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After Health Care Reform, Reform Democracy December 20, 2009

Posted by Dwight Furrow in Dwight Furrow's Posts, politics.

It ain’t over till it’s over, but unless Joe Leiberman decides to move the goal posts again, it looks like the Democrats have enough votes to approve health care legislation.

The compromises necessary to win the votes of a few conservative Democrats have opened a yawning chasm within the Democratic Party between those who hail the plan as a giant leap forward for progressive ideals and those who are bitterly disappointed about what could have been.

 Paul Krugman on balance approves:

But let’s all take a deep breath, and consider just how much good this bill would do, if passed — and how much better it would be than anything that seemed possible just a few years ago. With all its flaws, the Senate health bill would be the biggest expansion of the social safety net since Medicare, greatly improving the lives of millions. Getting this bill would be much, much better than watching health care reform fail.

At its core, the bill would do two things. First, it would prohibit discrimination by insurance companies on the basis of medical condition or history: Americans could no longer be denied health insurance because of a pre-existing condition, or have their insurance canceled when they get sick. Second, the bill would provide substantial financial aid to those who don’t get insurance through their employers, as well as tax breaks for small employers that do provide insurance.

All of this would be paid for in large part with the first serious effort ever to rein in rising health care costs.

The result would be a huge increase in the availability and affordability of health insurance, with more than 30 million Americans gaining coverage, and premiums for lower-income and lower-middle-income Americans falling dramatically. That’s an immense change from where we were just a few years ago: remember, not long ago the Bush administration and its allies in Congress successfully blocked even a modest expansion of health care for children.

The bill establishes a fundamental principle that liberals have been advocating for decades—that all citizens have a right to health care, regardless of pre-existing conditions or the ability to pay.

This is a rare opportunity—I don’t see how a genuine progressive could vote against such a bill.

But having said that, there is a sense in which the bill offers no real reform and progressives are right to be upset about our inability to replace a fundamentally broken system. The structure of the private, employer based insurance system is still in place. And the lobbying power of the insurance companies made sure of it—they stand to profit handsomely from 30 million new customers.

But such is the nature of political change in our system.

When Medicaid was passed it was unavailable to many low-income adults; the original Medicare bill didn’t cover people with disabilities, the original social security program excluded agricultural workers, government employees, railroad employees, etc. and offered no cost of living adjustments.

In order to achieve any significant social change, liberals must constantly battle to improve programs—but the programs first have to be written into law before they can be expanded.

Matt Yglesias thinks the bill is promising:

And the crucial question going forward is whether it will be possible to further improve this legislation.”

I think it’s very possible, but only if the people who are disappointed by the shortcomings of this bill take appropriate action. First and foremost, that means working as hard as possible to produce as good an outcome as possible in the 2010 midterm elections. […]

[Y]ou accept compromises and then keep on working to build more political power. You do it by contacting members. You do it by urging friends and colleagues to contact members. You do it by donating to and volunteering for good candidates. You do it by turning out and voting for the better candidate in the race even when that candidate is disappointing. You do it by urging viable candidates to mount risky primary challenges against incumbents who don’t reflect the real possibilities of their constituency. You do it by staying engaged, and working hard.

I think this is an excellent bill, all things considered, but whether you agree with that or not the most important thing is what does the progressive community do going forward to enact even better bills in the future.

I agree; progressive voices calling for a defeat of the bill are delusional.

The issue that ought to have progressives riled up is not the bill itself but the process by which the bill was created, which reveals the utter corruption at the heart of our political system. The wholesale bribery which we call “democracy” was on view. The insurance companies made out like bandits with millions of customers who are now mandated to purchase insurance and no competition or price controls that would limit insurance company exploitation. Most of the bill was negotiated in secret with lobbyists and their pawns in Congress calling the shots, supported by the always supine media who praised the so-called “centrists” as genuine pragmatists rather than corporate whores.

What seems to be in tatters is Obama’s promise to change the culture of Washington. Of course, it is not obvious how that culture can be changed (without a wholesale change in the make-up of the Supreme Court which has persistently enabled the Washington cleptocracy with its rulings on commercial speech). Change requires legislation and, with a Republican Party in full-dress, nihilist regalia, Obama had little choice but to play ball with corporate shills like Lieberman and Ben Nelson.

So going forward, while we try to mend the defects in the health insurance system, we should devote more attention to finding some way of mending defects in our democracy—apparently elections aren’t sufficient.

book-section-book-cover2 Dwight Furrow is author of

Reviving the Left: The Need to Restore Liberal Values in America

For political commentary by Dwight Furrow visit: www.revivingliberalism.com



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