Thanks for this post, Steve. It sickens me when well-off people see this as some kind of game (see Nader, Ralph), when it has real, deadly consequences.

Actually, I think it's pretty likely that passing this reform bill will result in a major court case that winds its way up to the Supremes, concerning the constitutionality of the individual mandate. We'll see how that gift to the insurance companies goes, and how quickly.

I think I side with you and Mr. Klein on this question, but have more sympathy than you two for Dr. Angell's argument. Mild reform now may just solidify the position of for-profit companies in our health care system. In future, there will be a big tendency to just tinker with the "fixed" system rather than go for more fundamental reforms.

But, like I said, I guess I favor reform now rather than waiting for the current system to get so bad even Democrats might work together to enact single-payer. It's odd that these reforms will probably end up making me feel more discouraged than encouraged about the future of the US and the Democratic party.

Overton's Window anyone? That's why the minority party is nearly unified in opposition - I doubt few are even aware of the substantive finer points of the legislation itself. They just know it will change the game. Forever.

the foundation has to be a foundation...that is what the smoke and mirrors bullshit is all about. if we get a corporate-run 'health care reform' bill signed by obama, it'll be about as worthless as a bush era "blue skies" environmental bill...

whether angell's "strategy" is right or wrong, what the bill actually does is of critical importance.

propaganda and doublespeak have come a long way, baby, since the 1930s...the clown car senate is a bought-and-paid-for chamber.

for more from the whinny left see the links in john nichols' piece:

http://www.thenation.com/blogs/thebeat/494236/six_smart_progressive_complaints_about_house_health_bill

if we can't pass health care reform now, we never will. it's conceivable that the political climate will improve, that dems will get larger majorities than they have now some time down the road, or that republicans may turn sane and support change, but i wouldn't count on it. this is the time. this is the time.

as obama won notes above, the consequences of failure are grave. literally and politically. you may want a single payer system as i do, but you're not going to get it if this effort goes down the tubes.

passing this reform bill will result in a major court case that winds its way up to the Supremes, concerning the constitutionality of the individual mandate.

Hard to see how there is a sensible argument that it is unconstitutional that doesn't involve rethinking the last 140 years or so of constitutional law.

If reform dies -- or, more accurately, if it's killed -- the alternative is not single-payer, it's 20 years of inaction and adverse political consequences for those who tried.

yeah, when I hear anyone say something like "scrap the whole thing and let's try again later", I know that they're completely ignorant, probably willfully ignorant, of what that really means. "Try again later" in the context of HCR means "never" or "not in our lifetimes".

and I have very little respect for those, left or right, who are so dismissive of the lives at stake while they continue to oppose anything that doesn't meet their subjective ideal. But why should Angell care any more than a congressman? She likely doesn't have to worry about going bankrupt or dying without healthcare coverage, so she can afford to make unreasonable demands.

Under Nixon, Teddy Kennedy came close to a health care bill but held out for a BETTER health care bill. He wished for three decades that he had taken the FIRST deal and spent the next three decades 'working' on it...

The "foot in the door" strategy works. Its record is clear. Only *blood in the streets* revolutionaries deny it. I ran with that crowd for a while and grew sick of their redder-than-thou record of failure.

I will say though, that if they don't get rid of the health insurance anti-trust exemption, and if there isn't a decent public option, then we will indeed be rewarding the monsters who caused this crisis.
But scrapping everything now before we even know what the final bill is going to look like?

The reforms that were passed in Canada in the 1960s allowed doctors to bill patients for any costs above what the government's insurance plan would pay. This meant that if the government was willing to pay $500 for a procedure but a doctor wanted to charge you $10,000, they could take the $500 from the government and send you a bill for $9500.

This practice was not ended until 1984. If the 1960s efforts had been scuttled back then on account of this rather glaring loophole, we would probably still be in the same boat as the U.S.

Whatever you do, you have to make sure the ball moves down the field. Problems, especially cost-effectiveness problems, can be fixed much more quickly than it would take to restart the whole reform process.

Academics don't have a good sense of what it takes to build a coalition to get big measures passed like health care reform, energy and greenhouse gas emissions.

It's one thing to conceive of better policy alternatives in the comfort of your study, it's another thing to make it happen.

Right now we have a Democratic majority in Congress laboring intensively in an off-year, with time to re-generate political capital before next year's election. No one said democracy was pretty -- we just need to keep slogging ahead.

The issue with this and really any other legislation of similar scope comes down to a fundamental disagreement on what is the appropriate role of government in a society.

Some people believe that government's role is to provide some semblance of order with which to fend off anarchy and tribal rule, along with a military with which to protect from external threats.

Others believe that government's role extends from that to provide not only order, but also to provide essential services (e.g., police department, fire department, civil engineering, health care)--things that are best done publicly, and not privately--because of the belief that those aspects of society should not be wholly in thrall to the profit motive.

Most Democrats prefer the latter, and most Republicans the former. Democrats understand that taxes are levied to gather necessary funds for the aforementioned essential civil services; Republicans pine to remove all taxes, assuming that private enterprise and capitalism works for everything, including essential services.

One way leads to societal growth for all, and the other way leads to the monetary growth of the few, and the servitude of the many.

Haiku me a riddle...

Astute pupil: Honorable Sensei... what makes a sensei a sensei?

Sensei: Knowing when it is time to raise, call, or fold.

Astute pupil: Honorable Sensei, what time is it now?

Sensei: Time to call.

I think it's also worth considering why "trying again later" is so counterproductive. It's a major effort to assemble a coalition of ordinary citizens around an issue like this, and that's the thing that tends to take a long time to rebuild after failure. We're nearly all volunteers, and not single-issue activists; we have to focus our efforts where they can do the most good. On the other side, paid lobbyists and astroturfers will be working full-time with no letup.

Our healthcare system has gotten much worse over the years since the failure of the Clinton plan. That didn't "just happen"; it's a result of the insurance industry taking the money we're giving them and using it to game the system so we have to give them more money, in a vicious cycle. Any time we're not moving forward, we're moving backward.

"The perfect is the enemy of the good. Anything worth doing is worth doing poorly."

Then perfect it.

What nobody seems to be considering is the possibility that something like the House bill will fail conspicuously and poison the well for future reform far worse than failure to pass anything would do. The potential is very much there: the bill does nothing to rein in overall costs; insurance companies can pass along the cost of the new regulations because their premiums will be tied to loss ratios rather than being capped pure and simple; and substantial premium increases make a highly toxic political combination with individual mandates, especially in the absence of a genuine public option to compete with the bloodsuckers and give people an escape route.

It's frankly just plain stupid on the part of political smartasses to dismiss as "left-wing purism" well-informed suggestions that this bill may really be worse than passing nothing at all. Bad policy can be very bad politics.

Thus, the "progressives" come to advocate the very same position as the GOP -- kill the bill.

BTW, if the Supreme Court does hold the health insurance mandate unconstitutional, the only path to universal coverage is to provide health care through the tax and entitlement method -- the single payer system. A briar patch, if ever one was.

out of curiousity....where are the votes for single payer in the Senate? Look, a robust public option is POPULAR and we still cant get it and it is labelled socialism. Can you imagine the nut jobs over single payer?

Now, for those of you that say it should be an easy sell to say "Medicare For All," I say you are wayyyyyyyyyyyyyy underestimating the MSM and the GOP's ability to misinform.

Watch: Medicare is one of the reasons for our runaway budget deficit. We tolerate it now (to some extent) because it takes care elderly Americans, evne though it is on the backs of young and future Americans. But now you want to throw EVERY American into the system. That will bankrupt us and every future generation.

See how easy that was. Truth is not an option for these people. I think Obama UNDERestimated their ability and willingness to lie.

There never was a chance of single payer for the simple reason that it is the very best option, period.

eric

But once the programs were passed into law, they were slowly and continually improved.

This, I hate to point out, is part of the Lieberman argument. That the public option puts us on the slippery slope to something that would actually be good and worthwhile and that his corporate masters might not like.

I disagree that Social Security and Medicare are successful. Social Security is inadequate for anyone to live on in retirement. I don't know what the minimum monthly payment is (

What kind of success is that?

Medicare is great for politicians that need to point to something to tell voters that they're good for, but it's been 44 years since it passed and it hasn't yet led to more successes in providing health care for all Americans. The current bills under consideration are no exception. They're bad, bad bills that will be touted for a generation as having solved, or supposed to have solved the health care problem, but they do not.

The little, initial successes often become excuses against making further progress. They stand in the way of reform for generations. In effect, they breed failure.

I hate saying "it's better than nothing." But as has been said, we don't have the votes for single-payer, and if we do nothing, the insurance companies will only become more powerful, will pay off more politicians...the only way I could see single-payer ever becoming a possibility is the ultimate Hail Mary of voters overwhelmingly populating the Senate AND the House with progressive Democrats during a Democratic presidency, and keeping that supermajority for a long enough period of time that the system gets firmly established, so it can't be dismantled without causing chaos. We can't negotiate with the current crop of Republicans, and they're only going to get more conservative in the immediate future.

In the more immediate terms, stopping the push for healthcare will only make Democrats seem that much more ineffectual, and thus more likely to lose seats in 10 and 12.

I hate saying "it's better than nothing."

But people just keep saying this without considering the reasons why that may not actually be true. If they would just make some attempt to actually deal with the objections this would be less annoying. I see mandate backlash combined with, if anything, an increase in the rate of health-care cost inflation as quite possibly threatening lethal political consequences for the Democrats. Why do you believe I'm wrong to worry about that?

Why do you believe I'm wrong to worry about that?

The legislature remains in the hands of the party that passed the original 2006 legislation, too.

There is a larger constituency for half a loaf than there is for no bread at all.

I have, of course, considered MassCare. I think for a variety of reasons- the difference between the impact of state and national-level reforms, the fact that not everyplace is Massachusetts, and the more generous subsidies and tighter insurance regulation than what is likely to be in the federal law, it is not a good predictor of what will happen politically if something close to the House bill passes. Also, the failure to control costs is really starting to bite fiscally, and I am more then sceptical that the cost-containment measures supposed to be adopted over the next few years will accomplish much; thus, it's far from clear at this point whether MassCare is really sustainable in the long run. (And the US Congress is unlikely to be as generous as the Mass. legislature.)

But genuine thanks for at least addressing the question, which puts you ahead of 95% of those who take your view.

"Social Security is inadequate for anyone to live on in retirement...What kind of success is that?" NealB @ 4:49 PM

Depends on your definition of "success", doesn't it? The two biggest groups in poverty in the 1930's were senior citizens and children. SS has gotten the seniors out of that least-coveted first place position.
But really, SS was NEVER intended to be enough to live on. The first monthly payments, in 1940 I believe, were about $16 a month, although I am open to correction if wrong. There was no way anyone could live on that then.
Of course, when SS was first enacted, many (most?) firms offered some form of pension; Ma Bell, GE, most of the automakers, all the railroads and others I can't recall. Add that to SS and one could live decently after retirement. That pensions aren't offered as they were when the original SS was enacted is, however, an excellent argument for increased wages to employees so THEY can save for their retirements on their own. Or at least make larger contributions to the SS Trust Fund if they don't set something aside for retirement.
SS has done exactly what it was intended to to do: drastically reduce the number of senior citizens living in poverty. Over the years it has also added on the other tasks mentioned in Mr. Benen's article; so, yes, it is a success.

Also, the failure to control costs is really starting to bite fiscally, and I am more then sceptical that the cost-containment measures supposed to be adopted over the next few years will accomplish much; thus

Get back to me on cost containment when the state ditches fee-for-service.

Get back to me when we have a Congress that would ever come close to ditching fee for service. This difference is part of what I meant by the state experience being of questionable relevance to what the national experience would be.

It's amazing to see self-declared progressives willing to sacrifice the life savings of millions of uninsured Americans because a bill does not meet their expectations for cost savings. The self-centeredness boggles the mind!

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