When asked about his greatest regret as a legislator, the late Ted Kennedy would usually point to passing on the opportunity for a universal healthcare deal with President Nixon. At the time, Kennedy held out for a single-payer plan and complained about Nixon's proposal, "It's really a partnership between the administration and insurance companies."
Sound familiar?
Kennedy came to regret his stance, saying, "We should have jumped on that." In a February Boston Globe article, Susan Milligan describes the impact of the episode on Kennedy's later legislative strategy.
[Compromise] was a lesson Kennedy learned the hard way.... President Nixon unveiled a plan to expand healthcare to nearly all Americans through their employers, with the federal government subsidizing insurance premiums for the poor. The plan was strikingly similar to many that Democrats would put forth in subsequent years. But in the early 1970s, the then 39-year-old senator from Massachusetts wanted more. He stubbornly held out for a straight up national healthcare system paid for through general revenues and Social Security taxes.
Milligan describes how Kennedy took from the episode the lesson of taking whatever he got, then coming back again and again for more, rather than looking for a single omnibus: "Kennedy adopted the long view, slowly wearing down the opposition until he got part of what he wanted. Then, he'd come right back with a new proposal to get a bit closer to his ultimate goal."
And he applied this on a variety of issues. For example, In 2007, right after the minimum wage bill was passed:
Still clapping his raised hands, Kennedy leaned over to Miller. "I'm introducing a new bill to increase the minimum wage again," he said, Miller recalls. When an incredulous Miller noted that they hadn't even finished celebrating the latest wage hike, Kennedy replied, "I know, but we've got to move on this."
We can't know exactly how Sen. Kennedy would have voted on the current bill, and there's a fair chance that had he been alive and active in the Senate the past few months, the bill and politics would look different than they do. But based on his history, if he were dropped down in the Senate today, it is not unreasonable to speculate that he would indeed have strongly supported passage. And immediately then said, "I'm introducting a new bill..."
How? Instead of blowing up the current bill and hoping to somehow make reconciliation work later on, consider passing this bill (with Lieberman, et al.'s support), then coming back with reconciliation next year to do either a public option or Medicare buy-in (both of which apparently would be more clearly permissible under reconciliation than the regulation aspects of the bill). Proponents of a public option might be placated by a public commitment to do this, but any such commitment would almost certainly lose votes from the current bill, which must therefore be done first.
Passing this bill doesn't need to end the process. You can improve things, except starting from a point where 30 million people more have at least basic coverage and a point where people with preexisting conditions are covered (even if it allows 50% higher premiums). It's not perfect, but it gets people some help.
In August, Steven Pearlstein wrote a column about Kennedy's conversion to incrementalism and outlining a likely healthcare compromise that would end up getting passed. He concluded,
And while there will be plenty of liberal Democrats who will be fuming about all the compromises forced upon them, somewhere from above will come a familiar voice with that distinctly Boston accent, whispering, "The dream will never die. Take the deal."
Update:
EmperorHadrian articulates well a point about mandates:
the mandate is just a tax you can be exempted from if you have health coverage....
and if you oppose the mandate on an ideological basis now, why didn't you when there was a PO (that only 5-10 million would have had access to) in the bill?
Furthermore, as many have pointed out, if you ban denial based on preexisting conditions without having a mandate, the economics fall apart, as then nobody would get insurance until they needed to use it, which destroys the idea of pooling risk...