Hey, Dr. Dean, President Obama: It's Time to Get Real with Progressives

Editor's note: In the following piece, Harold Pollack calls on Howard Dean and others who are vocally opposed to the Senate bill to support the legislation, no matter how flawed. He also urges President Obama to mend his relationship with progressives, many of whom have become deeply disillusioned with the Administration.

I've been spending much time recently with primary care physicians across Chicago. Interspersed with the work, I hear many stories about the difficulties experienced by urban low-income patients.

There was the man with diabetes who was uninsured until age 65. Thanks to Medicare, he now gets excellent care. That won't restore the sight he lost to diabetic retinopathy a few years ago. There were the uninsured women whose metastatic breast cancer was diagnosed in hospital emergency rooms. There are the uninsured men recovering from gunshot wounds who face large bills. There is the woman with a serious chronic illness worried what she will do if she loses her job, and thus her good employer-based coverage. There are the people who suffered strokes after going years saving money by skipping doctors' visits or by skimping on their pills.

These are not horror stories ginned up by advocacy groups. These are commonplace occurrences within most low-income communities. Every one of these patients would have benefited from provisions of the Senate health reform bill. Within the catchment area in which I do my work, maybe 100,000 people would gain health insurance through provisions in the House and Senate bills.

Dr. Dean. I thought about these stories as I read various emails from you and from your affiliated group, Democracy for America. I read with special dismay your recent Washington Post op-ed saying that you would vote against the Senate bill. These missives may reach a receptive audience. I'm dismayed myself by the loss of the public option, by affordability concerns, by the ridiculously long delay before reforms take full effect, by the unworthy prominence of Senator Joe Lieberman, given the real disappointment progressives are feeling, it's important to note how foolish and destructive your message could be. [EDITOR'S NOTE: On Sunday, Dean walked back a bit from his call for senators to vote against the health-care bill, saying on Meet the Press, "I would certainly not vote for this bill if this were the final product... I would let this thing go to conference committee and let's see if we can fix it some more..."]

As others have noted, Democrats are on the brink of enacting an imperfect but historic bill that will cover 30 million people and correct egregious defects in our current health insurance system. Fully implemented, the bill would provide about $200 billion per year down the income scale in subsidies to poor, near-poor, and working Americans.

Two hundred billion is a big number. It exceeds the combined total of federal spending on Food Stamps and all nutrition assistance programs, the Earned Income Tax Credit, Head Start,  the Department of Housing and Urban Development,the National Institutes of Health and the cash payments to single mothers and their children through the Temporary Assistance to Needy Families program.

More than that, this bill codifies the responsibility of the federal government to ensure decent and affordable health coverage is available to every American. The Senate bill does not yet live up to this responsibility in every particular. Still, by almost any measure this is a historic expansion in the humanity and the ambition of American government. Paul Krugman, Jonathan Cohn, Jacob Hacker, Ezra Klein, and Paul Starr disagree about many things. Not about this. Almost everyone I know with expertise in health policy, public health, and the politics of health care believes as I do: we just have to pass this bill.