? Easy, we already have a public option, only it's called Medicare and limited to those 65 and above. Of those eligible for Medicare, how many enroll? Essentially everyone. And how popular is it? Popular enough that republicans, who on a philosophical level despise the program and opposed passage of Medicare just like they oppose healthcare reform today, often spend significant time explaining why they support Medicare. They (feign) support for Medicare because they have to, because it is so popular.
Now imagine if the healthcare reform process produced legislation as popular as Medicare. Democrats would have a significant political advantage for the foreseeable future. How could republicans campaign on a track record of opposing policy that will have made such a positive impact on voter's lives? Alternatively, we can pass HR 3590 and force even more people into the arms of an already despised industry. Why don't we just hand republicans ammunition to campaign on.
When I say I oppose HR 3590 it's not even just the healthcare issue I'm considering. We have (or had) so much momentum to really push for good legislation that would be the right policy and that in turn would make for good politics. And we so desperately need that momentum and political advantage. The list of issues that need immediate attention is quite long. What about climate change? What about long-term peace with the Islamic world? The current status quo on these issues is a danger to our people and our nation just as real as death is to those without health insurance. How long will progressives continue to capitulate to conservatives and special interests who keep us from addressing the underlying fundamental problems of the world we live in. I see us at a fork in the road. We can pass HR 3590 for some measure of short-term minimal gain, or we can hold out for a better long-term solution and greatly improve the liberal political position.
You tell me people will die if HR 3590 isn't passed and that is true. But people will die if HR 3590 is passed too. What about those that will die when insurers deny their claims due to fraud? What about the lives lost because we can't put in place policy to effectively combat global warming? What about the lives lost in the ongoing conflicts in the Islamic world? I would rather accept a temporary defeat on healthcare now and be able to maintain (or even increase) the level of urgency for reform and get the right policy later than to capitulate and accept mediocre reform now that will doom future reform in healthcare and other important arenas.
Thank you for your time.
UPDATE: A few points. Some comments disagree with my usage of the phrase "sets us back a generation". I intentionally used this phrase to try to highlight what I think is the overlooked consequence of passing HR 3590. A capitulation by progressives here sends a message to conservatives and special interests that progressive interests can effectively be ignored because we can be bought off with the smallest crumb, as stated above. My lost generation refers to this time period going forward where progressives have lost all leverage to negotiate and bargain. The more common usage of "sets us back a generation" refers to the assertion that if we don't pass anything now reform won't be revisited for a period equal to past intervals between healthcare reform pushes (which I disagree with). I think there needs to be debate weighing these outcomes against each other, and I don't see that debate.
And to those that say pass this bill and continue to push for a public option: Do you really think that the public option will have a better chance of passing once HR 3590 is passed? I see industry becoming even more entrenched in our healthcare system, do you think that will help? I see the public growing weary of the topic and losing all interest after the issue is "fixed", do you think that will help? I see lobbyists who will grow bolder after their win and progressives who will diminish after their loss, do you think that will help? If you really think the public option has a chance after HR 3590 passes I admire your optimism but doubt your logic.