A ‘STARTER HOME’…. There’s a sizable chasm between the failed health care status quo and the progressive ideal. This, at a minimum, contributes to the differences between progressive proponents of reform — the same proposal can be seen by the same ostensible allies as both an important step forward and a bitter disappointment.
That said, Ezra Klein noted yesterday that the current Democratic health care bill “is, without doubt or competition, the single largest social policy advance since the Great Society.” I found Sen. Tom Harkin’s (D-Iowa) description at a press conference yesterday pretty compelling, too. Jonathan Cohn reported:
This is not “a mansion,” [Harkin] explained. It’s a “starter home” — with a solid foundation, a strong roof, and room for expansion.
A lot has been said about the flaws of the Senate health care bill, in this blog among other places. And that is because the flaws are many. From the protection against out-of-pocket costs, which could stand to be stronger, to the implementation timeline, which could stand to be quicker, it’s easy to find things in this bill that could be better. […]
But it shouldn’t take away from what a huge accomplishment this is. As [Sen. Chris Dodd] reminded people in his remarks, this measure is going to make life better not just for millions, but tens of millions of people. Those without insurance will get it; those with it will have guarantees of financial security they never had before. The government will begin creating an infrastructure for making our health care system focus on better quality care, even as it tries to make the system less expensive.
And that’s not the end of the story. There will be opportunities to improve this law even after it becomes law. Social Security evolved that way. Medicare too. Health care reform can too.
No, this legislation is not everything it could be. But Harkin is right: It’s also not everything it will be.
As we’ve talked about recently, progressives have faced this situation before. When Medicaid passed, it did very little for low-income adults, which is now seen as the point of the program. 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, producing genuinely awful legislation.
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 question — if we’re to assume that this bill will, in fact, survive — then becomes what progressive champions of reform are prepared to do to build on the starter home’s foundation.
Matt Yglesias had a good item on this, noting that “the crucial question going forward is whether it will be possible to further improve this legislation.”
I think it’s very possible, but only if the people who are disappointed by the shortcomings of this bill take appropriate action. First and foremost, that means working as hard as possible to produce as good an outcome as possible in the 2010 midterm elections. Recall that before 2006, SCHIP expansion couldn’t pass the Senate. And before 2008, SCHIP expansion could pass the Senate but couldn’t get signed into law by the President. Elections have consequences. Starting in January 2011 we might have new progressive senators representing Ohio, New Hampshire, and Missouri or we might have new conservative senators representing Nevada, Delaware, and Connecticut. This is a very big deal. Has Ned Lamont been able to beat Joe Lieberman back in 2006, this might have had a happier ending this year. Elections have consequences. […]
[Y]ou accept compromises and then keep on working to build more political power. You do it by contacting members. You do it by urging friends and colleagues to contact members. You do it by donating to and volunteering for good candidates. You do it by turning out and voting for the better candidate in the race even when that candidate is disappointing. You do it by urging viable candidates to mount risky primary challenges against incumbents who don’t reflect the real possibilities of their constituency. You do it by staying engaged, and working hard.
I think this is an excellent bill, all things considered, but whether you agree with that or not the most important thing is what does the progressive community do going forward to enact even better bills in the future.
The country can either go forward or backward. Those who wanted key provisions in this health care bill that were ultimately scuttled — a public option, Medicare expansion, etc. — can still achieve those goals, but not by throwing their arms up in despair or by deciding to register their frustration by staying home.
Remember: nothing becomes law in this Congress unless Ben Nelson and Joe Lieberman approve. Literally, nothing. That’s not an encouraging legislative dynamic, and it’s a huge impediment to progressive lawmaking.
It’s not within President Obama’s power to change that. It’s not within Harry Reid’s and Nancy Pelosi’s power to change that. It’s entirely in the hands of voters, who can either decide to elect those who’ll build on the foundation — the way policymakers did after the creation of inadequate Medicare and Social Security bills — or who can decide to directly or passive help those who’ll take a bulldozer to the starter home shortly after it’s completion.