03/18/2010 05:12 am ET Updated May 25, 2011

The Long-Term Value of Insisting The Health Bill Is Not Enough

In my piece yesterday about the rigged assumptions confining our health care debate, I might have added one more assumption that seems to be at work here: The assumption that "after this bill is passed, we will later come back and fix the things in the bill that are not good."

This assumption, of course, includes a bit of a contradiction with the first assumption from my piece yesterday - the assumption that this is our "last chance" to enact health care reform. It's not entirely logical to argue that we have one chance to enact health care reform because Congress will supposedly never revisit the issue in the future, and then simultaneously argue that Congress will be happy to revisit health care repeatedly to fix the stuff in this bill that's broken. It's either one or the other -- it can't really be both. And here's the thing: If it's the former, if this is our "last" or "only" chance because Congress won't come back to health care for a generation, then it means the failings of this bill will be cemented in stone; If it's the latter, it means Congress can, in fact, go back to the drawing board right now because it will be happy to revisit health care.

Of course, you could argue that if the current bill passes, Congress will be more likely to go back to health care in the future specifically because this bill will create all sorts of new things that Congress will need to/want to address. But if you are making that argument, then there is an X factor we must all remember as we continue to have this very heated "pass it/don't pass it" argument.

This week, the White House attacked Howard Dean and progressives for highlighting the very serious policy flaws in this bill -- the administration attacked us for threatening the future of health care reform. But what Dean and progressives are doing is actually increasing the chances that the final outcome will be better - both in the short term and the long term.

In the short term, the progressive critique is creating the possibility that the final post-conference bill that is passed into law is as good as it can be under these awful political circumstances. And it is working -- notice that Harry Reid's manager's amendment yesterday made some improvements.

In the long-term, the progressive critique today is helping to increase the chance that Congress will, in fact, revisit health care to make the improvements the bill's backers acknowledge will need to be made in the future. If there is no critique today, we will allow the idea to be baked into in the political discourse that this health care bill fixed everything and Congress doesn't need to touch health care again for a generation. But with the critique, we are laying down markers for what still needs to be improved. It's the dynamic we have, in the past, failed to create, as evidenced by this exchange between then-Rep. Bernie Sanders (I-VT) and President Bill Clinton, as recounted by OpenLeft's Chris Bowers:

I recently heard an interesting anecdote about the 1993 budget fight. While it is probably the most progressive piece of sizable legislation to pass into law in two decades, it was a grueling fight--passing both branches of Congress by a single vote -- and it still could have been better. At the signing ceremony, President Clinton found then Representative Bernie Sanders, and told Sanders that he, Sanders, should have made a much bigger public display of how he, Clinton, wasn't giving enough to liberals in the new budget. Such a public display would have provided Clinton more room to maneuver on the left.

I've heard talk from folks that the super secret plan among congressional Democrats is to pass the current Senate bill into law and then after the Liebermans and Nelsons can't finagle with that bill, do a reconciliation vote on a public option or Medicare buy-in. This may, indeed, happen -- but not because the congressional Democratic leadership will want to out of the goodness of its own heart. If power concedes nothing without demand, Democrats will only pursue that future course of action because there was such a furor over the failure to pass those measures in the original bill that they will feel forced to allow such a reconciliation vote.

So that gets back to the progressive strategy. If we are truly going to be a movement and not merely the arm of a political party, then progressives have to understand the different roles we all play. Politicians in Washington have one role -- they are predisposed to try to get anything done no matter what it is. We have another role -- and right now, our role should be to continue demanding improvements with tactics as cutthroat and as intense as those being used by the insurance industry (and, I know some people differ with me on this, but my own opinion is that means working right now to kill the Senate version of this bill). Because if we don't demand those improvements and show we're really willing to play hardball now, those improvements will never be made.

In other words, if you are a Democrat, wherever you come down on the "pass the Lieberman-gutted bill" or "don't pass the Lieberman-gutted bill" divide, it should be clear the fight we're having right now over the Lieberman-gutted Senate bill is a fight worth having not just for this particular bill. It's a fight worth having for the overall cause of genuine health care reform. The progressive movement backing the president and/or the Democrats because of party affiliation, falling in line out of some obligation to unity, and even using our limited resources to praise this bill as "a good step forward" fails to appreciate how a movement is different than a party or a set of politicians. It fails to maximize what movements need to do to make sure parties and politicians deliver the most they can in the short-term and follow through in the long-term.

Mind you, conservatives want to use right-wing arguments to make this bill as painful as possible to pass, so that Democrats never come back to health care again, and if they do, only to enact conservative (read: destructive) reforms. Progressives must fight that fire with our own fire - we have to use progressive arguments to make this bill as painful as possible to pass (if it does pass), so that Democrats feel forced to come back to health care again so as to make the health care system better.

The fight we're having may be unpleasant and uncomfortable. It may make politicians, pundits and the Professional Political Class angry (I've gotten my share of blowback, believe me). But it is a fight that increases the chances that health care is ultimately reformed, whether today or in the future.