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Posted by on Jul 28, 2009 in Health, Politics, Society | 35 comments

Is a Bad Health Care Reform Bill Better Than None?

This is what some supporters of health care reform are starting to ask:

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.

Ezra Klein thinks that we may never get health care reform that both addresses the enormity of the human problem, and is cost-effective:

Something might get done. And if that something that gets done extends health-care coverage to 40 million people who don’t now have it, that will be a big deal, and a big improvement in the lives of many, many Americans. It’s important for people who get good health care and have the luxury of seeing this as an intellectual and political project to keep that in mind.

But whatever gets done will be much too expensive because the political system is very afraid of harming any of the relevant industries. Taibbi is right that this, like climate change, is a litmus test for our government. Both are serious, foreseeable and solvable threats to our society. One threatens to bankrupt the country. The other threatens irreversible damage to the planet we live on. Responding to such threats is the test of a political system. And our system will fail it. We will not avert catastrophic climate change. We will not protect ourselves from health-care inflation.

In another post, Ezra again argues forcefully for keeping the focus on 47 million uninsured Americans:

The public option is not now, and has not ever, been the core of the argument for heath-care reform. It is the core of the fight in Washington, D.C. It is an important policy experiment. But it was not in Howard Dean or John Kerry or Dick Gephardt’s plans, and reformers supported those. It was not in Bill Clinton’s proposal, and most lament the death of that. It is not what politicians were using in their speeches five years ago. It is a recent addition to the debate, and a good one. But it is not the reason were are having this debate.

Rather, what has kept health-care reform at the forefront of liberal politics for decades is moral outrage that 47 million of our friends and neighbors are uninsured. That medical costs are one of the leading causes of bankruptcy in the United States. That an unemployed machinist gets screwed by fly-by-night insurance schemes while a comfortably employed banker need never worry. That the working class ends up in emergency rooms with crushing chest pains because they didn’t have health insurance and didn’t get prescribed cheap blood pressure medications five years before.


Opportunities at health-care reform do not happen frequently. The average between major attempts is 19.5 years. That’s 19.5 years in which the uninsured stay uninsured and their ranks grow. Where a situation that is already bad gets a lot worse. This year, Barack Obama is popular, and there are 60 Democrats in the Senate and huge majorities in the House. There is no reason to believe that Democrats will be in a stronger position anytime soon. It is not like when a weakened Nixon, or a fading Bush, offered a compromise.

If reformers cannot pass a strong health-care reform bill now, there is no reason to believe they will be able to do it later. The question is whether the knowledge that the system will not let you solve this problem should prevent you from doing what you can to improve it. Put more sharply, the question should be whether this bill is better or worse than another 19.5 years of the deteriorating status quo.