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What the Passage of Health Care Legislation Means for the Future

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Being into the whole history thing enough to have written a book on it, I tend to take a long view on the big policy battles we fight today. As I wrote the other day, no piece of legislation ever gets to perfection, and on plenty of them you can have a perfectly legitimate debate even over the most well-intentioned bill over whether it does more harm than good. In addition to the actual policy particulars, lawmakers have to weigh (if they care about political survival) a wide range of other factors, including the political implications both nationally and in their home districts, the symbolism of what they are doing, how the interest groups and donors that matter the most to them are impacted, and how the media nationally and back home are treating the issue. Trying to factor in all these things is intense, and it is understandable that politicians sometimes have trouble making up their minds.

For reasonably progressive-minded advocates and lawmakers on a huge issue like health care, after you factor in all of the above, at the end of the day you also have to ask yourself two very big questions. The first is whether the passage of this legislation sets the stage on other issues for better or worse things to come. The second is whether the legislation, even with all of its flaws and compromises, creates a platform to build on in the future.

I know that all of you think I'm writing about health care, and I am. But I think these two questions are equally applicable to the other big fights looming immediately in front of us- climate change, financial reform, immigration, maybe (hopefully) a jobs bill, Employee Free Choice Act. In every single case, progressives are going to have to make difficult decisions re the compromises they will be forced to make. On none of these issues will we be able to get what we want, and some of the tradeoffs will really suck. But as we are debating the policy pros and cons, we also need to keep those two big questions in mind.

Bob Creamer's post yesterday eloquently makes the argument for health care based on the first question, and my own experience in the Clinton White House, and in researching and writing my book, makes me think Bob nails it dead on. When we lost on health care in 1994, and then lost Congress in the elections because our base was so discouraged that they didn't turn out, it made Clinton and Democrats in general hyper-cautious about trying to do anything big or bold the rest of his Presidency. If we had won on health care, we would have kept Congress, and we would have emboldened Democrats to try other big things. It is one of the most basic laws in politics: victory makes you stronger, and defeat makes you weaker. You can fault Obama for some of his specific policy proposals, and for being too ready to compromise on some things, but one thing he has been willing to do is try to do big things, and if health care goes down, the attempt to do big things will probably will stop- climate change probably is given up on as too hard, financial reform gets weaker, efforts to create more jobs probably is given up on, immigration reform very likely gets shelved. If a health care bill is passed, as Bob argues, it will create the possibility of doing other big things.

The second question is more complicated, and depends on how you read the policy being developed. Paul Begala and I got into a debate this summer, because he was suggesting that progressives were being too stubborn on the public option, that we were "making the perfect the enemy of the good." I strongly disagreed with that argument, saying that I believed some reasonably strong form of a public option was an absolutely essential component of health care reform, because without it there would no check at all on the power of the private insurance industry. I still think I'm right, that the public option is part of the thing that gives us a platform we can build on for the future, but Paul's strongest argument was about Social Security: that when it was first passed, it was far weaker than today, and had many flaws progressives of today would have been rightfully upset about, but that it was a platform future progressives could build on. I think that's how we have to view this health care bill, the climate change bill, and at least some other legislation coming down the pike.

Making big changes is incredibly hard in this country. As I write about in The Progressive Revolution, chances to make truly big changes only tend to come along every 30-40 years, and those chances can be snuffed out very quickly, like they were with Clinton on health care. Where there is some early success, momentum can build into something bigger and more progressive over time: Lincoln, Teddy Roosevelt, FDR, and LBJ all achieved most of their big historic changes after more than a year in office. We need to create that platform so we can build big change one step at a time. Every one of those steps will be slow and painful and infuriating. I still have hope, though, if we can get the first step of health care done, we can take another step, and then another one, and that we will be able to look back many years from now with pride because we made big change history when our opportunity for it came.

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