There’s really not much in this Karoli post that I disagree with. Is Joe Lieberman odious? Yes. Should the Democrats strip him of everything, up to and including his jowls? Yes. Is there a good way to work around him? No. Has he effectively killed the public option and/or a Medicare buy-in, at least for this session? Yes. He has.
But does that mean health care reform, even without such an option, should simply be killed dead? No, it does not.
As Karoli points out, even after the public option is killed dead, the health care plan still ends banning people based on pre-existing conditions. It still provides significant subsidies. It still will mean the difference between millions of Americans being insured and uninsured, and that will save tens of thousands of lives a year. Is it perfect? Hell, no. Would it be better with a public option or Medicare buy-in? Hell, yes. But you pass the bill with the system of government you have, not the system of government you want, and for good or ill, the American system of government is designed specifically to kill big, sweeping changes, to whittle bills down into small, incremental, piecemeal steps.
This is, incidentally, the biggest problem with the liberal opprobrium aimed at Obama. (Reid — well, he’s another story, and I’ll talk about him at another time.) Barack Obama is the President of the United States, not the Prime Minister. He commands large majorities in both houses, but those majorities are fractious, and have grown up under the American system in which each legislator is a free agent, whose votes are up for grabs on every bill.
Yes, the Republicans are moving away from that to perfect parliamentary lockstep — we know, we know. But the Republicans were not much more unified when they held Congress, and were forced to actually govern. Remember how the Bush Administration muscled through Social Security privatization right after the 2004 election? You don’t? Right, because it didn’t happen. Without Democratic support for privatization in some form — support that was non-existent save, maybe, for Joe Lieberman — the Republicans in Congress were so disorganized, so fractious, so disunited, that they couldn’t even get a bill through the House. Had it made it to the Senate, it would assuredly have died, as the Democrats — who held more than 40 seats — would have filibustered it to death.
The last major piece of domestic legislation the GOP got through Congress was Medicare Part D in 2003 — which only passed because the Republicans were willing to play major games in both houses to get the bill over the top, going so far as to hold the roll open in the House for two and a half hours in order to wheedle for the final votes for passage.
The GOP got no major bills through congress in the last five years of the Bush presidency. For all the vaunted unanimity among the Republicans, Bush Administration efforts on everything from Social Security to immigration reform failed, due to a lack of party support.
So while it’s both tempting and true to complain that the health care bill has been whittled down to less than half a loaf, and maybe down to a single slice, we shouldn’t ignore the fact that said single slice contains more health care reform than has passed since Medicare itself was enacted. And that even in its very watered-down form, it will save lives and save families from penury. This is not a minor accomplishment. As Nate Silver notes, the public option was always a long-shot in the Senate, but keeping the focus on that still managed to allow a pretty decent bill to get to the brink of passage.
Bill Clinton couldn’t get get a bill this far. Jimmy Carter couldn’t get it done. Lyndon Johnson, Jack Kennedy, and Harry S Truman couldn’t get it done. No great Democratic majority leader ever muscled health care reform through the Senate. And until Nancy Pelosi, no Democratic speaker ever had shepherded health care reform through the House.
Quite simply, this watered down, attenuated, imperfect, tenth-of-a-loaf bill still represents one of the greatest legislative triumphs by either party since the Great Society programs passed under Johnson. And while it will need to be improved in the future, it will establish the baseline from which all future discussions begin: Every American deserves health insurance, and no American should be denied health insurance because of pre-existing conditions. Once that is enshrined in law, changes will only make coverage more robust. Just as Medicare once failed to cover prescription drugs, just as Social Security once failed to cover large swathes of workers, so too will this bill need to be improved. But there will be nothing to improve if we fail to pass this now, and there will be no chance at improving it if, in our pique at imperfection, Democrats choose to allow the same forces that have been trying to kill this bill to gain ground in Congress. Imperfect isn’t fun. It’s frustrating and annoying and it means we have to endure Joe Lieberman. But it’s better than a perfect bill that doesn’t pass. Better by far.
Oh no, you've figured me out!