The health care reform bill (whose final form we have yet to see) puts all Good Demcrats in a bind.
On the one hand, the bill would cure a whole host of major ills and abuses. On the other, it makes foolish concessions that we find nearly impossible to stomach. Purists are incensed by the flaws, while apologists fall all over themselves to make excuses for Dems who voted "no."
My own sense is that overall this bill is far more beneficial overall than it is flawed. We need to position ourselves between the two poles of the purists and the apologists -- one which would stop reform until it is perfect, the other which makes convenient excuses for not achieving a better outcome.
So please read on for the rationale, which speaks not only to the current health care debate, but also to how political sausage is made in general ...
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On the plus side, the bill would end the noxious HMO practices of denying coverage to those with pre-existing conditions or dropping those who get sick (known as "recission"). It would make coverage more available and affordable to millions currently either ineligible or unable to buy it.
On the downside, the House version failed to stand up to the anti-choice brigade (just as it has failed to repeal over the past 30+ years the 1976 Hyde Amendment preventing Health and Human Services from using funds for abortions). The timetable is too slow. The bill falls far short of the single-payer ideal. And many also believe it gives away too much to the HMOs, even though it also contains key provisions their lobbyists have fought bitterly, per above.
POINT #1: Inertia vs. Momentum
Establishing a national plan now is like getting an old, junker car that's been sitting in your driveway for years from a dead stop up to 60 mph. If we want to go 75 mph, we'll have the chance to do so, but only if we get the darn thing started first. If we stay at a dead stop, we're obviously not going anywhere.
And the last time health care reform was sidelined, it took 15-plus years to get it back on the road. Better to get the plan established and the ball rolling than to give the HMOs what they really want: No change at all.
POINT #2: Working an Impefect System
if we were always unwilling to support imperfect reforms, then we would have no Clean Air Act and no Anti-Trust laws. We would abolish the Food and Drug Administration, the Federal Trade Commission, the Federal Elections Commission and many more essential agencies.
For each of these agencies were created under less than ideal circumstances, and all of them are under constant threat of attack and co-option by lobbyist. There is a neverending fight to improve their standards. But while we can't stand many things about 'em, we'd be really sunk without 'em. So I say we are far, far better off to leave purism aside and establish national health care now -- and keep fighting in the coming days and years to make it better (just as the other guys will fight to make it weaker).
POINT #3: The Devil's in the Evolving Details
The battle now moves to the Senate, and from there to reconciliation. We should be focused now on fighting to get the asinine and dangerous Stupak Amendment stripped, along with some of the industry perks that slipped in at the last minute.
That's our imperfect, flawed system, one we accept only because it is less problematic than all the other systems, as the saying goes.
POINT #4: Don't Excuse the Inexcusable
On the flip side of the Kucinich-style purists are the apologists, who deserve far less sympathy because their political beliefs are based not in an excess of idealism, but in selfishness and self-aggrandizement.
Apologists will do backflips to avoid finding any fault at all with "their" politician. (In my neck of the woods, New York's Hudson Valley, we have Congressman Murphy who voted "no" on HCR after saying he supported it, and Senator Gillibrand who has a history of bashing immigrants.) No move is so egregious that they won't grasp at any straw of an excuse. Because s/he donated to or volunteered for or just once shook the hand of some candidate running under their party banner, the apologist will never revise their opinion -- and will eagerly forgive even the rankest trespass. Party loyalty and personal perks (however paltry) always come first.
We should thus be prepared to shame those who sold us out on this bill, withdrawing donations and volunteer time from them, and redirecting these resources wherever possible to primary challengers.
POINT #5: Be Pure of Heart, But Hard-Headed
My inclination is toward purism, as generally I find one can accomplish far more than people expect by just trying and following through. Too often, progressives fail because we spend more time daydreaming about a perfect world than working diligently to make it less imperfect.
In this case, with health care, we've forgotten how far we have come -- from a rightwing lunatic in the White House advancing Patriot Acts and handing out billions to Halliburton, to a Constitional scholar in that same house, establishing the beginnings of a program as important as Social Security or Medicare.
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So on health care as on most issues, I say: Neither a purist nor an apologist be. Just weeks ago, we were despairing of the House including any public option at all in the bill; now, we're one step closer to that once-unattainable goal, and it's time to finish the job with a disciplined, tenacious push.