The Core

Ezra objects to my post arguing that it might be better to reject a bill that sells out too much to the Blue Dogs:

But it’s also worth offering a more general reality check here: The public option is not now, and has not ever, been the core of the argument for heath-care reform. It is the core of the fight in Washington, D.C. It is an important policy experiment. But it was not in Howard Dean or John Kerry or Dick Gephardt’s plans, and reformers supported those. It was not in Bill Clinton’s proposal, and most lament the death of that. It is not what politicians were using in their speeches five years ago. It is a recent addition to the debate, and a good one. But it is not the reason were are having this debate.

Rather, what has kept health-care reform at the forefront of liberal politics for decades is moral outrage that 47 million of our friends and neighbors are uninsured.

I certainly agree with this, as far as it goes. Obviously, the core of the argument for health care reform is universal coverage. And, indeed, there are better ways of achieving this than a public option and employer mandates, although they’re not on the table. My concern is whether or not a compromise bill will, in fact, provide politically sustainable universal coverage, or anything close to it. If Ezra (and Kevin) are right that even compromise legislation will, in fact accomplish a lot, then I agree that it’s worth supporting, and I guess we won’t know until we have actual legislation on the table, and I’m willing to keep an open mind.

Ezra also outlines a criteria we should use to evaluate whether a bill is worth passing:

If reformers cannot pass a strong health-care reform bill now, there is no reason to believe they will be able to do it later. The question is whether the knowledge that the system will not let you solve this problem should prevent you from doing what you can to improve it. Put more sharply, the question should be whether this bill is better or worse than another 19.5 years of the deteriorating status quo.

I agree with this, to a point. Anybody who’s read the many nasty things I’ve had to say about late-period Ralph Nader knows I’m not a heighten-the-contradictions guy. If the proposed bill represents a substantial improvement and is constructed in a way that it will be politically sustainable, I agree that it merits support. However, there also has to be a point in which the two premises start to contradict each other. It’s true that there may not be many more opportunities to pass a good health care reform bill. It is likely, however, that there will be plenty of chances to pass incremental reform that is far too expensive because of the need to buy off vested stakeholders. (The 2003 Medicare expansion, after all, passed with the Democrats holding none of the elected branches, and pretty much fits this description to a T.) If the bill gets bad enough, it’s not clear how much is being risked by trying again, perhaps after mid-term elections likely to be favorable to Senate Dems.

…and, yes, progressives are going to have to use threats if there’s any chance that the bill will be worth supporting. If only conservatives (in both party caucuses) are threatening to torpedo the bill it’s going to be bad.

[X-Posted at TAPPED.]