Amidst all the debate about the public option, the mandates, the subsidies, and the loopholes, I have one question that stands out in my mind regarding healthcare: What's next? If we help the bill pass, where will we go from there? If we help the bill fail, how do we try again?
If the bill passes, our path is straightforward. Passage of the bill is the only way we have of stemming off the voters' wrath at our unsolved problems in 2012. If we can tout the bill as a success and a step on the path to solving America's problems, we can hope to keep our majorities and continue to control, to one degree or another, the legislative process. (And for anyone who doubts that the Democrats really do control the legislative process, reflect on the fact that for a full year we've been debating expanding healthcare, not privatizing social security.)
If the bill passes, we can work on reforming it piece by piece. Opponents will find it harder to oppose a medicare expansion by itself, or as part of a cost-saving bill. The public option is much more popular than the bill as a whole, too. We can have individual votes to close loopholes or expand subsidies. For those who don't know, the Social Security system we know today wasn't created out of a whole cloth--at its inception, millions of American citizens weren't covered (mostly women and minorities) because of the kinds of work they did and payments were a pittance, even compared to the minimal support given today. In 1940, social security payments amounted to about half a billion dollars in today's money. in 2009, that number is closer to 650 billion.
So we know for fact that large social programs can begin with small, insufficient, and horribly compromised first steps. That's because the first step is the hardest--it's the one that scares people. But that step, once taken, can lead us down a path toward genuine universal coverage if we work together to achieve it.
But what happens if the bill fails?
Does anyone honestly believe that a failed healthcare bill won't result in a bloodbath in 2010? Not many, I assume. So then the question is: What can we make of the slaughter?
It would be ridiculous, of course, to think that when we have 50-member caucus we'll be able to pass a better bill than when we had a 60-member caucus. So we'll have to work over the course of years to re-build our majority better and stronger than it is now. How many election cycles will that take? And what if, when we finally have our vaunted 60 seats and a Democratic president willing to sign a bill, the political atmosphere isn't right, or the opposition isn't as pathetic as the Republicans are today?
Failure now could doom healthcare reform for a generation--just like it has before. I'm asking, honestly: For those of you who want to see this bill fail, when do you see this opportunity knocking again?
As far as I can tell, the choice we're facing is between taking our first, dangerous step along a path and choosing to stand still for years or decades. If we're going to call ourselves progressives, we have to understand the progress is a process. I think it's time to start that process, and then work every day to keep it going.