(Of course, I'm going to cut right to good stuff. Click on the above link if you want to read the three paragraphs worth on the Public Option analysis.)
It might have been a necessary thing from an activism point of view, but convincing liberals that this bill was worthless in the absence of the public option was a terrible decision, wrong on the merits and unfair to the base. The achievement of this bill is $900 billion to help people purchase health-care coverage, a new market that begins to equalize the conditions of the unemployed and the employed, and a regulatory structure in which this country can build, for the first time, a universal health-care system. Thousands and thousands of lives will be saved by this bill. Bankruptcies will be averted. Rescission letters won't be sent. Parents won't have to fret because they can't take their child, or themselves, to the emergency room. This bill will, without doubt, do more good than any single piece of legislation passed during my (admittedly brief) lifetime. If it passes, the party that fought for it for decades deserves to feel a sense of accomplishment.
But bills like this one have failed before, even in my (admittedly brief) lifetime. Indeed, pretty much the only thing that bills like this one have ever done is fail. But somewhere along the way, a fair swath of people convinced themselves either that this legislation was pretty much a done deal, and the argument could move toward its margins, or that the legislation wasn't worth passing without the public option. Neither was true, and a lot of the difference between me and some of my progressive friends came because I placed a higher probability on, and had more of an aversion to, the failure of the underlying bill.
Basic passage here is a liberal win, and evidence that liberals are running the country. Channeling $900 billion towards the un- and underinsured is Jay Rockefeller's addition to the agenda, not Ben Nelson's. But structurally, liberals only have what power and influence they actually have. And that's not 60 votes' worth. The incredible organizing that's been done on the public option was, on some level, an effort to suspend that reality, and it worked a whole lot better than I thought it would. But it wasn't enough -- couldn't have been enough, really -- to overcome the math of the Senate.
Some will take that as a criticism of the folks organizing on the public option. It's not. There's no chance to win if you don't play the game. But constructing liberal influence and power is a project with a longer time horizon than health-care reform. It's not going to happen before this bill is passed, and I disagree, strongly, with those who think it will profit from this bill's failure. This was something of a test case. Democrats had their 60 votes. They had a majority unknown in modern times. A majority that isn't going to get bigger. And what we learned is that, in this game, that majority simply is not big enough.
The U.S. Congress is hostile not only to liberal power, but also to conservative power, and for that matter, to majority governance. The rules trump the election, trump the organizing, trump the 50-plus senators in support of the public option, trump all of it. Liberals will never have 70 votes in the Senate, and, in a useful symmetry for the purposes of coalition building, nor will conservatives, and nor, it seems, will people who want to make hard decisions to solve pressing problems. The story of the public option -- and of the preservation of employer-based health care, and the insufficient cost controls, and the protection of providers, and all the rest -- isn't just a story for liberals. It's a story about our system of governance and its inability to respond to problems even when you stack the deck in change's favor.
That's why the focus of this blog has shifted somewhat. The first problem for people who care about policy outcomes -- regardless of which direction they care about those outcomes from -- is that the Congress has developed an overwhelming bias toward inaction and the status quo. It is much stronger now than it has been in the past, and it's exacerbated because we are much more divided now than we have been in the past. The answer to the systemic dysfunction on display in the health-care reform debate does not lie elsewhere in the health-care reform debate. For now, you get the best bill you can given the constraints we have. But seeing those constraints clearly is, I think, a step forward, because it's a useful guide to where we need to go next.
Let me put an exclamation point on this posting by saying, categorically, that my personal preference is for a Medicare for all System. There are people who oppose this. Those people, frankly, are idiots.
Failing that (because, I know how to count), my next level of preference is for the Current Health Care Reform Package with a robust Public Option.
There are people who say that it is better to tank the whole bill, rather than let the Public Option slide away. As before, those people, frankly, are idiots.
Losing the Public Option will be a tragedy. Losing Health Care Reform itself will be criminal.