The divide between progressives on whether to support the health care bill is one of the most striking things I have seen in all my years in politics. The fact that so many good people are on different sides of whether this compromise should be accepted is the true sign of how complicated both the politics and policy is on this issue.
Beyond the well and passionately argued opinions on both sides, though, there are two facts which are undeniable: for better or worse, this bill passing the Senate keeps the process moving forward; and, for better or worse, the Senate bill is simply unpassable in the House.
Sen. Conrad and all the pundits can deliver all the pronouncements they want about how the House will just have to live with what the Senate did, but between the lack of a public option, the bad abortion language, the tax on health benefits, and other concessions to insurers, this bill cannot get 218 votes in the House. Nancy Pelosi is the best Speaker, and best Democratic House leader, since Tip O'Neill, but not even she cannot corral 218 votes for the Senate bill. Yes, it is true that she could pick up some Blue Dogs who like this far more conservative bill better, but remember that a lot of them are from fairly conservative districts, and for all the stuff progressives don't like in the Senate bill, it is still being attacked viciously by Republicans and the conservative attack machine. Between their political squeamishness, their lack of party loyalty, and the fact that they already voted no once, it will be tough to pick up a lot more of those votes.
The House bill had a two vote margin last time. Say you can pick up 10 moderate Dems who voted no last time. How many votes will be lost on the choice language? How many on the benefits tax? How many on the lack of a public option? How many on the combination of all of the above?
The Senate, and their allies in the White House, may not want to negotiate, but they are going to have to if they want a bill. The abortion language is a mess, and has to get better. Giving one break after another to the insurance industry after stripping the public option language is adding insult to injury. Taxing decent but hardly extravagant health plans is not acceptable. And this bill can't get 218 votes without making some changes in these items at a minimum.
As I have written before, no step in the process of passing a health care bill was ever destined to be easy. The Senate has no margin for error, and so progressives will have to accept some big disappointments, but the margin for error in the House is pretty damn small, too. Everyone needs to be serious about negotiation here, or this thing will not get done.