Pass the Health Care Bill - Then Improve It

There are many lessons to learn from the health care war that has
raged over the past year. We'll get to some of them below. But here's
the bottom line: Pass the bill, then improve it.

The health care bill that will emerge from the House-Senate
conference committee won't be what most progressives had hoped for, but
it is a major, historic turning point in American social reform
legislation, comparable to the Social Security Act, the National Labor
Relations (Wagner) Act, the Fair Labor Standards (minimum wage/40 hour
week) Act, the Civil Rights and Voting Rights Acts, the Clean Air Act,
and other progressive breakthroughs. None of those laws were what their
advocates wanted. They all involved compromises that, at the time, were
heart-breaking to activists. Each one was subsequently improved by
amendments, although not without reformers doing battle with
reactionary opponents.

It is incredibly irresponsible for some radicals and progressives to
call for killing the health care bill. It is important to push for
changes that would improve the Senate version of the bill. For example,
the House funding plan (a tax on families with incomes over $1 million)
is much better than
the Senate version (a tax on so-called "Cadillac" health insurance
plans). That's what the labor movement, liberal and progressive
Democrats in Congress, pro-choice advocates, and others will be doing
in hopes of putting a better bill on President Obama's desk, as Harold
Meyerson discusses in his latest Washington Post column.

But the idea that we should scrap this bill entirely and start from
scratch next year is both immoral and impractical. Like taking food out
of the mouths of hungry children, killing this bill will hurt tens of
millions of real people who are now suffering physically,
psychologically, and economically. Moreover, if we don't pass health
care reform now, we won't have another chance for at least a decade.
Pass it, then, over the next decade or two, fight hard to make it
better, in terms of regulating costs, expanding coverage, and
increasing government-sponsored insurance.

Even the flawed bill passed by the Senate will improve the lives of tens of millions of Americans. For proof, check out this chart,
put together by Jonathan Cohn and Jonathan Gruber (a health care
economist at MIT), based on CBO cost estimates of the Senate bill. It
shows the health care cost projections for a family of four at
different income levels. For example, a family of four earning $60,458
-- 250 percent of the federal poverty line -- would pay an estimated
annual premium of $12,042 and an annual out-of-pocket maximum of
$12,600 without the legislation (in total, 41 percent of annual
income). If the legislation passes, the comparable numbers are $5,797
and $6,300, respectively (or 20 percent of annual income). Families
with lower incomes benefit even more. Here's Cohn's article, that explains this in greater detail.

After the Senate passed its version of the health care bill earlier
today, Obama said: "This notion that somehow the health care bill that
is emerging should be grudgingly accepted by Democrats as half a loaf
is simply incorrect. This is nine-tenths of a loaf. And for a family
out there that right now doesn't have health insurance, it is a great
deal. It's a full loaf for a lot of families who have nothing to fall
back on if they get into a medical emergency."

We can differ with Obama on the math -- I'd say the House bill is
3/4 of a loaf and the Senate bill is 2/3 of a loaf -- but he's
basically correct about the real human impact. The bill will make life
better for most Americans -- those who don't currently have health
insurance and those who currently have inadequate health insurance.
Every serious progressive health care expert agrees that the bill is a
significant step forward -- a stepping stone toward universal health
insurance -- although they may differ on some particular issues. The
health care experts writing this week in the left-wing The Nation, the
progressive American Prospect, and even the barely-liberal New Republic
share this view.

Here's what J. Lester Felder writes in The Nation :

"Despite these very serious shortcomings, however, the bill
the Senate passed would reduce the number of uninsured Americans by 31
million by 2019. The Medicaid program will be open to new ranks of the
country's poorest residents, and the near-poor and middle class will
get subsidies to buy insurance. The Senate also advanced some important
delivery system reforms that could chart a path towards reining in

As disappointed as progressives are with the compromises
Democratic leaders made to get this bill through the Senate--and as
tempting it is to believe they may have gotten a better deal if they'd
pursued a more aggressive strategy--they are on the verge of doing many
other lawmakers have tried and failed to do. And if this effort fails,
another generation may pass before another chance will come to try

Here's what Jacob Hacker, the policy expert and Yale political
scientist who is credited with devising the original "public option"
plan, wrote in the New Republic :

"Since the first campaign for publicly guaranteed health
insurance in the early twentieth century, opportunities for serious
health reform have come only rarely and fleetingly. If this opportunity
passes, it will be very long before the chance arrives again. Many
Americans will be gravely hurt by the delay. The most progressive
president of my generation--the generation that came of age in the
anti-government shadow of Ronald Reagan--will be handed a crippling
loss. The party he leads will be branded as unable to govern...

The public option was always a means to an end: real
competition for insurers, an alternative for consumers to existing
private plans that does not deny needed care or shift risks onto the
vulnerable, the ability to provide affordable coverage over time. I
thought it was the best means within our political grasp. It lay just
beyond that grasp. Yet its demise--in this round--does not diminish the
immediate necessity of those larger aims. And even without the public
option, the bill that Congress passes and the President signs could
move us substantially toward those goals.

As weak as it is in numerous areas, the Senate bill contains three
vital reforms. First, it creates a new framework, the "exchange,"
through which people who lack secure workplace coverage can obtain the
same kind of group health insurance that workers in large companies
take for granted. Second, it makes available hundreds of billions in
federal help to allow people to buy coverage through the exchanges and
through an expanded Medicaid program. Third, it places new regulations
on private insurers that, if properly enforced, will reduce insurers'
ability to discriminate against the sick and to undermine the health
security of Americans.

These are signal achievements, and they all would have been politically unthinkable just a few years ago."

Paul Krugman in the New York Times, Ezra Klein in the Washington Post, Paul Starr in the American Prospect, and many others echo versions of these same sentiments.

The bill that eventually winds up on Obama's desk won't be what we'd
hoped for a year ago. There will be lots of articles and even some
books diagnosing what went wrong and what went right. Some initial

1. Lesson #1: We need major campaign
finance reform, preferably mandatory "clean money" public financing
plan (, as an alternative to our current
system of legalized bribery.

The biggest obstacle to more progressive reform is our system of campaign finance.
The drug companies, insurance companies, the hospital lobby, and the
American Medical Assn. have too much political influence because
they've spent hundreds of millions of dollars in campaign contributions
and lobbying -- something I've written a lot about over
the past year. The Republican Party is a wholly-owned subsidiary of the
medical industrial complex, as they've shown during throughout the
battle over health care reform. Unfortunately, a handful of moderate
Democrats in both Houses are also in the pockets of the health industry
lobby - most obviously Senators Max Baucus,
Ben Nelson, Mary Landreiu, Blanche Lincoln, and Kent Conrad. And let's
not forget one-time-Democrat-now-Independent-who-acts-like-a-Republican
Joe Lieberman, whose vanity, hypocrisy, and double-cross should be
rewarded by the Democrats by stripping him of his committee
chairmanship. Moreover, all people of conscience around the country
should unite in defeating Lieberman when he runs for re-election for
his Senate seat from Connecticut in 2012. I've written about Lieberman
as the "Senator from Aetna" , but he's worse than that.

2. Lesson #2: Kill the undemocratic filibuster rule.

Lefties have been too quick to criticize Obama and the Democratic
Party for compromising with the moderate Dems and their sponsors, the
insurance industry. The truth is that of the 58 Democrats in the
Senate, 53 of them (plus Bernie Sanders, the Independent socialist from
Vermont) supported the public option and, later, even more supported
the Medicare buy-in proposal (for people 55-64), as a way to create
competition with the insurance industry. In a true democracy, 53 votes
(out of 100) should be enough to pass a bill. So the second obstacle to
real reform is the filibuster rule, which gave the five-member "Baucus
Caucus" (who together represent states with 3 percent of the country's
total population), and then Lieberman, too much influence.

3. Lesson #3: Grassroots organizing saved health care reform from an early death.

Recall, at the end of the summer, pundits were already writing
obituaries for major healthcare reform. Particularly during the August
Congressional recess, an epidemic of right-wing anger against Obama and
his policy agenda--of which healthcare reform was simply an immediate
and convenient target--captivated the media, which reported disruptions at Congressional town hall meetings as
though they were an accurate reflection of public opinion rather than a
pep rally for extremists, encouraged by Fox News and talk-show jocks.
The right-wingers stoked fear and confusion by warning that Obama's
"socialized medicine" plan would create "death panels," subsidize
illegal immigrants, pay for abortions and force people to drop their
current insurance. Republican officials, including Senator Charles
Grassley, Senator Jim Demint, and Republican National Committee chair
Michael Steele, and conservative pundits Glenn Beck, Rush Limbaugh,
Sean Hannity, Bill O'Reilly and Betsy McCaughey repeated these myths.
And support for the public option tumbled over the summer in response.
In June, 62 percent of Americans told Washington Post/ABC pollsters
that they favored a public option. By mid-August, support had slipped
to 52 percent. Obama's popularly fell, too, as jobs continued to
disappear and the administration's proposals to bail out the banks and
the auto industry met with right-wing attacks and public skepticism.
The death in August of healthcare reform stalwart Senator Ted Kennedy
bolstered Baucus' influence as chair of the Senate Finance Committee.

As Marshall Ganz and I wrote in
the Washington Post at the end of August , the grassroots momentum from
the Obama campaign seemed to be stalled. To the rescue came Health Care
for America Now (HCAN), a coalition of unions, community organizations,
consumer groups, environmentalists and netroots groups such as MoveOn,
that began spearheading the reform campaign since the group was
launched in July 2008.

I've written about HCAN's influence elsewhere.
Suffice it to say that in late August, seeing defeat on the horizon,
HCAN and other reform activists regrouped. They decided to act more
like a grassroots movement and less like an interest group. That meant
mobilizing voters, focusing attention on the insurance industry,
humanizing the battle by giving insurance company victims an
opportunity to tell their stories and using creative tactics to
generate media attention. They sponsored rallies and protests,
including civil disobedience, in cities around the country. They helped
focus public attention on the insurance industry's outrageous profits
and executive compensation, its abuse of consumers and its outsized
political influence. And they warned Democrats not to get duped by the
industry's pledges of cooperation.

Public support for the public option recovered after taking a tumble
over the summer. In late October, a Washington Post/ABC poll found that
57 percent favored a public insurance option, while 40 percent opposed
it. If a public plan were run by the states and available only to those
who lack affordable private options, support for it jumped to 76
percent. Under those circumstances, even a majority of Republicans, 56
percent, favored it. That kind of grassroots pressure helped the
liberal Democrats in the Congress fight to keep a decent bill alive,
even though eventually Lieberman forced the Dems to compromise on the
public option and then the Medicare buy-in.

4. Lesson #4: Watchdog the media.

The mainstream media made it very difficult for Obama, the
progressive Democrats, and health reform advocates. During the past
year, the mainstream media gave right-wing activists a megaphone that
gave them a much larger voice than they deserved. The ultra-right --
including the "tea party" lunatics, and reactionary Republicans like
Senators Jim DeMint and Charles Grassley, egged on by Glenn Beck, Bill
O'Reilly, and their Fox News colleagues -- got much more attention than
they should have. As Todd Gitlin and I noted,
the media covered the right-wing protests AGAINST health care reform,
but barely reported on the protests sponsored by health care reform
activists like HCAN.

The mainstream media acted like stenographers, repeating the right
wingers' lies about the health care plans, without trying to verify
them or put their outrageous statements in context. At the same time,
the mainstream media completely shut out the voices of the left wing of
the health care debate, the advocates for a single-payer system. With a
few exceptions, the media repeated the right wing's lies about Canada's
health care system without correcting them, and allowed them to frame
the mainstream Democrats' public option plan as "socialism." Trudy
Lieberman, the nation's best media critic, has been keeping tabs on the
media's misreporting of the health care debate all along. It is worth
reading her regular columns and blogs to
see how much the media set the public agenda and framed the debate in
ways that undermined progressive activists and President Obama.

5. Lesson #5: This isn't just about health care.

Last summer, Republican Senator Jim DeMint of South Carolina said
out loud what most Republican members of Congress were thinking and
plotting. DeMint called the president's health care proposal "D-Day for
freedom in America" and said that stopping Obama's plan for health care
overhaul could be the president's "Waterloo," a reference to the site
of Napoleon's bitter defeat in 1815.

What DeMint meant, and what his Republican colleagues and their
allies like Glenn Beck, Rush Limbaugh, and others intend, is that
defeating Obama's health care reform would undermine his presidency,
and set the stage for major GOP victories in the 2010 elections and
again in 2012, including defeating Obama's re-election bid.

DeMint, a fervent reactionary, is now almost in the mainstream of
his party. Over the past 30 years, the Democrats have shifted slightly
to the left, but as Jacob Hacker and Paul Pierson documented in their
book, Off Center, the Republicans in office have moved dramatically to the right. According to political scientists Nolan McCarty, Keith T. Poole, and Howard Rosenthal,
there are now very few "moderate" Republicans in either the House or
the Senate. Most Republicans in Congress have no interest in
bipartisanship or compromise. They simply want to destroy the Democrats
and their liberal policy agenda.

They have understood that if the unholy alliance of medical industry
muscle, right-wing mob tactics, Republican Party hardline unwillingness
to compromise, and a handful of conservative Democrats' obfuscation is
able to defeat Obama's health-care proposal, it will write the
conservative playbook for blocking other key components of the
president's and progessives' agenda -- including action on climate
change, immigration reform, marriage equality, a second jolt of
economic stimulus, pro-consumer bank reform, and updates to the
nation's labor laws. So those progressives, like Howard Dean and Dennis
Kucinich, who say, "kill the bill" are doing more than dooming tens of
millions of Americans to health care hell; they are setting the stage
for a Republican resurgence.

Obama has certainly disappointed many progressives on a number of
fronts, including the Wall Street bail-outs, the weak foreclosure
program, the too timid stimulus plan, and most recently by expanding
the war in Afghanistan. What's missing from these criticisms is the
failure of progressive forces to mount an effective grassroots movement
to push Obama and the Democrats -- and counter the power of big
business, the Religious Right, and the NRA. Both grassroots groups
(including unions, enviros, community organizing groups, gay rights
groups, peace groups, and others) and the Obama administration haven't
yet learned how to play the inside-outside strategy game as effectively
as they could. Like FDR, Obama's success depends on the existence of a
progressive movement that organizes, protests, influences public
opinion, lobbies, and keeps the heat on so that the inevitable
legislative compromises are stepping stones to further reform. When
activists asked FDR to support progressive legislation, he told them,
"I agree with you. Now go out and make me do it." Obama has sent the same signals.

The Right understands this. That's why Glenn Beck, Limbaugh,
O'Reilly, Congressmembers King and Issa, and others have been so
persistent at attacking SEIU, ACORN, Van Jones, and others. They want
to destroy the progressive movement and make it more difficult for
Obama to be a successful (and two-term) president.

For example, the Right's persistent attack on ACORN over
the past year and a half was effective. ACORN, with a strong
constituency in Arkansas, was expected to play an important role in
keeping the heat on Senator Blanche Lincoln, a moderate Democrat who
seemed to be in bed with the insurance industry. ACORN did some
effective grassroots organizing to hold Lincoln accountable, but it was
weakened by the Right's attacks, and so busy fighting for its own
survival, that it couldn't mount the kind of full-court press on
Lincoln that was needed.

The failure of many Democrats, even many liberal Democrats, as well as many liberal funders,
to stand up for ACORN when it was under attack made it more difficult
to pass health care reform, and to build the kind of progressive
grassroots movement that is necessary to pass reform legislation. Their
behavior is even more shameful in light of a new report,
released this week by the nonpartisan Congressional Research Service,
documenting that the various accusations against the group by
Republicans and the right-wing media echo chamber -- especially about
alleged "voter fraud" -- are totally bogus. Here are some of the
report's key findings:

  • There were no instances of individuals who were
    allegedly registered to vote improperly by ACORN or its employees and
    who were reported "attempting to vote at the polls." Memorandum from
    the Congressional Research Service to the House Judiciary Committee,
    "ACORN Investigations" (December 22, 2009), at 1.
  • As of October 2009, there have been 46 reported federal,
    state, and local investigations concerning ACORN, of which 11 are still
    pending. "ACORN Investigations," Table 1.
  • No instances were identified in which ACORN "violated the
    terms of federal funding in the last five years." "ACORN
    Investigations," at 1.
  • Recently enacted federal legislation to prohibit funding to
    ACORN raises significant constitutional concerns. The courts "may have
    a sufficient basis" to conclude that the legislation "violates the
    prohibition against bills of attainder." Congressional Research
    Service, "The Proposed 'Defund ACORN Act' and Related Legislation: Are
    They Bills of Attainder?" (November 30, 2009), at 25. [A recent court
    ruling did, in fact, find that the legislation violated the law]
  • Concerning recent "sting" operations relating
    to ACORN, although state laws vary, two relevant states, Maryland and
    California, "appear to ban private recording of face to face
    conversations absent the consent of all the participants." Memorandum
    from the Congressional Research Service to the House Judiciary,
    "Allegations of Recording Conversations with Various ACORN Affiliated
    Individuals without Their Consent" (October 9, 2009), at 1.

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