03/18/2010 05:12 am ET Updated May 25, 2011

It Takes Guts to Support Health Reform

Breaking news on Saturday December 19: The "Manager's Amendment" is now online and the Senate is apparently going to have 60 votes to pass the bill by Christmas Eve. You can read the new changes at: Manager's Amendment.

At this point in the legislative process, let's pay some attention to those legislators who have NOT been grandstanders (e.g. Rockefeller, Weiner, Harkin, Feingold, Warner). Let's focus on those who have mostly kept their mouths shut in public but have worked behind the scenes to make health reform legislation stronger. It takes guts for them to be positive and humble when it's so easy to be negative and famous.

Most Senators and public advocates are clearly preaching to their base right now. Sen. Lieberman of course. But also no less Dr. Dean and Senator Nelson and his stupefying Stupak affection. But what seems to be lost in the drama is the fact that this is how politics works. You push for your position, either publicly or behind the scenes, and then when it's clear that you can't win, you accept the reality of a compromise. You go to the end with the Senate you have, not the Senate you wish you had (sorry Rumsfeld but it's irresistible to paraphrase this). When it became clear that, for whatever reasons, the public option was not going to survive, each Senator had to decide if he or she was going to stick with the process and try to make the best of it or give up and pout.

So this post is a shout out to those Senators and Congress people who have worked hard to make the health reform bills better, but who have not tried to grab the glory. There's Senator Rockefeller, for example, who has been relentlessly positive. Or Congressman Anthony Weiner who has tried his best to keep a public option alive despite apparently insurmountable odds. Or Senators Feingold or Schumer, part of the latest "gang" of "ten"who tried to find an innovative way to keep choice in the bill by providing a Medicare buy-in at 55 or an expansion of the plans available to federal employees. And this list doesn't even begin to include the dozens of House representatives and Senators who worked quietly and ferociously behind the scenes to make the House and Senate bills better. They deserve, not only our votes, but our help in getting re-elected the next time their terms are up.

What is in the Senate bill that is worth passing? A lot. I have blogged previously about elements of the House and Senate bills that will help a lot of Americans. I am pleading with my fellow progressives to first read the whole bill before you go over the cliff with Dr. Dean. If you read the whole bill, I think you cannot help but see the good that it will do. 1) Expand Medicaid 2) Train more physicians and nurses 3) Help young adults stay on their parents' plans until they are 26 4) Remove the discriminatory practices of the insurance industry related to pre-existing conditions and 5) Reform the way Medicare pays providers so that payment is related to outcomes not just volume. And I could go on. Major economists like Dr. Alan Garber of Stanford University and others have supported the cost containment in the Senate bill, while urging even more reform.

And that brings me to the final point here -- what passes this year or early next year is only the beginning of the reform process. There are many opportunities to refine the legislation, make it better, perhaps even initiate a reconciliation process next year to insert a public option. As veteran legislators have pointed out, Social Security did not start out as a strong program. It was strengthened over a period of years by dint of hard work and, yes -- behind the scenes work. Somehow the petulance of those who would defeat this bill because it is not everything they wanted, strikes me as immature and actually quite selfish. I read the comments that say kill the bill. And all they tell me is that these folks must either have insurance already or they do not give a damn about anyone who does not.

So let's celebrate those of our representatives who have the guts to support reform now. When it is not perfect, but when it is really necessary.

UPDATE: Thanks to Ezra Klein for this paragraph from Max Weber's "Politics as a Vocation", written in 1946. Could not be more true today, and it reinforces my point about the many legislators who have worked hard for health reform but were not glory hogs about it. (And by the way, although Weber uses the male pronoun, this applies equally to women!)

Politics is a strong and slow boring of hard boards. It takes both passion and perspective. Certainly all historical experience confirms the truth--that man would not have attained the possible unless time and again he had reached out for the impossible. But to do that a man must be a leader, and not only a leader but a hero as well, in a very sober sense of the word. And even those who are neither leaders nor heroes must arm themselves with that steadfastness of heart which can brave even the crumbling of all hopes. This is necessary right now, or else men will not be able to attain even that which is possible today. Only he has the calling for politics who is sure that he shall not crumble when the world from his point of view is too stupid or too base forwhat he wants to offer. Only he who in the face of all this can say 'In spite of all!' has the calling for politics.