Compromise and Health Care Reform

I’ve warned before that it could turn out to be the left which kills health care reform and we see another example of this mind set in a post by Scott Lemieux. He expresses dissatisfaction with some of the compromises which are under consideration, which is understandable, but goes on from there to suggest that if the final bill doesn’t contain everything he wants we should just let it die:

In light of reports that Senate Dems may strip the public option and the employer mandate from the health-care bill, Steve M. asks a good question: “Is this even worth it? Is it even worth fighting to pass a compromised, inadequate bill?”

I largely agree with his take on the politics. But even if getting any bill called “health-care reform” passed would be good short-term politics, it’s worth further emphasizing that signing a bill without (at a minimum) a public option would be a substantive disaster. Such a bill would not be “reform” in any meaningful sense.

The normal justification for passing a compromise bill is that once a new system is entrenched it can be tweaked later. But I don’t think it applies in this case. The public option is the core of the reform; a Blue Dog bill isn’t so much half a loaf as a few meaningless crumbs. And far from making a public option more viable in the future, if anything, passing something that could be called health-care reform will reduce the impetus to pass actual reform. And, worse, a bill with no public option will further entrench the insurance industry and make it easier for them to block actual reform in the future.

There’s no inherent value to passing a health care bill, per se. If it doesn’t contain the elements that make it worthwhile, progressives shouldn’t let it out of Congress, and Obama should make clear that a Blue Dog bill would be vetoed. A bad bill would be worse than no bill.

This is exactly the same mistake that the Clintons made when Hillary convinced Bill to threaten to veto any plans which differed from hers. The point of a veto is to block a bill which has undesirable features, not block a bill which doesn’t go as far as you would like. Even if there is no employer mandate and no public plan we have far more than “meaningless crumbs.” Among the benefits included in the current legislation which would be worthwhile even without the public plan and employer mandate:

  • Far more of the currently 47 million uninsured will have insurance coverage.
  • Those who are seeking to purchase insurance will not be denied coverage because they have medical problems or lack coverage for pre-existing conditions.
  • People who have coverage will not lose their coverage because of developing medical problems.
  • People who have coverage will not lose their coverage due to losing their job or deciding to change jobs.
  • The disparity between reimbursement for primary care services and procedures will be reduced.
  • Medicaid reimbursement for primary care services will be increased to Medicare levels, eliminating the problem of Medicaid patients having poor access to care due to inadequate reimbursement. (Even some Republicans have seen advantages in giving “lower-income Americans a way out of the Medicaid ghetto so they can have the dignity of private insurance.”
  • Fix the flawed Medicare reimbursement formula.

It doesn’t matter if people receive these benefits due to being in a public plan or form private insurance. Despite scare stories from the right, the public plan is expected to only cover a small minority of people.

Howard Dean is also upset about the proposed compromise saying, “This bill is going to cost us a lot of money and it isn’t going to do anything, if this so-called compromise is true.” This is rather puzzling as, even with such compromises, the currently proposed legislation goes much further than the health care plan he proposed while running for the Democratic nomination in 2004. Is he then saying that the health care plan which he ran on would do nothing?