Why It's Essential to Pass the Health Care Bill, Then Improve It

There are many lessons to learn from the health care war that has raged over the past year. We'll get to some of them below. But here's the bottom line: Pass the bill, then improve it.

The health care bill that will emerge from the House-Senate conference committee won't be what most progressives had hoped for, but it is a major, historic turning point in American social reform legislation, comparable to the Social Security Act, the National Labor Relations (Wagner) Act, the Fair Labor Standards (minimum wage/40-hour week) Act, the Civil Rights and Voting Rights Acts, the Clean Air Act and other progressive breakthroughs. None of those laws were exactly what their advocates wanted. All involved compromises that, at the time, were heartbreaking to activists. Each one was subsequently improved by amendments, although not without reformers doing battle with reactionary opponents.

It is incredibly irresponsible for some radicals and progressives to call for killing the health care bill. It is important to push for changes that would improve the Senate version of the bill. For example, the House funding plan (a tax on families with incomes over $1 million) is much better than the Senate version (a tax on so-called "Cadillac" health insurance plans). That's what the labor movement, liberal and progressive Democrats in Congress, pro-choice advocates and others will be doing in hopes of putting a better bill on President Obama's desk, as Harold Meyerson discusses in his latest Washington Post column.

But the idea that we should scrap this bill entirely and start from scratch next year is both immoral and impractical. Like taking food out of the mouths of hungry children, killing this bill will hurt tens of millions of real people who are now suffering physically, psychologically and economically. If we don't pass health care reform now, we won't have another chance for at least a decade. So pass it, and over the next decade or two fight hard to make it better, in terms of regulating costs, expanding coverage, and increasing government-sponsored insurance.

Even the flawed bill passed by the Senate will improve the lives of tens of millions of Americans. For proof, check out this chart, put together by Jonathan Cohn and MIT economist Jonathan Gruber, based on CBO cost estimates of the Senate bill. It shows the health care cost projections for a family of four at different income levels. For example, a family of four earning $60,458 (250 percent of the federal poverty line) would pay an estimated annual premium of $12,042 and an annual out-of-pocket maximum of $12,600 without the legislation (in total, 41 percent of annual income). If the legislation passes, the comparable numbers are $5,797 and $6,300 respectively (or 20 percent of annual income). Families with lower incomes benefit even more. Cohn's article explains this in greater detail.

After the Senate passed its version of the health care bill, Obama said: "This notion that somehow the health care bill that is emerging should be grudgingly accepted by Democrats as half a loaf is simply incorrect. This is nine-tenths of a loaf. And for a family out there that right now doesn't have health insurance, it is a great deal. It's a full loaf for a lot of families who have nothing to fall back on if they get into a medical emergency."

We can differ with Obama on the math -- I'd say the House bill is three-quarters of a loaf and the Senate bill is two-thirds of a loaf -- but he's basically correct about the real human impact. The bill will make life better for most Americans -- those who don't have health insurance and those who have inadequate health insurance. Every serious progressive health care expert agrees that the bill is a significant step forward -- a stepping stone toward universal health insurance -- although they may differ on some particular issues. The health care experts writing last week in The Nation, the American Prospect and even the New Republic share this view.