Well, here we go. It looks like this Sunday, the Democrats will take their best shot at finally passing a health care reform bill. There's been lots of anxious hemming and hawing on the left about this bill. We all agree that it's pretty lousy, and pretty far from what we really want. But the question is, should we reluctantly support it anyway? With Dennis Kucinich's recent defection from the anti- to pro-bill side, I thought I'd reopen this debate.
It seems to me that if you oppose passage of this bill from the left, you have to believe at least one of the following three things:
- Killing this bill will make it easier to get something better (i.e. single payer) in the future.
- Passing this bill will strengthen the far right, because it will be so unpopular.
- Passing this bill will make the health care situation in this country even worse than it is now.
The argument against (1) is that we've seen what happens when health care fails: the issue gets frozen in carbonite for 15 years, while everyone buries their heads in the sand and ignores the accelerating crisis. The argument in favor of it is that this time is different, because we're going to hit the wall pretty soon: the growth in health care costs and the attendant fiscal crisis of the state will become genuinely unsustainable very soon if nothing is done. If the current reform passes, it may be possible to cobble together a solution that preserves the private insurance industry. If it fails, we may be forced into a more radical and better solution.
The argument for (2) mostly turns on the individual mandate that forces people to buy insurance. If you think that the combination of the mandate and inadequate subsidies will outweigh the other things in the bill (like the ban on recissions and denial for pre-existing conditions) in the minds of voters, then you believe this point. If not, then you don't.
As for (3), I direct you to these talking points from Physicians for a National Health Program, which go into the many problems with the bill--including not only the mandates and subsidies issue, but the prospect that the regulations on insurers may not work. If you accept this critique, and you believe that it will be harder to fix this bill in the future than it will be to fight for a totally different bill if this one fails, then you can oppose health care for reason (3).
My personal view is still kind of ambivalent, though leaning toward being pro-passage of the bill. Of the reasons to be opposed, I'm most drawn to (1), but I ultimately think that if we wait for the crisis to overtake us we'll end up with an even more reactionary solution based on austerity rather than expanded coverage. (2) I think is really implausible--this bill will only become more popular if it passes, and less popular if it fails. I think I accept the first part of the justification for (3)--the bill really does suck a lot--but not the second part, because I think fighting to fix this bill will be easier than starting from scratch.
But by no means am I certain about any of this. So I want to open this up to all our commenters and regular contributors: where do you stand on all this?