Where Dean stands, where Dean stood

WHERE DEAN STANDS, WHERE DEAN STOOD…. We talked yesterday about the debate among supporters of health care reform — progressive activists/operatives who believe the existing plan should be defeated, and progressive wonks who believe the plan advances the cause of reform and still needs to pass.

Howard Dean, who was largely on board with trading a public option for a Medicare buy-in, yesterday sided with the activists/operatives: “Honestly the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill.”

Kevin Drum argues that Dean is living in a “dreamland.”

If you don’t like the Senate bill, fine. Don’t support it. But in what universe will healthcare reform get revived anytime soon if it dies this year? 2010? With the legislative plate already jammed, healthcare reform probably polling in the mid 30s, and midterms coming up? 2011? After Republicans have gained a bunch of seats in both the House and Senate thanks to public disgust with Democratic disarray? 2012? A presidential election year? 2013? 2014? […]

[T]he fate of failed major initiatives is so obvious that I can’t believe anyone is taking this seriously. When big legislative efforts go down in flames, they almost never spring back onto the calendar anytime soon — and that’s especially true when big healthcare bills fail…. If healthcare reform dies this year, it dies for a good long time. Say what you will about the Democratic leadership, but Harry Reid, Barack Obama, Rahm Emanuel, Nancy Pelosi, and Steny Hoyer all know this perfectly well. So do John Boehner and Mitch McConnell. (Boy do they know it.)

When reform bills go down, health care tends to be too hot to touch for about 20 years. And when the issue is brought back, it’s less ambitious than the previous effort. As Ezra explained last month, “Failure does not bring with it a better chance for future success. It brings a trimming of future ambitions.”

What’s more, let’s not forget that the existing Senate Democratic plan — with no public option and no Medicare buy-in — is already far more ambitious and much more progressive than what Howard Dean was proposing just five years ago. Go ahead and read Dean’s 2004 health reform plan — his signature issue — and notice that it features no competition for private insurers, fewer consumer protections, and would cover fewer of the uninsured.

This is not to disparage Dean, who has done as much personally to advance the cause of health care reform as anyone in the country, but rather to highlight just how far we’ve come in a short period of time. In 2004, Dean, considered a liberal firebrand, offered a health care plan that even he would dismiss as weak and tepid today. If Republicans presented Dean’s 2004 plan today, Democrats would laugh them out of the room.

Five years later, a Democratic president has a vastly better, more ambitious, more liberal reform plan nearing the finish line … and Dean wants to kill it?

Kevin’s piece summarized some of the strengths of the Democratic plan:

* Insurers have to take all comers. They can’t turn you down for a preexisting condition or cut you off after you get sick.

* Community rating. Within a few broad classes, everyone gets charged the same amount for insurance.

* Individual mandate. I know a lot of liberals hate this, but how is it different from a tax? And its purpose is sound: it keeps the insurance pool broad and insurance rates down.

* A significant expansion of Medicaid.

* Subsidies for low and middle income workers that keeps premium costs under 10% of income.

* Limits on ER charges to low-income uninsured emergency patients.

* Caps on out-of-pocket expenses.

* A broad range of cost-containment measures.

* A dedicated revenue stream to support all this.

What’s more, for the first time we get a national commitment to providing healthcare coverage for everyone.

And we get a strong foundation that can be built upon going forward, just as Social Security and Medicare were expanded in time, and just as every other country that has universal coverage has done in other industrialized democracies.

To let this rare opportunity slip away would be a mistake.