So, now we're arguing about an excise tax. Apparently, the unions don't understand. Apparently, the unions are anti-Democrat, and promulgate right wing memes. Such is the death spiral of political discourse.
We never got to argue about single payer. It was seen as impossible, so aiming for it was seen as pointless. Even though doing so might have reframed the entire debate, by allowing us to negotiate down from it to a public option, which would have been seen, from the start, as the compromise it was.
We argued about the nature of the public option. Was opt-out acceptable? Were triggers? Every step of the way, some accepted every step down, along the way. Every compromise. Every capitulation. Every gift to corporate interests. Every relaxation of what would have been real regulatory reform.
Then the public option was dropped. We argued over whether a Medicare expansion would be enough compensation for dropping a public option. Some said it was. It was enough. It was imperfect, but it was good. Then the Medicare expansion was dropped. And the same people who had been telling us what a great idea it was began telling us it wasn't that big a deal, anyway.
We lost reimportation of medicines. We lost the ability of HHS to negotiate cheaper prices. We pushed the Overton Window backward on reproductive choice. And we were told that it was all good. No matter what we gave up, no matter how badly the bill was eviscerated, the same people kept telling us it all would be okay. And even if it isn't okay, we can fix it. How the Congress that couldn't get it right in the first place was going to fix it never was explained. How the Congress we will have next year, with smaller majorities, will fix it never was explained.
We got mandates. Once upon a time, mandates were bad and the public option was good. Now, the public option is gone and mandates are here. The anti-trust exemption all but negates any positives that might have come from the exchange. Collusion. Coming to an exchange near you.
There is inadequate enforcement. There is inadequate regulation. There is nothing to minimize the literally deadly effect of ERISA section 514. There is nothing to ensure that people mandated to buy private insurance will have their conditions treated. People with pre-existing conditions now will have coverage. Because they will have to buy coverage. But there will remain no mechanism to ensure that those pre-existing conditions will be treated. Some might say that sounds unfair.
There is so much wrong with the bill, and there has been so much wrong with the process. But it really can be summarized thusly: once upon a time, we were debating the will to pass a public option; now, we're debating the efficacy and fairness of an excise tax.
We're going to get a health insurance bill. We're not going to get a health care bill. The difference between the two defines what has gone wrong.