Reforming the healthcare system is a social engineering undertaking comparable in scope to the civil rights struggle. Civil Rights was one of the great liberal causes for more than a century, following the civil war. Even when we finally began to make progress, we didn't achieve our goal with one bill. We needed the civil rights act of 1957 to establish the Civil Rights Commission. We needed the Civil Rights Act of 1960 and the Voting Rights act of 1965 to help secure the right to vote. We needed the Civil Rights Act of 1964 to prohibit race discrimination on the federal and state level. We needed the Fair Housing Act of 1968. And even then our work was far, far from finished!
This bill is a first step-- and it's a step we desperately need to take.
Every analysis I've read tells me it will insure roughly thirty million more Americans than are covered in the present system. It will do this, and establish for the first time as a principle of law that every American ought to have health insurance.
It ends recission.
It ends discrimination for preexisting conditions.
It controls costs, albeit to a very limited extent.
It takes steps to begin weaning us from employer dependency for our healthcare needs.
Depending on the final bill (And this is where we really need to push) it should also eliminate the annual and lifetime caps on coverage that contribute so greatly to medical bankruptcy.
It requires 85% of every dollar of healthcare be spent on patient care.
This is no small accomplishment.
We all know what it does not do. It doesn't change the system, it doesn't make it fair, fully universal or fully affordable. It doesn't get us a publicly financed system or negotiate drug prices-- or many of the things that a modern, civilized healthcare system should be expected to do.
The solution to this isn't to kill the bill.
A bill passed by reconciliation will help, but nothing stops us from pushing for reconciliation after we get this bill passed-- because most of the things we DO get in this bill we can't get through reconciliation. We should start pushing for it the very day this bill is signed into law-- once Nelson and Lieberman have already signed away their leverage.
More realistically, we can expect-- no, demand-- to pass another bill in 2014, and again in 2018. We must not stop until America genuinely has a health care system that can be said to be the envy of the world. But we can't get there in one step.
If we do not pass the bill, healthcare will be as toxic as it was after Clinton's defeat. We won't have any hope of getting , and instead of being three steps closer to what we want, we'll begin by trimming our ambitions-- like we did in 1973, 1993 and 2009.
In attempting to kill this bill, we are turning our backs on the legitimate progress it represents-- and empowering the Republicans who have been pushing for this kind of a disaster all along.
Don't side with the Republicans.
Take what we can squeeze out of them now, and then immediately demand for more. It's the only way to actually make progress on a challenge of this magnitude.
Step by painful step.