I'm pissed off.
I'm pissed off at health care reform. I'm pissed off at this endless process of emotional highs and lows and exhilaration and dejection and history and infamy.
I'm pissed off that President Obama "thanked" the independent senator from Connecticut even though the senator nearly killed health care reform this week.
To that point, I'm pissed off at Joe Lieberman. I'm pissed off at his childish, vengeful, opposite-day hackery. I'm pissed off at his giant pie-shaped head and his passive aggression. I'm pissed off that he enjoys government-run Medicare benefits while opposing government-run insurance for the rest of us.
I'm pissed off at the Senate. The whole Senate. The rules, the senators, the color of the walls, the fact that a doof like Chuck Grassley can actually be elected to it. Multiple times. I'm pissed off that even though we finally have a 60 seat supermajority, it's dysfunctional and Harry Reid is in charge of it. I'm pissed off that senators of both parties receive government-run primary care from the Office of the Attending Physician, while denying it to everyone else.
I'm pissed off at cable news and the establishment press for focusing more on The David Letterman & Tiger Woods Underpants Party than the substance of health care reform.
I'm pissed off at Rahm Emanuel and I'm pissed off at the "scary profane a-hole" mythology that's built up around him, and how he only seems to use his powers of intimidation to bully the left.
I'm pissed off at the Republicans. I'm pissed off at their ongoing self-contradictions and lies and bumper sticker sloganeering. I'm pissed off that around 55 Republicans are on Medicare, yet they oppose government-run health care for the rest of us.
I'm pissed off at Tom Coburn's bulbous Dirk Diggler haircut.
I'm pissed off at having to compromise while a handful of lopsidedly powerful conservadems get whatever they ask for.
I'm pissed off at the Senate health care reform bill. I'm pissed off at the House health care reform bill. I'm preemptively pissed off at the conference report, too, and I don't even know if we'll even get that far.
And I'm pissed off that my progressivism leads me to the unavoidable conclusion that if we don't pass health care reform now, innumerable bad things will continue to happen due to the fact that there's a very serious health care crisis in America. I'm pissed off that I can't, in good conscience, allow my anger to coerce me into believing that we should "kill this bill." I'm pissed off about that, too, because I know what could have been, and yet I have no other choice but to settle for what is. For now.
But being pissed off doesn't make this reality any less real.
While I clearly empathize with the dominant sense of rage spreading throughout the progressive movement right now, we've always taken pride in our ability to grasp the objective reality of both policy and politics. And the objective reality of this conundrum is that if health care reform dies here, it won't be back anytime soon.
I don't need to tell you that we've been outflanked on health care reform and so the whole affair has been tainted with the foul stink of compromise and bad faith, with someone as universally despised as Joe Lieberman absconding off with the smoking gun -- grinning from ear-to-ear across that jowly pie plate of his. That's what it feels like right now, and suggesting that it's an unpleasant sensation is vastly understating the rage.
Yet I can't help but to believe that killing reform will only heap an even larger failure on top of losing the public option, the Medicare buy-in and so forth. Only this time, it won't be a failure limited to an ideological or political routing. The failure of health care reform will invariably mean at least another decade (if not two decades) of a desperate health care system in crisis. Another decade or two of medical bankruptcies and deaths due to a lack of insurance -- exponential premium hikes and rescissions. You know the list.
If I stop being pissed off long enough to take a good look at what remains in both the Senate and House bills, there aren't necessarily fool-proof solutions to these problems, but there are regulations, subsidies and reforms that will ameliorate a significant chunk of the present crisis. For example, the Senate bill will reduce the cost of insurance for a family of four earning $54,000 from around $19,000 per year to around $9,000 per year.
To put this a bit more sharply, if I could construct a system in which insurers spent 90 percent of every premium dollar on medical care, never discriminated against another sick applicant, began exerting real pressure for providers to bring down costs, vastly simplified their billing systems, made it easier to compare plans and access consumer ratings, and generally worked more like companies in a competitive market rather than companies in a non-functional market, I would take that deal. And if you told me that the price of that deal was that insurers would move from being the 86th most profitable industry to being the 53rd most profitable industry, I would still take that deal.
So would I, even though I'm pissed off about it. But it undeniably makes sense to take the deal. If progressives successfully convince enough Democrats to kill the bill, do we really want to be the group that plunged the last blade into the back of reform?
Do progressives really want to tell working-and-middle class families of that they're not allowed to get a $10,000 annual break on their insurance payments? If you're okay with that, I admire and respect your integrity, but I just can't be a part of it. Objective reality dictates that there's no other path at this point but to support the bill and to subsequently endeavor to fix it.
If we can holster our anger, check our pride, pin our noses and allow this thing to pass -- hopefully without further right-leaning compromises -- we have a decent enough infrastructure onto which we can attach additional reforms. There will be gaping loopholes to fill, and lots of areas to reinforce, but this seems like an easier mission than starting over from scratch.
And just imagine, for a moment, starting all over again.
At what point, and how many years from now will there be another center-left president with a Democratic quasi-supermajority in Congress? Certainly not after next year's midterms. But imagine the perfect storm happening again down the road. History has proved that health care reform is always weaker after a failed effort. So we start there. Then where to? The centrist Finance Committee? More watering down of the legislation? It's 2009 all over again, only weaker. Suffice to say, I can't imagine anything resembling Medicare for All being passed without an intervening health care reform bill.
America has always been governed by incrementalism, and health care reform is no exception. Health care reform was always going to be a work in progress -- we're just going to have to work a little harder to make up for a lack of a public option and the Medicare expansion.
Maybe our anger would be better channeled into fixing the bill than killing it. Amendments can be attached to budget bills and war spending supplementals. If you recall, the Wellstone amendment, forcing insurance companies to cover mental health, was passed in the stimulus bill last February. And there's no reason why the Democrats couldn't bring up the public option and Medicare buy-in as its own reconciliation bill. But SHH! Don't tell Joe Lieberman.
As pissed off as I am, I'm hopeful that we're going to be a part of achieving something good here. And perhaps the temporary loss of the public option and the other things will provide the political motivation to achieve a perpetual run of smaller victories as we help to shape this bill into something we can be happy about.