Don't Kill the Health Reform Bill - Improve It

The blogosphere is aflame with debate over the Senate health care bill. I've just been sent 10 reasons (in one blog post) why progressives should kill the bill and start over in the battle to really reform health care. Administration spokespeople add fuel to the flames when they lecture critics on the left about how great the legislation is -- or dismissively explain to the media how the White House doesn't need progressives politically (and why they don't need to listen to us on substance of reform).

As someone who has campaigned actively for Jacob Hacker's version of the public option for more than three years, I am as frustrated as anyone -- both with President Obama's lack of leadership and with the bizarre Senate rules that allow one Senator out of 60 to cut this essential part of reform out of the bill. But I urge my fellow progressive activists (and liberals in the House and Senate) to work to improve the bill -- through conference and final passage -- not to kill it.

If I were a member of the Senate, I would have voted for the Senate bill -- as did Sherrod Brown, Bernie Sanders, Jay Rockefeller, and other progressives who fought to strengthen the Senate bill. Why? Because, despite its flaws, even the Senate bill contains important reforms and subsidies that will make it easier for millions of Americans to get health coverage, and it makes a beginning on what will be a longer effort to either reform or replace the private insurance industry. And because voting for it allows the Congressional process, as screwed up as it obviously is, to go forward to a conference committee with the (superior) House bill.

But I am not a US Senator. As co-director of the Campaign for America's Future and one of the founders of Health Care for America Now, my job is to keep pushing - so that the conference between the Senate and the House produces a better bill,
  • one that makes health insurance more affordable,
  • requires corporations to cover their workers,
  • and gives Americans alternatives to buying private health insurance.

And it is my duty to warn the Congress and the White House about the flaws in the bill that could cause millions of Americans to rebel against their health reform in the 2010 elections, the way seniors rebelled against the costly Medicare Catastrophic Coverage Act of 1988 and got it repealed the very next year, damaging Ways and Means Committee Chair Dan Rostenkowski and endangering many Democrats.

So I am trying to get today's Democrats to understand that
  • if they force Americans to purchase health insurance, it better be affordable, and
  • taxing middle-class health insurance policies is a formula for political disaster. For more information on this battle, go to

I can hear the rejoinders from many of the activists who have added their passion and intelligence to the fight in recent months: "This bill is a sellout to the insurance and drug industries. It does nothing to break their stranglehold on our health care system -- and our political system. And costs will skyrocket without the competition of a robust public option!"

My response: three years ago we had a health insurance system and a political system dominated by the insurance and drug industries. Costs were skyrocketing then, too. The difference is that, thanks to a mobilized citizens' movement, the Federal government (and the Democratic Party) is now promising to provide affordable comprehensive health care coverage to every American and legal resident.

Will the legislation that passes this year fulfill that promise? Probably not, but if Obama and the Democratic party play their cards right, they will present this legislation not as the only legislation we will need, but rather as the first step in a series of reforms that will eventually achieve what the American people want. Will the private insurance and drug industries fulfill that promise of affordable comprehensive health care coverage for all -- by turning themselves into Swiss or German-style non-profits? Don't bet on it. But when they fail, the vibrant, progressive health care movement we have built in recent years had better be there, pushing for a public option and even stronger measures to make sure the promise of affordable, comprehensive health care for all is really accomplished.

To my fellow progressives, I would urge that we celebrate what we have accomplished: we put the issue of health reform on the agenda during the elections, and, based on that mandate, got President Obama to make health reform a priority. Starting with lots of confusion and no consensus in the Congress, we got 55 + Democrats in the Senate publicly committed to public option. And, with the House Progressive Caucus unified, we got at least 200 votes for a "robust" public option. And we got the same kind of support for the idea of a Medicare buy-in. That's not a bad Congressional base to build on -- for a big idea that is consistently supported by strong majorities of the American voters.

The bill that can be passed will raise expectations. The American people will hear that that President Obama and the Democrats are promising to take responsibility for getting affordable, quality health care for all. Will the private health insurance industry be able to meet that high bar? Not likely. More likely they will raise premiums in order to survive in a regulatory system that tells them they can't discriminate against sick people, or women, or bad risks -- and they will also devise ways to cheat, anyhow.

So President Obama can celebrate his victory and momentum, but he had better not pretend this legislation is all the health fix we need. A better way to frame it would be to talk about a first step. (Or Sen. Harkin's image of a "starter house" that can be added onto.) President Obama -- and our growing movement -- should take credit for getting us here and then declare that we will monitor the performance of the insurance and drug companies carefully, enforcing regulations and strengthening them when necessary. Already, progressives are campaigning for new laws to force drug companies to lower their prices through competition -- far beyond the Senate or House health reform acts.

We as progressives should never have expected that the first health reform legislation would break the power of the special interests that control health care in America. And we shouldn't have expected that our growing health care movement could pack up and move on to other issues. And we sure shouldn't have expected a lot until we dramatically change the way the US Senate works.

An historical note about movement building.

In 1964, when the civil rights movement was trying to pass the Civil Rights bill, southern Senators succeeded in watering down provisions to guarantee voting rights, citing states' rights. Martin Luther King and the movement he led took what they could win in that historic bill, but knowing that political change would never occur (and elected officials would never respect the rights of black communities) unless people had the right to vote. So the movement went to the grass roots all over the South -- like Neshoba County, Mississippi, where three voting rights workers were killed a month after President Johnson signed the '64 bill -- and zeroed in on one of the worst places for violation of voting rights: Selma, Alabama. On March 7, 1965, a voting rights march was met with violence on the Pettus Bridge. And on August 10, Congress passed the Voting Rights Act of 1965. The movement that saw the '64 Civil Rights bill as just one step toward freedom, had zeroed in on what was missing and made the country -- and even the US Senate -- take the next big step toward social and racial justice.

Our movement should see this health care act as just one step toward real health reform.