Already, those whose instincts are to try and write the first draft of history have taken fingers to keyboards - believing it somehow akin to taking quill pen to parchment by the light of a fading candle - to tell us how bravely historic and impressive last night's vote was.
Thanks a lot... but no, thanks.
As with every step along the healthcare process - and indeed, emblematic of the whole "future tense" discussion of the Obama Administration - the backpatting and self congratulating are premature. The Reconciliation bill is not law yet (we'll see if Harry Reid can actually follow through on promises not just to pass the bill, but to pass it cleanly in a way that doesn't require further House action), and the Senate bill remains, even with those fixes, more problematic than boldly impressive.
Oddly, I think Ezra Klein actually managed to put things into a relatively helpful perspective - in the process, I think, of showing the kind of progressive incrementalist he is growing up to be - by calling the bill, in essence, bold incrementalism. Where he, and many others, are wrong is in these fanciful assumptions that we've entered into a "start" on reform that leads, bright lined, to future action on further reform.
(And that, I think is a good lesson to the angry progressives who've opposed this bill all along, passionately arguing that the real solution is single payer: your enemy was not this bill, but the ability of many "reasonable" liberals to accept half-loaves and promises of a bright tomorrow. You have to trample on your friends' dreams to get the kind of change you really want. And I think many progressives - dreamers all - don't have that level of cruelty within us.)
What we're getting is what we've got: an employer based healthcare system, that tries, on the margins, to cobble together solutions for those who don't fall, neatly, into the employment box. That's how you expand Medicaid (without paying for it), add in health insurance "exchanges", and generally increase regulatory pressure on insurers to continue coverage when its economically challenging - preexisting conditions, the "lifetime costs" of people with expensive procedures, and such. Structurally, the bigger problem is never addressed: separating healthcare and employment is key to any rational reform that would actually change how we deliver care in this country. Without that, we're really doing very little.
With a bill that kicks the most substantial changes way down the road, which hides from the hardest choices - even Nancy Pelosi's claims that the "Medicare Doc Fix" (which, essentially, runs away from any serious effort to rein in Medicare reimbursements) will happen later shows the dishonesty in all of this - we're not getting real reforms, not any time soon... and in the long run, not at all. Republican claims to "repeal" the reform bill are unlikely to succeed (or to occur)... but incrmentalism is probably also the road map of how incrementalism will also come out: much of what's in the Senate bill could be nibbled away, years before it's even set to take effect.
In the end, I think the rush to claim history's mantle, to hail this passage as far more than it ever was or will be is a signal about Democratic desperation to have something, anything, to point to as a success in a dismal Presidency that is, by any honest reflection, not quite what anyone wanted. The bill passed, in the end, because failure would, too obviously, underline what hasn't happened as a result of electing Barack Obama. But in a month's time, maybe less, I suspect that the underlying reality will shine through: redefining a "historic win" can't shield Democrats from what's likely to come - renewed divisiveness, lack of additional accomplishments, and in November, midterm election results that will make everything that much harder and much less positive. To those who would take today, and the days that follow, to cheer a little too loudly, I can only say, it just depends on what you think you've won. And maybe, try thinking again.
we are officially in a bizarro world when our government tells us we don't have a right to health care but do have an obligation to buy health insurance...at the same time!
Posted by: jinb | March 22, 2010 at 02:59 PM