How dare a progressive suggest a vote against the Senate health bill? When Howard Dean did just that last week he was roundly condemned for casting aspersions on what even many of its more ardent supporters admit is an obviously flawed bill. Instead of focusing their wrath on the few obstructionists in the Senate who blackmailed the majority into dropping a much needed public option in order to avoid a filibuster, they made Dean the villain for daring to suggest that passage of this deeply compromised legislation might make the nation's health care system worse.

Dean deserves much better, and his concerns as a physician and a progressive politician are worthy of serious attention. As the former governor noted in a Washington Post Op-Ed article last week: "I have worked for health-care reform all my political life. In my home state of Vermont, we have accomplished universal health care for children younger than 18 and real insurance reform-which not only bans discrimination against preexisting conditions but also prevents insurers from charging outrageous sums for policies as a way of keeping out high-risk people. I know health reform when I see it, and there isn't much left in the Senate bill. I reluctantly conclude that, as it stands, this bill would do more harm than good to the future of America."

The devil is in the details, and the devil's scribe here is Joe Lieberman-and, by extension, the insurance companies he so faithfully represents. Lieberman was responsible for striking a public option and Medicare buy-in from the Senate legislation that now includes no effective restraints on the power of the big insurers that have created our health care monstrosity. The insurance companies know they have won big, as reflected in the dramatic increase in their stock valuations in recent weeks as the Senate bill came to exclude all forms of the public option.

The likelihood that even the anemic public option will not appear in the final bill was made clear Tuesday when President Barack Obama dismissed the option provision, which the House bill still includes, as nothing more than "a source of ideological contention between the left and right," adding in an interview with The Washington Post, "I didn't campaign on the public option." True, but he did campaign against Hillary Clinton's plan to mandate insurance coverage as the Senate bill does. As Obama put it in Wisconsin in February 2008: "I believe the reason people don't have health care isn't because no one's forced them to buy it. It's because no one's made it affordable."

The biggest problem is that the legislation passed by the Senate forces Americans, under penalty of law, to make a decision about an expenditure of their own funds that they may not feel is in their interest. The carrot of a publicly financed option has been eliminated, and thus tens of millions of Americans are left with the stick of an expensive insurance obligation that they may not be able to afford. In criticizing the Massachusetts law, which is close to the Senate bill in conception, Obama said on a campaign stop in Cleveland in February 2008, "We still don't know how Sen. Clinton intends to enforce a mandate, and if we don't know the level of subsidies that she's going to provide, then you can have a situation, which we are seeing right now in the state of Massachusetts, where people are being fined for not having purchased health care but choose to accept the fine because they still can't afford it [insurance], even with subsidies."

That's what concerns Dean about the Senate bill: "The bill was supposed to give Americans choices about what kind of system they wanted to enroll in," he said. "Instead, it fines Americans if they do not sign up with an insurance company, which may take up to 30 percent of your premium dollars and spend it on CEO salaries."

Hopefully, if the bill is passed, Dean will be proved wrong and I respect the man enough to expect that he would welcome a positive outcome. But I fear that the opposite will occur, with the cause of health reform given a bum rap as costs increase, the public feels ripped off and Obama is held responsible for the health care mess he insists he can correct without getting to the heart of the problem: providing a publicly accountable alternative to the proven greed of medical industry corporations.