As Paul Krugman argued in his column earlier today, there are three choices on health care reform: (1) pass the Senate bill, and improve it later; (2) try to come up with some new health reform plan; or (3) do nothing.
The third choice would be such a pathetic abdication of the possibilities of the moment that I do not seriously entertain it as an option.
In my view, the second choice option is the "I want my unicorn" approach. Face it, we have a dysfunctional Congress -- particularly in the Senate. The odds of them coming up with a new health care bill are roughly zero, maybe less. It's just not going to happen. In other words, there isn't much distinction between options two and three. And even if there were, as Krugman points out, what's the point of a one-legged stool?
So for me, the first option -- passing the Senate bill and then trying to fix it later -- is really the only option. Otherwise we're not going to get a single damn thing.
Does being limited to that one option make me angry? Yes. The Senate bill has glaring weaknesses. It relies on the excise tax to cut costs, it doesn't have the public option, it doubles down on our current system. But if we do nothing, we're still going to have our current system. We're still not going to have a public option. And while we won't have an excise tax, the cost of health care is skyrocketing so fast that it might as well be an excise tax.
All that needs to happen for the Senate bill to become law is for the House to vote it out of the chamber and onto the President's desk. If the House can find the political courage to take that stand, the debate over health care will instantly change.
Suddenly, we'll be able to start pushing for the addition of individual elements like a public option or for the removal of bad elements like the excise tax. We can expand access to the exchange, and strengthen its consumer protections.
But while we have those debates, we'll have resolved the question of whether or not the social contract includes health care. Almost every American will be covered. Insurance companies will be forced to cover everybody, regardless of pre-existing conditions, and they won't be able to charge people more just because they got sick.
If we want to accomplish those things anytime in the near future, then the Senate bill is our only vehicle. This health care debate has dragged on for far too long. Proposing to drag it out further without passing it is almost certainly going to mean killing it, not improving it.
The bottom-line is that if you want health care reform, but you want something better than what the Senate bill has, you've got two choices. You can pass the Senate bill and then work to improve it, or you can reject the Senate bill and try to create something new. The fact that the second possibility is completely unrealistic is evidence that our system is broken, but when you have a broken system, you still have to do the best that you can.
That's why I believe the House should pass the Senate bill. Once it is passed, we need to set to work to fix those pieces of the Senate bill that fall short. Given the maladies of our political system, if we want health care reform, it's almost certainly the only way it will happen.