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

Progressives take heed: Killing a bill that could save thousands is not good politics; it's like stealing food from the mouths of hungry children.

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Here's what J. Lester Feder writes in The Nation:

"Despite these very serious shortcomings, however, the bill the Senate passed would reduce the number of uninsured Americans by 31 million by 2019. The Medicaid program will be open to new ranks of the country's poorest residents, and the near-poor and middle class will get subsidies to buy insurance. The Senate also advanced some important delivery system reforms that could chart a path toward reining in costs.

As disappointed as progressives are with the compromises Democratic leaders made to get this bill through the Senate--and as tempting it is to believe they may have gotten a better deal if they'd pursued a more aggressive strategy--they are on the verge of doing what many other lawmakers have tried and failed to do. And if this effort fails, another generation may pass before another chance will come to try again."

Here's what Jacob Hacker, the policy expert and Yale political scientist who is credited with devising the original "public option" plan, wrote in the New Republic:

"Since the first campaign for publicly guaranteed health insurance in the early twentieth century, opportunities for serious health reform have come only rarely and fleetingly. If this opportunity passes, it will be very long before the chance arrives again. Many Americans will be gravely hurt by the delay. The most progressive president of my generation--the generation that came of age in the anti-government shadow of Ronald Reagan--will be handed a crippling loss. The party he leads will be branded as unable to govern....

The public option was always a means to an end: real competition for insurers, an alternative for consumers to existing private plans that does not deny needed care or shift risks onto the vulnerable, the ability to provide affordable coverage over time. I thought it was the best means within our political grasp. It lay just beyond that grasp. Yet its demise--in this round--does not diminish the immediate necessity of those larger aims. And even without the public option, the bill that Congress passes and the President signs could move us substantially toward those goals.

As weak as it is in numerous areas, the Senate bill contains three vital reforms. First, it creates a new framework, the "exchange," through which people who lack secure workplace coverage can obtain the same kind of group health insurance that workers in large companies take for granted. Second, it makes available hundreds of billions in federal help to allow people to buy coverage through the exchanges and through an expanded Medicaid program. Third, it places new regulations on private insurers that, if properly enforced, will reduce insurers' ability to discriminate against the sick and to undermine the health security of Americans.

These are signal achievements, and they all would have been politically unthinkable just a few years ago."

Paul Krugman in the New York Times, Ezra Klein in the Washington Post, Paul Starr in the American Prospect and many others echo versions of these same sentiments.

The bill that eventually winds up on Obama's desk won't be what we'd hoped for a year ago. We can expect lots of articles and even some books diagnosing what went wrong and what went right. Some initial thoughts:

Lesson #1: We need major campaign finance reform, preferably a mandatory "clean money" public financing plan as an alternative to our current system of legalized bribery.

The biggest obstacle to more progressive reform is our system of campaign finance. The drug companies, insurance companies, the hospital lobby and the American Medical Association have too much political influence because they've spent hundreds of millions of dollars in campaign contributions and lobbying, something I've written a lot about over the past year. The Republican Party is a wholly-owned subsidiary of the medical industrial complex, as they've shown throughout the battle over health care reform. Unfortunately, a handful of moderate Democrats in both Houses are also in the pockets of the health industry lobby -- most obviously Senators Max Baucus, Ben Nelson, Mary Landreiu, Blanche Lincoln and Kent Conrad. And let's not forget one-time-Democrat-now-Independent-who-acts-like-a-Republican Joe Lieberman, whose vanity, hypocrisy and double-crossing the Democrats should reward by stripping him of his committee chairmanship. All people of conscience around the country should unite in defeating Lieberman when he runs for re-election for his Senate seat from Connecticut in 2012. I've called Lieberman the "Senator from Aetna" but he's worse than that.