What's "Progressive?" Surely Not Absolutism?

I've just been reading this column on Huffington Post called "Admit it, a Robust Public Option is Dead." The author, Miles Mogulescu, says that even the public options considered by the three House committees are so small and lacking in teeth that they're "meaningless," and as for the Senate...well that's self-explanatory. He suggests several things that should be added to the bill to make up for the absence of a public option, that could represent an actual constructive answer to Obama's invitation for other ideas to accomplish the same goals: regulating insurance rates, putting a trigger on implementing individual mandates until insurance is affordable, giving medicare the power to negotiate for lower drug prices, and preserving the Kucinich amendment clearing the way for states to enact single-payer on their own is passed.

All good ideas, but they're overshadowed by this passage, an the overall tone of the article evident in it:
"As detailed below, if government regulation of insurance rates and a trigger on individual mandates are added, a bill which bans insurance companies from rejecting customers for pre-existing conditions might still be worth passing. Otherwise, it's little more than a massive government subsidy of the insurance and drug industries and it ought to to be defeated."

This perfectly captures the essence of the huge flaws I've been detecting for quite a while now in the approach progressives have been taking to health care reform and to Obama more generally. The most obvious element, though not the only one, is how the public option--a fairly recent invention, especially in the long history of health care as a signature Democratic issue--has become the totally all-encompassing, non-negotiable, line-in-the-sand, be-all-and-end-all of reform for progressives. It's an eminently good and important idea, and I did expect that this president and solid majorities in Congress would have been able to pass it by now. But I had a feeling all along that the Blue Dogs and their Senate equivalents might get squeamish about it, so the ultimate course of legislative events isn't a huge surprise.

But the way proponents have responded to this situation--amongst Congresspeople like the Progressive Caucus members, pundits, and bloggers--I find a bit more unexpected and a bit frightening. What's developed is a Mexican standoff between the Blue Dogs and the Progressives, some number of whom (claims vary) have signed a pledge championed by the progressive blogosphere, to vote down any bill that doesn't have a "robust" public option in it. Either the public option gets passed, or nothing gets passed, they proclaim. A quick survey of the Senate should tell you that the most likely of those two outcomes is nothing.

As a tactic, the progressives' stand certainly has validity; it helps keep the public option alive and at the center of the debate when it might otherwise have been discarded much sooner and without much notice. It also boosts their own clout within Democratic caucus and Congress overall. But the prospect that they might actually go through with it strikes me as even scarier than anything that's come out of the Gang of Six or the slump in Obama's approval ratings. This "Progressive Block" is basing its stand on a number of faulty premises and assumptions about the other elements of the reform plans and what would happen after its passage or non-passage.

The scenario they foresee if a health care bill without a public option passes is probably true to some extent: the absurd costs of coverage and care won't be reined in, and many people, faced with an individual mandate to get insurance will still be struggling to afford it. Since no one has yet provided a satisfactory answer to what else is in the bill(s) or might be added that could effectively reduce costs as the public option is meant to do, it is a real danger, and would certainly create headaches for Obama and Democrats down the road. But some commentators' predictions of a 1994-redux in 2010, a political backlash that would dwarf the current tea parties and Glenn Beck's 9/12ers, masses of voters turning against the Democrats for a generation, and failure on health care becoming (in the words of columnist Matt Taibbi) as big an "albatross" around Democrats' necks as the Iraq war for Republicans are rather suspect. As important and passion-inducing as health care is, it isn't likely to overrule the economy as a decisive issue for voters in the future. If the economy, mainly the job market, hasn't improved by the 2010 and '12 elections, then that will be the albatross, not health care. If it has improved, then Democrats will probably be okay.

In the other scenario, if progressives do vote down the bill because the public option isn't there, what happens after that? Some seem to think that they can pass genuine health care reform some other time, after they've gotten rid of all the Blue Dogs and corporate stooges in the primaries (an ad being run by FireDogLake in Arkansas names two top targets). Such primary challenges may be a good thing to do in some districts, but putting off reform until then would be an extremely dangerous gamble. If the current Congress can't pass the public option, how plausible is it that Congress in 2010 or later will be any more favorable to it? If it isn't passed now, health care reform would likely have to get through a Congress with shrunken Democratic majorities, and if the Republicans win back the majority, then it would really be hopeless. What would almost certainly happen if the House rejects a public option-less bill is that the status quo would continue, Obama and the Democrats would be saddled with the baggage of a major agenda failure, and progressives would get the blame. It's a lose-lose scenario all around, for Democrats, for progressive causes, and for the country. How long would it take for another opportunity for health care reform to come around? I'd rather not wait and see.

Finally, the core problem, which is how these progressives have cast the rest of the bill, sans public option. On blogs like Open Left and on MSNBC, they use terms like "gift to the insurance industry", "bailing out Blue Cross," "craptastic," "garbage written on Republican toilet paper," and from Mogulescu, "massive government subsidy" of the evil corporate fat cats. Of course they have legitimate concerns about people being able to afford the insurance that they'd now be required to buy, and I wouldn't blame them for being unenthused about the idea of subsidies received by low-income people ending up in the coffers of the insurance companies that aren't facing the new competition from the public option. But what really makes up the rest of the bill that they're trashing?

http://www.whitehouse.gov/issues/health_care/plan/

Well, there is the insurance exchange plan for uninsured people and small businesses, which includes a number of competing plans. The individual mandate would have a "hardship waiver." Some steps toward incentivizing quality of care instead of the quantity of tests done. And above all, there are the consumer protections, effective immediately, to prohibit denial for pre-existing conditions, prohibit recission and limits on coverage, and cap out-of-pocket expenses.

While other progressive bloggers and pundits have done some dancing around these points, Mogulescu actually says succinctly what they've been saying indirectly: only if there is a public option or regulations like what he suggests, "a bill which bans insurance companies from rejecting customers for pre-existing conditions might still be worth passing."

Seriously? Of all the heartbreaking stories you hear about people getting screwed by their insurance companies, don't a huge majority of them involve exactly those things: pre-existing conditions, recission, etc? Aren't those the worst of the worst abuses that have to be gotten rid of? When someone in Congress or the White House talks about the 80% of health care reform that all sides already agree on (even if its not the right number), that's what they're talking about--protecting people from being denied coverage for the terrible sin of actually needing it. And that's what "progressives" like Weiner, Nadler, Hamsher, Sirota & company are willing to throw out if they don't get this one particular newfangled cost-saving measure along with it. How is that "progressive?" How is that standing up for change, or for the interests of the country and the people? It isn't. It's unreasonable, dishonest, and flat-out moronic.

It gotten to seem like some of the members of the "Progressive Block" in the House, and the bloggers and pundits urging them on, that they actually want the conference committee to send back a bill that they can kill. Throwing a bill they call "not real reform" over the edge, they think, would prove that progressives have spines, can hold their ground, and that would give more momentum to progressive priorities in the future. It would do no such thing. Perhaps public-option absolutism is only a proxy for single-payer absolutism, and these people didn't want to pass anything else to begin with. If they just want to wait around for passing single-payer to become possible, they'll be waiting an awfully long time, and may have to watch the progressive movement they helped build go on a long downhill.

Rarely does Congress pass something that most people would consider "complete" or "comprehensive." With luck, what they pass is added on to and improved over time. But nothing turns more people against Congress, parties, and presidents than doing nothing. There are a few people on cable and online who get this, and have a healthy pragmatism to complement their progressivism, such as Jonathan Alter, Jonathan Cohn, and Nate Silver. They can emphasize what's good about the other elements of the bill, and make a reasoned case that enhanced co-ops or a trigger on the public option should be acceptable to progressives if they are constructed right. The public option dead-enders not only refuse to consider this, but seem to express utter contempt for anyone who suggests it. Their attitude isn't limited to health care. In a number of places in the blogosphere, they are now attacking Obama with as much frequency and ferocity as they used to attack Bush. Wasn't it supposed to be the just the right wing that had that kind of ideological purity police?

It is often said that the only (any legislative initiative) that matters is the one you can get through Congress. If a plan like what Obama put forward last week can get through, it will definitely matter to huge numbers of people. Would a health care bill with most of the president's proposals minus the public option be comprehensive? Maybe not. But would it still be reform, and a great improvement over the status quo? Sure. More improvements will likely be necessary down the road, and they can be made with the right kind of effort. Instead of threatening to call everything off at the beginning over one element, progressives should be preparing for those fights when they come.

Miles Mogulescu "Admit It: A Robust Public Option is Dead" The Huffington Post
Nate Silver "A Trigger--with Teeth?" FiveThirtyEight
Matt Taibbi The Rachel Maddow Show for Monday, August 17 MSNBC