When the health care debate began lo these many (many, many, many) moons ago, I felt sure of some things based on my experience with the health care reform battle in the Clinton White House. I was certain that it would take far longer than was being projected; that the bill would have lots of compromises that would make me unhappy; that the process would be messy, ugly, convoluted, bitter and highly partisan; and that every single step of the way would be wrenchingly hard.
It turns out that I was an optimist.
All of my assumptions came true in spades, but in every single case it's been worse than I feared. We are now finally - finally - coming to the end game. Over the next couple of weeks we will finally know whether having gone this far, Democrats can drag this wounded beast of health care reform across the finish line.
There are so many things about this process and this bill that I am unhappy about. The Obama White House made way too many tactical mistakes, compromised too early and too often, gratuitously insulted their base multiple times, and failed to show the leadership they should have on some of the biggest issues. The final package, while improved in some very significant ways from what the Senate passed, will be deeply flawed both policy-wise and politically. At this final moment of decision, though, I think progressives need to say yes to getting the bill passed.
Over 40,000 Americans a year are dying from not having insurance, and that number will go up if this bill isn't passed. People who don't have any way of getting insurance currently will get insurance with this bill, and subsidies to help pay for it - subsidies that progressives have succeeded at increasing from the inadequate Senate bill. A right to health insurance would finally be established in this country, crossing a rubicon that we have worked to cross for over a century. Insurers will no longer be able to screw people who have pre-existing conditions. Insurers will finally be subject to federal rate regulation. National exchanges will improve competition for insurance companies.
For all the disappointments, for all the flaws, this legislation does some critically important things, and I believe it sets the stage for doing better things down the road. If Democrats can't get this passed now, the lesson that Democrats will learn is to never try anything big or difficult again. If we get this legislation passed, it begins to change the psychology of Democrats just a little: that they can succeed at being ambitious and that they can make big changes if they persevere in the face of big money and political challenges.
So I'm all in. As painful as the process has been, as disappointed as I am by the flaws in the bill, I'm all in. I'm not consulting with anyone anymore on this issue (HCAN has had me as a consultant for a while, but that's been done for some time). I'm in this fight because I think it's the right thing to do. Which brings me to the rather painful decision I had to make late yesterday: that cruise trip I won a few months ago in the Air American contest (many thanks to all of you who voted for me) leaves from San Diego tomorrow, and I've decided not to go. My wife and I were really looking forward to it, having never been on a cruise, and we were very excited to be able to spend some time with Rachel Maddow, who is the featured guest on the cruise. (Seriously, Rachel, you are my all-time favorite cable show host, and getting to hang with you was the main reason I wanted to go on this trip. Maybe we can do lunch sometime.) But with the fate of this bill hanging in the balance, with the Speaker still facing a tough hill to get the necessary votes, and next week being the time to finally pin people down and get this done, I could not in good conscience go on the trip. I started working for universal health care 30 years ago, I fought the good fight with the Clintons the last time around, and I am not going to leave the battlefield for a week now. I am going to fight tooth and nail to get it done this time.
Plus I have one other big reason to stay: the insurance industry is coming to town. As I wrote yesterday, thousands of people will be marching to the Ritz-Carlton, where the insurance executives are meeting, and we're going to shut the meeting down. I want to be there with my friends and allies to hold these insurance execs accountable for the people who have died because of the way they do business. I hope you will join me.
To all my progressive friends who have been fighting this long, hard fight on health care: I know not all of you agree with me that this bill should be passed. But I think on balance that this is the right thing to do, not only in terms of health care but in terms of our broader progressive agenda. Because of you, not even the fight for the public option is over (although it's way uphill). Let's stay on the field, keep fighting, get this bill done, and then keep fighting for better things in the future.