As Washington grapples with the outcome of the election in Massachusetts this week, it's important to remember one key thing: Congress can still pass historic legislation that will make health care a right, not a privilege, in the United States. While the procedural route may be different, Congress still can do what it intended to do before Tuesday. It can enact a comprehensive bill that will make good health care affordable to tens of millions of people who are uninsured or underinsured and end the practice of denying people coverage or charging people more for pre-existing conditions. It can end the specter of medical bankruptcy, provide free access to preventive care, and more. None of these historic achievements can be done through "incremental" reform, and failing to accomplish these goals would put the Democratic Party in profound political peril.
While it may seem appealing to carve up the many facets of reform into smaller bites, that won't get the job done. Take, for example, the promise that has most resonated with the public: stopping insurance companies from denying coverage for preexisting conditions. You can't do that without requiring everyone be covered because many people would wait to get covered until they needed treatment and that would drive premiums too high. But you can't require people to get coverage without providing income-based subsidies to make coverage affordable. And you can't raise the money for subsidies without finding savings in the system, like the proposed changes in Medicare, or raising new revenue. All that adds up to comprehensive reform.
The same logic applies to the other basic items Americans most want from reform, like relief from medical bankruptcy or stopping insurers from charging more to women or making the health insurance market work for small business.
At its heart, comprehensive reform is a simple guarantee that you will have access to good, affordable coverage whether you work for someone else, are self-employed, or are unemployed. The bills that have passed both houses of Congress achieve that goal through the same basic mechanisms: expanding Medicaid, establishing new health insurance marketplaces, providing income-based subsidies for buying regulated insurance within those marketplaces, extending tax credits to at least small businesses, and establishing some requirements for most businesses to offer coverage or pay for it. Both bills raise the money through changes in Medicare and new revenues. Taken together, that will mean that for the first time every American will have access to affordable health care coverage.
If we look at history, we see that once we have built such a foundation, Congress will improve on it. When Social Security was enacted, it left out major categories of workers and didn't provide for surviving spouses or dependents. Those omissions got fixed later.
If we fail to pass reform or pass minor reforms that don't really change anything, it will be at least 15 years before the nation tries again. If we enact the agreed upon reforms, Congress will continue to debate how to improve upon what's in place. And it will defend the new right to health care against those who would tear it down - just like Republicans have been trying and failing to privatize Social Security since it was first passed.
This isn't just a policy question; it's a political one. Republicans are counting on stopping the Democratic agenda so that Democrats will fail and voters will give the Republicans another chance. The Massachusetts election demonstrated that Democrats need to deliver on the promise of change. After a year of getting within sight of the finish line on comprehensive health care reform, the only choice from a policy and political perspective is to get the job done.
As the national campaign manager of the nation's biggest progressive health care campaign - one that has organized hundreds of thousands of people in all 50 states and spent $45 million fighting for reforms that go well beyond what now seems possible - I understand as well as anyone how frustrating progressives find this situation. But we should never lose sight of what Dr. King said about health care in this nation: "Of all the forms of injustice, inequality in health care is the most shocking and inhumane." Congress is on the brink of dramatically reducing this inequality even though the legislation has many imperfections.
So on behalf of the army of activists who have fought with us for more than a year, our message to Democrats in the House and Senate is simple: pick yourselves up, dust yourselves off, and enact the compromise plan you were set to pass before the Massachusetts election. You still have big majorities in both houses. Because of Republican obstructionism, you'll need to use different procedures to get the job done. But just do it! And know that each and every year you will have saved tens of thousands of lives, rescued hundreds of thousands of families from medical bankruptcy, and proved to America you are up to the challenge of building a new and better future for our children and the generations that follow.