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?

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  1. 1
    Ohioprof says:

    I think we progressives should reject entirely any so-called “reform” plan that does not provide for a strong public option. I think we should reject the entire thing as an expensive and inadequate and as meaningless when it comes to reform. This plan as it is shaping up will not provide universal coverage, it will not reduce costs, and it will not make health care more affordable for most Americans. It will do nothing to reduce my health care costs, and  it will probably make my health care more expensive, not less.

    The idea that we should compromise on something as critical as good, affordable health care is nonsense. President Obama never even tried to work for single-payer universal health care. Let’s reject the Obama plan entirely and fight for what we really need: single-payer universal health care. This terrible plan put forward by Democrats will benefit the insurance companies, not the people. Our health care system should not exist to enrich insurance companies. We should cut them out entirely. The President needs to listen to the people on single-payer universal coverage. 

    In 1965 we got an excellent universal health care system for the elderly. It’s called Medicare. Why should we settle for lesss just because members of Congress get money from insurance companies? We need to expand Medicare to cover all Americans of all ages. 

    We the people reject this flawed so-called health care reform plan. Let’s say no to President Obama and the Democratic leaders on this one and fight for single-payer universal health care. Support House Bill 676 and Senate Bill 703!  

  2. 2
    Ron Chusid says:


    You are missing the important lesson of 1965. Improvements in health care with regards to government action have been incremental. When universal coverage couldn’t be achieved they settled for Medicare to cover those who were most vulnerable. There are many good things being proposed and we should whatever can be passed. It makes no sense to snub these improvements because you cannot get everything you want.

    Single payer has no chance of passing. A tremendous number of people are happy with their current coverage and would not accept a plan which forces them to replace their current coverage with a single payer plan.

  3. 3
    Cardozo says:

    This post is a breath of fresh air. So many people on the left seem to think that President Obama, Senator Reid and Speaker Pelosi should be able to simply co-opt the entire legislative process and jam through whatever they like.
    In truth, allowing conservative Democrats (and even Republicans) a crack at the process is the best way to garner votes FOR cloture from certain members, even if they vote against the bill for whatever reason.
    For better or worse, there are no tricks here. If we have the support in the Senate for a public option, it will be in the final bill. If not, we need to elect some new representatives, especially in Senate districts where Democrats filibuster their own party’s legislation.

  4. 4
    nomoreGOP says:

    I couldnt agree more with Ron here… How was Hillarycare any better than the GOPs stance of “let the free market work itself out”? How would an Obamacare be with a “our way or no way” attitude? Not any better than the current GOP/Republican lack of a plan at all?? The answer is simple – They arent any different at all. They both are choosing politics over people and they both leave us with the status quo (better known as Republicans AND Democrats making sure insurance companies stay very rich so that they can keep their lavish “public servant” lifestyles of yachts and sports cars.) Plain and simple.

    We need to start chipping away at the current status quo or NOTHING WILL EVER HAPPEN. There is no way that either side will ever compromise and we will be stuck in this pathetic partisan BS until we are all either dead or uninsured and dying..

    EVERYONE needs to be mature enough to know that any step forward is good for the country as a whole..

    Personally I think that during the next couple of elections there should be a cleaning of house, pun intended, in our Govt. We need to take Obamas “Change” to heart and change who we have let run our country into the ground for the past 30 years.

    Because guess what? ITS THE SAME HANDFUL OF PEOPLE. We have a bunch of Cold War Era paranoid white guys (who have ALL had FREE Government Health care for the majority of their lives) who would rather dump billions of dollars of our tax payer money into wasteful defense contracts and endless wars of religious persecution, instead of reform an industry that they dont see as needing reform.. They have never had to deal with Kaiser from the patient-doctor stand point. I mean think about it.. the only thing that health care means to these people is millions of dollars in campaign donations, etc..

    So they lie and avoid the situation by focusing on anything and everything but the fact that they dont plan on doing much at all..

    We really do need to take our country back from these greedy bastards.. Obviously easier said than done, but this is getting out of control..

  5. 5
    Nancy says:

    For all those fed up with the BS surrounding Health Care Reform, and the attempts to ‘water it down’, I have set up a petition. If you agree, please sign it – and spread the word!!!!

  6. 6
    bruno says:

    For as much as I would like to see Universal Healthcare or at least a Public Option included in the final bill that gets signed by Obama, I agree with Ron that it is better to take what we can get.
    Another aspect to keep in mind:
    1) Republicans won’t be able to contain themselves from boasting to their constituents how they watered down Obama’s plan. How they were the only brave Americans standing between good ol’ America and Obama’s slide into Socialism.
    2) Of course all of this will be well documented.
    3) Insurance premiums WILL keep going up.  Health care in general WILL continue getting more expensive as time goes by.
    4) Even people who claim to be happy about their coverage, will eventually need to use some of that premium coverage and find out that the small print has limitations on what they’d like to get.  Because by then, even dense people will have experienced less than desirable interaction with their co-op and/or  private insurance company, Obama’s Public Option will look far more appetizing.
    5) It will be easy to portray that Republicans were the ones against meaningful health care reform. We’ll see a replay of the same arguments, except they won’t work as much.  Demographics lean in the direction of a more progressive country, not a more conservative country.
    In other words… it’s only a matter of time for a public option and eventual Universal coverage to be implemented.  THAT is what Republicans know and are fighting against.  They also know that historically, anything they’ve ever fought against has become accepted by the vast majority of Americans.
    You just can’t stop progress…  Is it slow?  You betcha.

  7. 7
    Ron Chusid says:

    “Republicans won’t be able to contain themselves from boasting to their constituents how they watered down Obama’s plan.”

    True, but they would have far more to brag about if they stopped any plan from passing. The Democrats would have far more to brag about than the Republicans if they were to pass a decent plan, even if it lacks a public plan. Also not how Obama is saying that he could support a bill without a public plan, which would reduce any bragging rights for the Republicans.

  8. 8
    Eclectic Radical says:

    It is worth noting that, despite the rather understandable anger on the left at Senate Democrats like Max Baucus and at the Blue Dogs in the House, ‘the left’ is not killing health care reform all by themselves. Health reform is being cut to pieces by the Senate Finance Committee in their great desire to be ‘bipartisan’ even if it means not passing the best possible bill. We still don’t know what form the final Finance Committee bill will take, and it is increasingly likely that the Finance Committee’s ‘bipartisan’ bill will be the one embraced by the White House rather than the Health and Human Services Committee bill that Teddy Kennedy was ramrodding.
    Now, I happen to agree that incremental reform is better than no reform or counter-reform. That’s why I am a registered Democrat despite being, on the whole, disgusted with the Democratic Party (the self-proclaimed ‘progressives’ as much as the Blue Dogs and the New Democrats) far more often than not.
    But that doesn’t mean that we should be happy with incremental reform, refrain from pushing from the most meaningful reform possible, or questioning some of the decision making processes of Senate Dems and the Obama Administration. It does not mean we should refrain from fair criticism of genuine failings.
    Do I disagree with the ‘all or nothing’ argument? Yes.
    However, the only way that the left will even have a chance to kill health care reform is if the center-right continues to aggressively cripple it in the name of ‘bipartisan compromise’ that the economic stimulus already proved was largely mythical. We are not truly seeking ‘bipartisan compromise’, but intra-party compromise with individuals who will ask the president to campaign for them  (or at least raise money for them) in the mid-terms after this is all over.
    Incremental reform is sometime necessary, but it is generally not good enough. Is it worth passing if it’s ‘better’? Of course. The problem is, as it was with Medicare, that much of the country will think the job done when a bill is passed. Even if the people is toothless compared to the necessary level of reform.
    It’s all well and good to say that if we do this now, we can improve on it in the long run… but have we improved on Medicare in the long run or have we fought a slow and at least partially unsuccessful battle against privatization? Did we improve on AFDC, or did we largely kill it? Incremental reform, all to often, becomes the target for reactionary counter-reformers and NOT the building blocks for long term reform.
    To paraphrase John Maynard Keynes, the trouble withincremental reform is that we’ll all be dead before the next incremental reform… assuming someone doesn’t kill that incremental reform in our lifetimes.

  9. 9
    nomoreGOP says:


    I absolutely agree with you.. but then there is reality.. And until we are able to get the GOP/Conservative affiliation down to under 10% (and maybe get a new party up there that will once again make our democracy strong by presenting alternate ideas and policies instead of delusional relgious dreams) these blue “coughselloutscough” dogs and other questionable democrats just will not allow themselves to appear as if they aren’t bipartisan.. Maybe they are in situations where their career may be on the line because of campaign support or district locations that are red-heavy..Unfortunately, it’s just simple human nature.. Self-preservation at its truest form.. Im not saying its a good thing, or that we shouldn’t fight for as much reform as possible.. I just think we also can’t be as delusional as the other side if we ever want to get anything done..

    I mean look at “Hillarycare” and its miserable failure.. What if she would have been more open to different ideas? Whos knows if the incremental changes would of grown into bigger ones?

    And I also thinks its a good idea to note that with small changes, public opinion might start to change and the scare tactics of the right might (just maybe) start to lose their luster..

    Just a thought

  10. 10
    Eclectic Radical says:

    I don’t completely disagree with you, nomoreGOP, but it’s a lot more delusional to think that the GOP’s vote share will shrink that low or that the questionable Democrats wouldn’t just flip parties to prevent that from happening. I understand all the political factors, but the two parties are simply not playing on a level playing field when one has embarked on a bitter fight to the death to block everything but its own agenda and force that agenda down all throats by any means necessary and the other is talking about ‘unifying, bipartisan government.’
    It might work great for the voters, but the only way to bring conservatives into the process is to give them their way. This is counter-reform, not reform. Republicans are saying that the government is going to force senior citizens into end-of-life counselling if health care reform passes, and Democrats are trying to build ‘bipartsian’ support for health care reform.
    Do you really think the current Democratic strategy is not already delusional?

  11. 11
    nomoreGOP says:

    You have a very good point Eclectic.. To be totally honest.. I think you would be hard pressed to get a defined “stategy” from the left at this point.. How do you have a strategy against crazy?

  12. 12
    Eclectic Radical says:

    “You have a very good point Eclectic.. To be totally honest.. I think you would be hard pressed to get a defined “stategy” from the left at this point.. How do you have a strategy against crazy?”
    A start would be for Senate liberals to actually vote like liberals and for the White House to stop currying ‘bipartisan’ favor and commit to an all out partisan campaign to pass reform. Compromise within the Democratic Party would still be necessary because of the Blue Dogs and New Democrats in the party, but there’s no reason to cater to Republican insanity to boot.
    The most effectively ‘bipartisan’ presidents (Lincoln, Franklin Roosevelt, and Lyndon Johnson) were devoted partisans who played the game to win and not to agree on a mutual draw. Opponents who don’t believe you are committed to winning will not respect you. Opponents who understand you are out to beat them just as they are out to beat you will not assume that if they just keep bullying you then you will give them what they want.
    More importantly, Americans like guts and the ability to fight for one’s beliefs far more than they like someone who shares their beliefs. It’s very difficult to whole-heartedly fight for someone who isn’t a fighter. The Democrats have to fight in order to get the support they need. Emotion is a lot more powerful than facts. The Democrats need to play the emotion card as forcefully as the GOP. On every single issue.
    It was emotion and not rationality that passed the New Deal and the Great Society, despite the fact that FDR and LBJ were Machiavellian politicians who are all about pragmatism over emotion.

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