The Choice

The problem with health care reform is not public option versus no public option — it’s change versus no change. The difficulty with passing health care reform is not the size of the bill, or the price tag, or the specific provisions in it — well, it is to a point, but it’s not the heart of the problem. The real difficulty is Congress — Congress as an institution: the way it operates, the way it approaches change. And we have a choice now (“we” meaning progressives and liberals who support health care reform) between allowing long-standing institutional problems to be an excuse for letting health care reform die because it doesn’t have a public option or has a public option that has been watered down beyond recognition, or supporting a really good bill that will help many millions of Americans who are suffering and will suffer even more without it.

The above is a very imperfect summary of a post by Ezra Klein on the larger issues behind the public option, and health care reform in general. Obviously, Ezra is knowledgeable about health care, and a very, very smart guy. But the more I read him, the more I think he also brings a perceptiveness, an intelligent flexibility, and a focused sense of priorities to this debate that few others do. Ezra knows what he wants: He wants tens of millions of uninsured and underinsured Americans to get health care. He wants thousands of Americans no longer to die every year because they lost their insurance, or because they are uninsurable in the current system because the current system is controlled by an insurance industry for which the top priority is shedding the people who actually need health care the most — people who are sick, who have chronic illnesses, who have preexisting conditions, who have lost their jobs and have no income. If this bill does that, or makes a really excellent start at doing that, to turn the public option into a deal-breaker is deeply wrong.

I did not always feel this way. I’m not sure Ezra did, either. But he has persuaded me, and it’s because it’s so clear what he cares about. You need to read the whole thing, but here is a taste:

It might have been a necessary thing from an activism point of view, but convincing liberals that this bill was worthless in the absence of the public option was a terrible decision, wrong on the merits and unfair to the base. The achievement of this bill is $900 billion to help people purchase health-care coverage, a new market that begins to equalize the conditions of the unemployed and the employed, and a regulatory structure in which this country can build, for the first time, a universal health-care system. Thousands and thousands of lives will be saved by this bill. Bankruptcies will be averted. Rescission letters won’t be sent. Parents won’t have to fret because they can’t take their child, or themselves, to the emergency room. This bill will, without doubt, do more good than any single piece of legislation passed during my (admittedly brief) lifetime. If it passes, the party that fought for it for decades deserves to feel a sense of accomplishment.

But bills like this one have failed before, even in my (admittedly brief) lifetime. Indeed, pretty much the only thing that bills like this one have ever done is fail. But somewhere along the way, a fair swath of people convinced themselves either that this legislation was pretty much a done deal, and the argument could move toward its margins, or that the legislation wasn’t worth passing without the public option. Neither was true, and a lot of the difference between me and some of my progressive friends came because I placed a higher probability on, and had more of an aversion to, the failure of the underlying bill.

Ezra Klein is essential to understanding the health care policy debate in the same way that Glenn Greenwald is to understanding constitutional and civil liberties issues in law and public policy. Please, please, please, go read his post.