12/23/2009 12:24 pm ET | Updated May 25, 2011

PASS THE HEALTH-CARE BILL: It's Deeply Flawed, but It's Better Than Nothing

Very early Monday morning, just after 1 am, the Senate, by a vote of 60 to 40, the minimum required, ended a Republican filibuster of the health-care bill.

There is a deep partisan divide on Capitol Hill, with no Republicans, not even the few moderates left (like Snowe and Collins from Maine) coming over to the Democrats, but there is also, as we have come to see all-too-visibly in recent months, and even more so in recent days, a deep divide among Democrats, not to mention among those more broadly on the left. There are any number of issues that divide us, including the Afghan War, but the real fault line is to be found on the battlefield of health-care reform.

I am on record, like many on the left, advocating for a single-payer system (like the one we have here in Canada).

I am also on record, again like many on the left, advocating for a robust public option -- there is a public option in the House bill, but it is likely that what will pass is the Senate bill pretty much as it is now.

But reality is reality, and politics are politics, and, given the Senate's ridiculous rules and procedures that effectively require a supermajority of 60 to pass legislation, the votes just aren't there even for a Medicare buy-in, let alone for a public option, let alone for a robust one, let alone for anything even more substantial.

Like it or not, that's just the way it is, and while I wish there had been a stronger push by progressives and liberals for concessions from right-leaning reform-skeptic Democrats like Nelson, Lieberman, and Baucus, specifically regarding subsidies for those who simply will not be able to afford the insurance they would be required to buy, and while I wish Obama, and the White House generally, had pushed for more substantial and transformative legislation (it's still not clear to me what Obama is actually for, if he is for anything other than the Senate bill as is, which he may not be), we are left with a stark choice: pass the bill or kill the bill.

I think the choice is clear: PASS THE BILL.

Over at Firedoglake, Jane Hamsher, whom I admire a great deal, presented "10 Reasons to Kill the Senate Bill." She made a compelling case, as have many others on her site, and as have many on the left generally. As Think Progress's Igor Volsky explained, though:

The top 10 list isn't reason to kill the bill, it's reason to improve it in the years to come. After all, the choice isn't between passing this bill or a better bill -- it's between passing this bill or nothing at all. Seen in this context, the Senate health care bill provides an adequate foundation for transforming the system in the years to come.

That's been my position for some time. Again, while I wanted a better bill, I think that even imperfect reform -- and it was never going to be perfect anyway -- can be the thin end of a wedge leading to more substantial reform down the road. Over time, as further reforms are undertaken, a new, fairer, and more just system will become part of the American social and political fabric, much like Social Security. As Americans see that this isn't what the right says it is, namely, encroaching socialism/fascism, they'll come to accept additional changes. There may not be a single-payer system any time soon, but there could well be a robust public option sooner rather than later.

The Senate bill is "seriously flawed," as Paul Krugman wrote, and as even some of its most ardent supporters (Krugman included) admit. Obama and Reid can spin this however they like, but we don't deny the flaws. But at the same time, the bill is, in a way, "an awesome achievement." Instead of focusing on what isn't in the bill -- and working to kill it -- we should be celebrating the fact that there is a bill, a pretty amazing fact given all the obstacles.

Now, I realize that this puts me in opposition to some of my friends and acquaintances in the blogosphere, to many commentators I like a great deal. Whether it's Jane or Markos Moulitsas (Kos) or our very own Arianna Huffington (who correctly sees the bill as yet another victory for special interests) or any of the other thoughtful opponents of the bill, I respect their views, as I respect them personally, and I appreciate that there is such healthy disagreement and dissent on the left. (One of the key problems, as Taylor Marsh explains, is that many of those in the Democratic Party just aren't genuinely liberal, which is why the bill isn't a better one.) I simply, yet hesitantly, disagree with them. TNR's Jonathan Cohn puts it well:

I respect [Jane Hamsher's] right to that opinion. I respect the fact that she's making substantive arguments about what the Senate bill would mean for real people. And I really respect the effort she's made, over the last few months, to promote the cause of health reform.

But I still think she, and those who agree with her, are wrong.

In her column, Hamsher offers ten reasons why she opposes the Senate bill...

But a crucial question, which Hamsher and most lefty critics I know never address, is "compared to what"?

Well, compared to nothing. Because if it's not this bill, it's nothing. Sure, proponents of reform should push for concessions once the House and Senate sit down to hammer out a joint bill, but, as I said above, I don't think we'll get much more, if anything.

And if there's no reform now -- if the bill is killed -- Republicans will be further emboldened (as opposed to fearfully outraged, as they are now, showing just how much they've lost) and that will be that for a long time.

Because there wouldn't be a new bill next year, a midterm-election year, nor likely in the two years leading up to the 2012 election. And then what? Who knows what the political landscape will look like? Democrats may lose control of Congress, Obama may even lose in 2012.

Like it or not, the time is now, and this is the bill.

And, however unfortunate and difficult to swallow it may be, we find ourselves in the position of having to take what we can get. After all the advocating for a more substantial bill, after all the pushing for a public option, which I still think is an essential component of meaningful reform, we need to be realistic: This is what we can get now.

Should we stop fighting? Absolutely not. But let's accept this initial victory and then push for more in the days, weeks, months, and years to come.


For more on why the bill ought to be passed, see Jon Cohn at Kaiser Health News:

Could the deal be better still? Of course it could. The House bill, for example, offers substantially better protection from out-of-pocket expenses.

That's an argument for improving the Senate bill in conference committee, when its members meet with their House of Representatives counterparts, and for improving the law if and when it goes into effect. Those of us on the left can, and should, fight for both.

But we should also recognize the Senate bill for what it is: A measure that will make people's lives significantly better. Surely that's worth a little enthusiasm.

I'm not sure I can muster all that much enthusiasm. But there's good reason to be positive and optimistic. This is an historic development, with meaningful reform soon to come, and America and the American people will be better for it.

(Cross-posted from The Reaction.)