11/14/2009 05:12 am ET Updated May 25, 2011

Conventional Wisdom and the Health Care Debate Now

So the dust is beginning to settle after the President's great speech Wednesday night. His poll numbers are up, his plan's numbers up as well. Republicans are on the defensive because of their tea party style histrionics. Democrats are feeling more confident and more unified.

That's all good. The question is where does the debate go now, especially on the center stage issues such as the public option. Unfortunately, I am beginning to fear that instead of using their newfound momentum to win a decisive victory and pass a strong reform bill, too many Democrats want to revert to their old conventional wisdom, culture-of-caution instincts, and move toward a safe "centrist" bill -- centrist meaning one that doesn't take on the insurance industry too much.

The combination of conventional wisdom-laden political analysis ("We could never get a good bill past the Senate"), political caution (not wanting to face the wrath of the powerful insurance industry), and a belief by the policy technocrats that regulatory fixes mean we don't really need that strong a counterweight to the insurance industry in the form of a public option is moving this dynamic in the wrong direction. But there is still one counterweight that might save the day, the same counterweight that progressives have been hoping will stand strong since this debate started: progressives in the House.

The point here is not to blow up the bill. Few progressives, inside Congress or not, want to stop comprehensive health care reform -- it is something a lot of us have been fighting for our entire professional lives. But we also know that without some kind of strong, available to everyone competition to private insurers, they will run amuck in this new system -- raising rates at will and finding ways around the new regulations to keep denying people coverage. Take a look at Massachusetts' skyrocketing insurance rates, where their have universal coverage, but no public option, if you want to understand the problem. Health care consumers are guaranteed quality insurance at an affordable price only with a strong competitor to private insurers. That is the bottom line, end of story. The president has said the public option is only a means to that end. Fine, but nothing proposed so far by public option opponents -- not a co-op, not a trigger -- comes even close.

It is more and more likely we are going to get some kind of bill. What progressives in the House have to do is hold strong and hold together. Negotiating as a block of 60 members makes you a thousand times stronger then letting yourself get picked off one by one by one. If progressives hold strong and hold together, we can still get comprehensive reform with a decent public option. If they don't, the all-important details of this legislation will get worse and worse.

This is what it was always going to come down to: how much courage and moxie House progressives would have in the final negotiations on this bill. The end game has arrived. It is time to stand and deliver.