I never thought I would see the day when the left wing of the Democratic Party (my comfortable political home) would prove to be as collectively short-sighted as the right wing of the Republican Party. In the last two weeks of the health care reform debate, since the beginning of the Senate debate, really, I have been proven sadly mistaken.
Healthcare reform has been the Democrats' signature issue since the Truman Administration. Richard Nixon made an attempt at a Republican reform measure to stave off calls for a single-payer system, but Watergate took over the national consciousness before he could even attempt progress. Otherwise, healthcare has not been a mostly Democratic issue, it has been an exclusively Democratic issue. It has been one of our great weapons against the Republicans, who have repeatedly either sided with the system as-is or focused on wholly peripheral issues like tort reforms. We should be careful, Progressives, not to take that great weapon and aim it at our own foot.
Several diaries ago, on the night that the Senate voted to begin debate on the reform measure, I contended (at great risk to my digital person, it turned out) that the public option in any truly meaningful form was a lost cause. I did not say that it was a bad idea (I personally have supported a public option strongly throughout the debate), but that there was no way for it to get past the Senate. I pointed out that the 60 vote threshold could not be met without Lieberman, and Snowe (who could in theory fill the gap) would not accept the option in any real sense.
I did not stress enough then that reconciliation is a red herring. The rules concerning reconciliation state that only matters related directly to mandatory spending or revenues can be passed in that manner, and any Senator may appeal to the Senate parlaimentarian about the budget-relevance of the item in question, whose judgment is binding. While the Medicare reforms (which save a TON of money, not to mention go a long way toward saving the embattled program) and the new fees could get through, the Exchange and the public option within it are not budgetary matters by any construction that could pass the laugh test, least of all that of the Senate parlaimentarian. It will not work.
Which leaves the only alternative for those who seek to avoid the much-maligned number 60 is to change the cloture rules of the Senate, which could technically be done by majority vote by invoking the so-called Constitutional option, which involves raising a point of order and a ruling by the chair that the filibuster is unconstitutional. The convoluted process would result in a functional change in the Senate rules requiring 60 votes for cloture. The problems with using it in this context are twofold. First, it hands the Republicans an enormous propaganda tool by claiming we are changing the rules mid-game (for once, their charge would actually be accurate). Second, the precedent for using the nuclear option on a partisan basis would make any future Democratic Senate minorities powerless to block any measure the Republicans would care to pass. The threat of political MAD as well as the institutional chaos that could result from a rubber-stamp majority Congress has hitherto held impetuous Senators in check, as it should now.
Accordingly, 60 is the number. Any possible way of using 50 votes to pass is either an illusion or the fuctional equivalent of burning down the candy store to get a chocolate bar. That stark reality leaves the healthcare reformers with two choices; compromise to get sixty or take nothing. I've been hearing much from the left to suggest that nothing is perferable to a bill without a public option.
Here's the deal, folks. If you like preexisting condition denials and recission, oppose this bill. If you think that people in the individual market would rather be alone than band together for lower rates, oppose this bill. If you think women should be charged more for health insurance, and insurance companies should be able to arbitrarily charge an exorbitant amount more for the sick or elderly, oppose this bill. If you think Medicare Advantage should continue to bankrupt the program for my parents' generation, least of all mine, oppose this bill. If you think fee-for-service is the most efficient way to pay for our healthcare, oppose this bill. Otherwise, shut your mouths and get on board. If you kill this bill because it doesnt include a program that less than 20% of our population would be able to choose (and only 5% actually would!) I will hold you personally responsible for every recission-caused death, every elderly person in twenty five years without insurance, every bankruptcy caused because someone was stuck in the individual market with nowhere to go.
The good is not the enemy of the perfect. Progress is better than the nigh-unstructured chaos that is our current system. To be frank, public option or not the system that Congress is trying to set up would run circles around our current one in every concievable way including the two most important; outcomes and affordability. Lets not act as though the public option IS health reform. Clinton's plan didn't have one, and I've not yet heard the first liberal glory in the fact that it failed. In the absence of the perfect you take the best you can get. This bill even without the option is an exceptional and historic step forward. Liberals, we oppose a bill this good at our own risk. Otherwise, in ten years our great intentions now will be little comfort when the system degenerates beyond repair.