THE MEASURE OF REFORM

Bob Cesca
Bob Cesca's Awesome Blog

November 8, 2009

I've been thinking about how to peg yesterday's very historic reform victory in the House.

Clearly 220 House votes for healthcare reform with a level-playing field public option and a conservative anti-choice amendment is about as good as it gets with a very popular Democratic president and a wide majority in the House. In other words, with all of the momentum for reform, this is about as much reform (in terms of policy) as popularity and majorities can buy, given the level of opposition.

As much as I'd like to see single-payer, this ought to prove that such a thing would never have reached this point, and it would've derailed the broader reform effort for another generation. In fact, it appears as though reform with a robust Medicare-based public option and no Stupak amendment might not have passed either.

It illustrates how powerful the cartel and opponents of reform really are. It also shows how backwards, cowardly and ignorant some of the conservadems and Blue Dogs really are as well. (Despite their chickenshit fears, this reform bill is an easy sell. But some Democrats still fear the marginalized wingnut teabaggery.)

I've been thinking about what sort of realistic scenario would've passed single-payer or a fully robust public option in the "more liberal" House. How large would the Democratic majority have to be? How popular would the president have to be? How liberal would they all need to be in order for single-payer to pass? The answer: far beyond current thresholds, obviously. So we get an incremental solution that will help millions of people to afford healthcare, and we get a means to a single-payer end. Regardless of the obvious flaws in the bill, this is not a terrible deal.

America has mostly operated like this. Incrementally. Historical perspective shows that despite FDR's popularity and the collective desperation of the Great Depression, he was only able to pass a rudimentary framework for Social Security -- a law that didn't cover large groups of American workers, from railroad employees to the self-employed to farmers to government staff to clergy. There were no survivor or disability benefits, either. Hardly robust. Lydon Johnson's Medicaid, for all of Johnson's strong-arming tactics and landslide 1964 mandate, contained a dreaded state opt-out feature (to date, no state has opted out of Medicaid). Very popular presidents like Teddy Roosevelt, FDR and JFK weren't able to achieve any healthcare reform whatsoever, and not from a lack of trying.

So how do we peg reform at this point? There are still major hurdles ahead. And as I wrote above, it's not perfect and there are gaps to be filled, as there were with Social Security, Medicaid, SCHIP and other similar kinds of reform. But this is a major step towards an eventual single-payer system.

Without this reform, single-payer would be less likely. Put another way, this isn't a loss for single-payer, it's a victory in a battle on the road to winning the war.

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