THE FIGHT OVER THE FIGHT…. For the last several months, there’s been a relatively quiet debate among progressive supporters of health care reform. While the participants tend to agree on nearly all of the relevant policy details, there’s been an important point of division: whether a bill that lacks key liberal goals should be passed anyway, or whether such a bill should be scrapped altogether.
In light of recent events, this fight is getting significantly louder. As Greg Sargent noted, the dividing line seems fairly clear: “[O]ne thing that’s interesting is how cleanly it breaks down as a disagreement between operatives and wonks. The bloggers who are focused on political organizing and pulling Dems to the left mostly seem to want to kill the bill, while the wonkier types want to salvage it because they think it contains real reform and can act as a foundation for further achievements.”
Quite right. Leading progressive activists now consider the reform bill a failure worthy of defeat. The group includes, but is by no means limited to, MoveOn.org, Markos Moulitsas, and much of the FireDogLake team.
Leading progressive wonks take a far different view.
For any “progressive” who is concerned about the inequality of wealth, income and opportunity in America, this bill would be an absolutely monumental achievement.
Disappointed progressives may be wondering whether their efforts were a waste. They most decidedly were not. The campaign for the public option pushed the entire debate to the left–and, to use a military metaphor, it diverted enemy fire away from the rest of the bill. If Lieberman and his allies didn’t have the public option to attack, they would have tried to gut the subsidies, the exchanges, or some other key element. They would have hacked away at the bill, until it left more people uninsured and more people under-insured. The public option is the reason that didn’t happen.
And if public option supporters lost in the Congress, they won in the country as a whole. The underlying political problem for liberals remains what it has been for a generation: profound and widespread distrust of government. But polls consistently showed voters thought the public option advocates were right–that, at least when it comes to health insurance, government can be trusted. It was a small victory, but it’s on top of such small victories that political movements are built.
The moment of decision on health-care reform is arriving for progressives in Congress. Some of them have insisted they will refuse to vote for any bill without a public option, and that is now the only bill that has any chance of passing. If they hold to their position, the most significant social reform on behalf of low-income Americans in 40 years will go down to defeat.
A lot of progressives woke up this morning feeling like they lost. They didn’t. The public option and its compromised iterations were a battle that came to seem like a war. But they weren’t the war. The bill itself was. When liberals talked about the dream of universal health-care insurance 10, 20 and 30 years ago, they talked about the plight of the uninsured, not the necessity of a limited public option in competition with private insurers.
“This is a good bill,” Sen. Sherrod Brown said on Countdown last night. “Not a great bill, but a good bill.” That’s about right. But the other piece to remember is that more than it’s a good bill, it’s a good start…. On its own terms, the bill is the most important social policy achievement since the Great Society. It will save a lot of lives and prevent a lot of suffering. But moving forward, it also makes future improvements and expansions easier.
I want to emphasize that the distinction between activist/operatives and wonks is often blurred. To argue that Markos and Jane Hamsher, for example, don’t care about substantive policy details is absurd. Likewise, to think that Nate and Ezra are blithe to the concerns of the larger progressive movement is equally mistaken. I’m noting the distinction/debate here, but I’m using terms like “activist leaders” and “wonks” loosely.
I should also emphasize that there is no actual “bill” as yet, so it’s probably premature to give a still-unfinished product the thumbs up or thumbs down.
That said, as far as I’m concerned, the question is whether the reform framework in the Senate is a step backward or an incremental step forward. Does it make the status quo worse, or does it make improvements with the promise of additional progress? If it’s killed now, are reform proponents more or less likely to have success in the years to come?
Given what we think we know about the state of the legislation, I think the effort is clearly a step forward. It’s not the bill I’d write if I were dictator, but it advances the cause of reform, and creates a foundation that can be built on in the future. If this bill were to fail, I suspect it would be decades before anyone even tried to improve the broken status quo. In the meantime, the effects on those suffering under the current system would get worse.
As we’ve talked about recently, progressives have faced this situation 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 the programs passed, and once they 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 became law.
The key, in each instance, is creating the new foundation. The Democratic reform plan does just that.