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Will Marshall

Will Marshall

Posted: December 17, 2009 02:09 PM

Will Liberals Really Kill Health Reform?

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The never-ending story of health care reform took another turn for the weird this week.

It began with liberals working themselves into a lather over Sen. Joe Lieberman's threat to scuttle reform unless the Medicare buy-in was dropped. Now Howard Dean, liberal paladin and former Chairman of the Democratic National Committee, is campaigning openly to kill a Democratic president's top domestic priority. Vermont's Sen. Bernie Sanders, the Senate's sole self-avowed social democrat, warns the White House that he is not a certain vote for health reform, though it's unlikely that he would cast a vote with the Republicans to filibuster it either.

Liberals believe, perhaps with some justification, that Sen. Lieberman has forced changes in the bill simply to spite them. But it has to be said that Lieberman, at least, makes no pretense of being a party loyalist. He crossed the political Rubicon by appearing at the Republican National Convention in 2008 to endorse his friend John McCain. His decision to caucus with the Democrats is a marriage of convenience, so charges of infidelity seem beside the point.

No good purpose is served by the left's fixation on Lieberman as a kind of progressive Judas. It's creepily reminiscent of the orchestrated venom directed against the fictional turncoat "Goldstein" in George Orwell's 1984.

What prompted Dean's scream on health reform was the decision by Senate leaders, backed by the White House, to drop both the public option and the Medicare buy-in in pursuit of the 60 votes needed for passage. In a characteristically self-righteous outburst in today's Washington Post, Dean helpfully accused his fellow Democrats of selling out to the health insurance industry.

The rifts among Democrats, coupled with monolithic Republican opposition to the Senate bill, have fed growing public doubts about health reform. According to a new NBC-Wall Street Journal poll, more Americans oppose the legislation than favor it (44-41 percent). Other surveys show that voters are worried that they'll actually wind up paying more for health care after reform.

Now, liberals are understandably angry that Senate filibuster rules effectively give a handful of moderates inordinate power to block progressive measures backed by a majority of Senate Democrats. That's triggered an important debate - featured on Progressive Fix over whether it's time for progressives to change those rules to either circumscribe or abolish the filibuster.

But it's also true that liberals should not have expected that the Senate bill include a public option or the provision allowing people as young as 55 to buy health coverage from Medicare. The Senate Finance Committee bill did not include them and Obama promised neither during the campaign. In fact, the president has explicitly ruled out a single-payer approach, instead echoing the Progressive Policy Institute's call for a distinctly American approach to universal health care, a public-private hybrid based on the principle of "shared responsibility."

Many single-payer advocates, however, apparently view the president's stance as purely tactical; surely, deep down, he's with them. They see the public option and the buy-in as incremental steps toward a "Medicare for all" approach that ultimately will displace private health insurance.

Obama, however, has been admirably consistent about his top-line goals: expand coverage through public subsidies and mandates; prevent insurance companies from denying coverage or dropping people who get sick; drive medicine toward higher quality and lower costs; and do it all in a way that adds nothing to the deficit. The Senate bill, though riddled with imperfections and compromises, does an acceptable job of advancing those goals and moving the process forward to the final stage: a conference to reconcile House and Senate versions of reform.

So liberals have a choice. They can torpedo a bill backed by a Democratic president and nearly all Senate Democrats, a bill that would cover 30 million uninsured Americans, discipline health insurance companies, and begin the challenging task of containing health care cost growth, in favor of alternatives that stand no chance at all of passage. Or they can pocket the undoubted progressive gains embedded in the House and Senate bills, help their party pass landmark legislation, and keep working to build support in the country for their vision of health reform. Congress meets every year and there will be ample opportunities to refine whatever emerges from today's legislative scrum.

Despite the public infighting and fratricidal rending of garments, congressional Democrats are only one vote away from an historic victory on health care reform. So progressives should stop obsessing over Joe Lieberman, turn off Howard Dean, and help Barack Obama bring home the prize.