Many progressives are deeply dismayed about the shortcomings of the Senate bill. And they should hold onto that feeling! History suggests that this reform will get much better over time — but only if people keep demanding improvements.
But I think my reaction to the bill’s apparently imminent passage is being shaped, in part, by memories of how it was, not long ago. Five years ago, after the 2004 election, I was devoting most of my efforts to an attempt to stop Social Security privatization. And it seemed likely to be yet another losing battle: all the wise heads, all the makers of conventional wisdom, were sure that Bush was going to get what he wanted, and that people like me were just boorish obstructionists unwilling to embrace change.
But Social Security survived. And here we are now with a reform that, for all its faults, is the biggest expansion of the social safety net since Medicare. That, in my book, counts as a big victory.
James Kwak, at Baseline Scenario, is too. He points to the irony of Mitch McConnell's complaints.
It’s hard to see what else the bill could have done. Remember, we have a largely private-sector health care system (both insurance and delivery), which means the government cannot simply order providers to charge less. A single-payer system might be able to take such draconian steps, but Mitch McConnell, who claims, “Two thousand seventy-four pages and trillions of dollars later, this bill doesn’t even meet the basic goal that the American people had in mind and what they thought this debate was all about: to lower costs,” is the last person who would vote for single payer. And the Republicans are similarly against anything that allows the government to use the one big lever it does have–Medicare–to force lower cost levels. So the only political option is incremental reform through small programs that experiment with different ways to change the incentives of private-sector actors at the margin.
Politico reports that Democrats are already gearing up for more change.
Just hours after a critical Monday morning vote in the Senate, Democrats were already talking about future changes to the health reform effort in hopes of calming a revolt among liberal activists.
Sen. Tom Harkin (D-Iowa), chairman of the Health, Education, Labor and Pensions Committee, predicted the government health insurance option long favored by liberals would be part of that second look.
“It will be revisited,” Harkin said. “This is just the beginning. … What we’re building is a starter home, not a mansion. And guess what? We have room for expansions and additions later on.” ...
... The legislation lacks the group’s No. 1 priority — a permanent fix to doctors’ Medicare reimbursement rates, which perennially threaten doctors with deep cuts. But the endorsement could help the group get action on a fix after reform is finished, which is what it is pushing for now.
The so-called doc fix is one of the first elements of health care reform that Democrats would address if they pass the comprehensive bill early next year.
Asked whether Democrats would reopen the public option debate next year, Harkin said: “You never know. I believe it is so vital and so important, it will be revisited.”