There is a lot of talk about what the fate of HCR means for the Democratic Party come November. Opponents of the Senate HCR bill insist that Nelson, mandates, no PO, or some other something will just be awful for our electoral prospects. Our Congresscritters will have failed as legislators, reformers and Democrats.
Let's say -- for the sake of argument -- that that is all true. The Senate bill is every bit as wretched as people say and any Dem voting for it is simply doomed. Let's assume that's all 1,000% true, as unassailable as the notion that the sun will rise tomorrow.
I ask you to consider: Is it worse than passing nothing?
I think that's rather the bottom line when you get right down to it. Would failing to enact any reforms (kill the bill) be worse than passing the Senate HCR bill as is?
I, for one, think passing nothing would be worse. I believe that the regulatory features of the Senate bill are critically important and we can't get those through reconciliation. It is my opinion that Citizens United changed everything and unless we get the 85% MLR for group plans enacted, reform just gets harder and harder as time goes on.
As deaniac pointed out, the Senate bill achieves 85% of the Democratic Party platform regarding health care. Much has been written about what the Senate bill actually accomplishes and what improvements it makes. Even Jacob Hacker, who brought us the public option, says the Senate HCR bill should pass.
Just as much has been said about how poorly the Senate HCR bill polls with the public. I will note here that these assertions are rarely accompanied by links allowing examination of the polls in question. What are the crosstabs? What questions did they ask? I'm sure anybody asked how they feel about the mandate would say "No, sir. I don't like it." But how many were asked about the mandate and the end to rescission and PEC exclusions it allows? As Nate Silver points out, individual elements of the bill are quite popular; the problem lies in the fact that most people still do not have an accurate conception of what the bill entails:
What we see is that most individual components of the bill are popular -- in some cases, quite popular. But awareness lags behind. Only 61 percent are aware that the bill bans denials of coverage for pre-existing conditions. Only 42 percent know that it bans lifetime coverage limits. Only 58 percent are aware that it set up insurance exchanges. Just 44 percent know that it closes the Medicare donut hole -- and so on and so forth.
...How would public opinion change if people were fully informed about the content of the bills? It's hard to say for sure, but on average, the individual components of the bill are favored by a net of +22 points. An NBC poll in August also found that support went from a -6 net to a +10 when people were actually provided with a description of the bill.
Much more interesting, though, is a recent column by David Wessel, outlining what happens if nothing passes:
The numbers are so large they're hard to grasp. The U.S. health-care tab in 2009 was $2.5 trillion, equal to 17.3% of the nation's gross domestic product, the sum of all its output, much bigger than 2008's 16.2% because the recession depressed GDP. The economy will grow again, of course, but health-care costs will rise even faster. In a new forecast, the federal Centers for Medicare and Medicaid Services predict that without some big change, health care will amount to 19.3% of GDP by 2019.
...the Urban Institute ran the do-nothing outcome through its computers, and offered three scenarios. In the best case, the number of uninsured rises to 57 million, or 20.1% of the population, from 49.1 million, or 18.4%, in 2009, most of them middle-income adults. More employers drop coverage as it grows more costly. The fraction of Americans on the government's Medicaid and Children's Health Insurance Program, now at 16.5%, would rise sharply to between 16.5% and 18.3%.
..."the fiscal course that we're on...is unsustainable and it needs to be addressed," White House budget director Peter Orszag said this week. "If we don't address rising health-care costs, there's nothing else that we're going to be able to do that will alter that basic fact," he said.
I may be alone in this, but I just don't see how passing nothing inspires electoral wins. The bill is imperfect; no one would deny that. But an imperfect step is still a step and we have to do that before we can run. It is my opinion that passing the Senate bill, warts and all, is a better campaign platform than "We got nothin'."
It seems to me having the foundation of the Senate HCR bill affords all kinds of fodder for the Dem message: "We took the first step and if you send me to D.C., I will make sure we finish the job." They can campaign in November on improving the bill with the wildly popular Public Option, whatever it means anymore. They can point to all the footage of Republican obstruction. Fortunately, this is ready-made for Dem campaign ads, as "No!" doesn't take much time to say. I truly believe that passing the imperfect bill we have gives Dems a focus and rallying point for November. More to the point, though, I am convinced passing nothing is the worst thing that could happen.
Kevin Drum has some fascinating insights along these lines in a recent Mother Jones piece. There's a new Public Policy Polling report that really puts the electoral risks in perspective:
It turns out that Republican are ahead in the generic congressional ballot regardless, but there's a direct pair of questions asking for support levels if healthcare passes vs. healthcare failing. If it fails, Republicans lead by five points. If it passes they lead by only four points. In other words, there's no difference: Dems don't lose anything by passing healthcare, so they might as well do the right thing and then do their best to sell it to the public over the next ten months.
...I went and looked at the crosstabs. And guess what? The news is actually better than I expected.
The conclusions are basically that passing health care reform loses us no republican votes (duh!), actually increases Democratic support and cuts the GOP margin with Independents almost in half.
All of this leads me to believe that we have nothing to fear by passing even something as flawed as the Senate bill but everything to fear from doing nothing. I am firmly in the pass the damn bill camp. I don't expect everyone to agree with me there.
But I would ask everybody participating in this debate to take a minute with themselves and decide which is worse: passing the Senate bill as is or doing nothing. I really think that's what it all comes down to at this point.