Even passage isn’t the end

EVEN PASSAGE ISN’T THE END…. On Friday afternoon, a couple of fairly reliable progressive senators talked a bit about what to expect from the rest of the debate on health care reform, and both seemed to be making an effort to lower expectations.

In a conference call with reporters on Friday, Sen. Sheldon Whitehouse (D-R.I.) and Debbie Stabenow (D-Mich.) both stressed that they will continue to try to tinker with changes to the health care insurance and delivery system and the pharmaceutical industry, even after legislation passes.

“This is fairly clearly the beginning and not the end of health care reform,” said Whitehouse. “There is going to be an awful lot of oversight of the big programs, which is necessary. We have got to change the delivery system so it provides better health care to Americans with less… And the ongoing nature of this continuing effort to make the American health care system one we can be really proud of is one that will allow plenty of time for people to continue to advocate for their views. It is not as if, if you don’t get your voice heard in this particular episode, or if you don’t win the program or position that you wanted in this particular episode, you have to walk away forever. This is going to be continuing.”

At face value, it’s easy to see this as pacifying, unsatisfying spin — the senators were effectively telling reform advocates not to be disappointed with the final bill, even if it falls short in some areas, because a) it would still be a major step forward; and b) the overall policy will continue to be improved in the coming years.

And while “You Can’t Always Get What You Want” seems to be playing in the background, I happen to find the spin fairly compelling.

We’ve been here before. When Medicaid passed, it did very little for low-income adults. When Medicare passed, it all but ignored people with disabilities. When Social Security passed, the benefits were negligible, and the program excluded agricultural workers, domestic workers, the self-employed, railroad employees, government employees, clergy, and those who worked for non-profits. The original Social Security bill offered no benefits for dependents or survivors, and included no cost-of-living increases.

These are, of course, some of the bedrock domestic policies of the 20th century, and some of the towering achievements of progressive lawmaking. But when they passed, they were wholly inadequate. There were likely liberal champions of the day who perceived the New Deal, the Great Society, FDR, LBJ, and their congressional Democratic majorities as disappointing and incompetent sell-outs who failed to take advantage of the opportunity before them.

But once the programs were in place, they improved, expanded, and became integral to the American experience. It took years and perseverance, but progress happened after the initial programs were in place.

The key, in each instance, is creating the new foundation. If/when health care reform passes, and Americans have a baseline of coverage and protections, improvements can be made. Exchanges can be expanded. Public options can be strengthened (or, I suspect, created).

If reform dies — or, more accurately, if it’s killed — we can expect 20 years of inaction and adverse political consequences for those who tried.

If reform survives, it means coverage for the uninsured, new protections for those who are already covered, and an ongoing fight to keep building on the foundation.