Better or Worse

03/18/2010 05:12 am ET Updated Dec 06, 2017

The new Senate deal over the public option has its good points and bad points, which I wrote about on Wednesday, and which everyone right now is analyzing and debating. A lot of how people feel about it, though certainly not all, is a classic glass half full vs. half empty argument: It all depends on whether you tend to see things in a positive or negative light, and whether you are optimistic that progressives can build on what's good about this in the future, or whether you think that's false optimism given the power of the insurance industry. Given my generally more upbeat nature, I am starting to feel more positive about this deal in terms of what can be built on in the future, even though I remain generally growly about the compromises we have had to make.

Discussing the upside and downside of the deal announced Tuesday night is not the purpose of this post, however, since that has already been done by me and hundreds of other people. I will no doubt come back to the nature of the bill as details emerge, but today's topic is about focusing on working on making the bill better, and working to keep it from getting worse. One of the problems in the fast moving and intense phase we are in right now is that if we spend too much time debating or bitching about the merits of a particular compromise, the compromise might get worse before the ink is dry, or we might lose the chance to make it better.

As I wrote a few days back, there is no such thing as a done deal on a policy issue as big as health care until the president actually signs the bill. All the good things announced in Tuesday night's compromise are under vicious assault by the big health industry lobbies, and the bad things still might get negotiated for the better in the conference committee or even in the manager's amendment in the Senate. The hospitals, American Medical Association, and insurers are bitterly attacking the Medicare buy-in; the insurers hate the 90% provision (that at least 90% of their revenue has to go into paying out benefits), and don't like being forced to compete the way they are in the federal government health plan; even the trigger, as weak as it is, is under assault. Basically, everything that progressives might like in this compromise is under fierce assault by the big health care special interests.

At the same time, there is an opportunity, mostly in conference committee, to improve the details of this package in some significant ways. The numbers and language around Medicaid could be negotiated upward. The cost formula for people getting in on the Medicare buy-in can be negotiated for the better. S-CHIP provisions could be strengthened and more children and youth could be covered as a result. A whole range of issues around the public option related package could potentially be improved if House progressives bargain aggressively and smartly. And there are still so many issues beyond the public option that need to be bargained over in conference committee (I have written about all these issues here, and Chris Bowers had a good summary here) that are incredibly important -- the issues around both the financing package and the subsidies for poor and middle income people alone are of truly profound economic and political importance. And we have to continue to battle conservative threats to screw both women on abortion coverage, and immigrants on everything.

At the end of the day, as unfortunate as the overall public option defeat is, if we can get Medicare buy-in for 55- to 64-year-olds, expansions in coverage for children and youth through S-CHIP, major expansions in Medicaid coverage, decent subsidies for the uninsured to buy coverage in a more competitive marketplace, and strong new insurance regulations, that would be a pretty remarkable accomplishment. But none of this is done, and this bill can get either a little better or a lot worse. We need to focus right now on pushing to improve the bill wherever we can, rather than getting caught up too much in debates over just how good this still theoretical, still undefined "deal" actually is. Whatever the outlines of this deal currently are, the best parts will go away fast if progressives don't keep pounding away on getting the best possible deal.