What’s in it for the left

WHAT’S IN IT FOR THE LEFT…. I had an item last week about the fate of health care reform being dependent, at least in part, on the willingness of progressives to stand up and fight for it. I received a very sincere note soon after from a reader who asked, “What’s in it for the left?”

As the reader saw it, the Democratic reform package had provisions intended to make Republicans happy, and measures geared towards centrists, but with the public option and a Medicare buy-in scuttled, progressive reform proponents are wondering what they get in this package.

The answer is pretty straightforward: they get health care reform.

Ezra noted today that some progressives “have lost sight of the fact that the very existence of this legislative process is a huge progressive victory.”

Five years ago, no one had ever heard the term “public option.” But progressives had been talking about the uninsured for decades. There’s probably no more constant lament in Democratic campaigns than the plight of the nation’s 50 million uninsured. And this bill is, fundamentally, an effort to address that. Once it’s up and running, it spends $200 billion a year to help low-income and working-class Americans afford health-care coverage. About 15 million of those people will become eligible for Medicaid, which is public insurance. Another 15 or so million will get private insurance.

But that private insurance will now be a very different beast: It will have to spend 85 percent or 80 percent (depending on the market) of every premium dollar on care. It won’t be able to reject people for preexisting conditions. It will be in a regulated exchange where it has to justify premium increases and bad behavior or face exclusion. And those exchanges, regulations and subsidies will also create the core structure of a universal health-care system in this country, which should be comforting to progressives who look to the improvements in Social Security and Medicare and Medicaid and CHIP and the EITC and know that the history of American social policy is that, in general, we build on our imperfect foundations and make them stronger and fairer over time.

He added that liberal reform proponents “have lost some very hard battles but are on the cusp of winning an incredibly important war.”

Kevin had a similar message today: “It is, finally, time to step up. Like it or not, Scott Brown’s victory in Massachusetts drew a very strong boundary around healthcare reform. We can either pass what we have or pass nothing at all. Passing what we have (with a few small tweaks via reconciliation) will help millions, put us on a path toward ever more serious healthcare reform, and give progressives their biggest victory in decades. But only if progressives stop moping and get behind it.”

And Chris Bowers has a list of the “ways progressives strengthened health reform legislation.” It’s not a short list, which is kind of the point.

The right — misguided, misled, and confused — is fighting as hard as it knows how to kill health care reform. The question is whether the left is prepared to match their intensity and volume.

President Obama said last week, “I urge every American who wants this reform to make their voice heard.” If they do, the likelihood of success goes up considerably. If progressives fail to fight, reform will likely fail to pass.