Politics can make for strange bedfellows. Over the last two days, progressives have joined conservatives in their calls to delay or kill the health care reform bill, but party icons like Bill Clinton are advocating to stay the course.

After Howard Dean articulated his position in favor of killing the bill (remember: he's saying that the good should be maintained, but the removal of major provisions removes the need for a major bill), the responses and reactions began pouring in.


Dean has spent time refining and clarifying his response, saying to Salon:

What irks him the most in the current bill, he said, is that it permits insurance companies to charge as much as 300 percent more to some customers than others. So even though they must provide coverage to anyone who applies — known as "guaranteed issue" — the price differential that can be charged to older or sicker customers virtually erases that promise. "If you have to pay $20,000 a year for insurance, what good does it do if you have guaranteed issue?" he asked rhetorically. "Which is in fact what you'd have to pay if they can charge you three times as much as they do ordinary people. They have 300 percent rate differences in that bill. In Vermont, we have 20 percent rate differences, and that works."

The bill lacks sufficiently stringent controls on insurance company pay for executives and other wasteful expenditures as well, Dean argues, which is why he also opposes its mandate requiring all Americans (with few exceptions) to buy health insurance. "Why should you force Americans into a system that takes between 20 and 30 percent off the top for CEO salaries and return on equity?" he asked. "You're forcing them into that system and it's unfair." There should be no mandate without a public option, he said.


Uber-pundit Keith Olbermann launched the second wave on Wednesday night's Countdown.
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Other notables from Olbermann's comment (taken from his diary at Daily Kos):

There could not be a finer line between the words compromise and compromised and tonight, with the greatest possible reluctance, I believe I have to go on the air and state my opinion that the Senate bill in its current form has clearly crossed that line and, as currently constituted, cannot be passed.

The American Insurance Cartel is the Death Panel, and this Senate bill does nothing to destroy it. Nor even to satiate it.

It merely decrees that our underprivileged, our sick, our elderly, our middle class, can be fed into it, as human sacrifices to the great maw of corporate voraciousness, at a profit per victim of 10 cents on the dollar instead of the current 20.

Sir, if they are going to call you a socialist no matter what you do, you have been given full unfettered freedom to do what you know is just. The bill may be the ultimate political manifesto, or it may be the most delicate of compromises. The firestorm will be the same. So why not give the haters, as the cliché goes, something to cry about.


This sentiment is mirrored by many progressives, who are concerned that reform will be a much larger benefit to insurance companies than to those it was originally conceived to help. Nate Silver, Markos Moulitsas and Jon Walker are arguing in circles about benefits and costs. However, I found stumbled across an easier way to explain it, thanks to my friend G.D. at PostBourgie, who recently posted a plea to progressives who want to scrap the reform bill:

This bill will be imperfect in a lot of ways. A public insurance option would have given the government the ability to negotiate lower prices with hospitals, which would have in turn lowered the cost for people insured privately. Even a Medicaid buy-in, the last, best compromise on the table after the all the public option stuff was killed, would have been a considerable improvement over what this final bill will look like. But it's worth remembering that Social Security, a landmark piece of progressive legislation, was a mess when Roosevelt signed it into law. In its original form, it effectively excluded women, people of color, farmers, nurses and tons of other folks. These were horrible exemptions, but to mix metaphors, the safety net was expanded as legislators added meat to the original skeleton.


G.D. also borrows an analogy from Nate Silver, who writes:

Suppose the following scenario plays out when you're trying to buy a used car:

Dealer: The price of the car is $2,000.
You: For that beat-up Honda Accord? I'll give you $1,200.
Dealer: Nope, it's $2,000.
You: How about $1,500?
Dealer: I'm going to stick with $2,000.
You: Will $1,700 get it done?
Dealer: My best and final offer is $2,000.
You: Give a guy a break! $1,875?
Dealer: $2,000.
You: $1,995 and a Slurpee coupon?
Dealer: Now we're talking - step into my office.

Is that a negotiation in bad faith? Is the dealer moving the goalposts? No. He's being very stubborn and very firm - but he's also being very explicit about what he wants. It's possible that you were an incompetent negotiator and that maybe if your first offer had come in a little lower, or a little higher, you could have gotten a better price. But more likely the dealer simply had more of the leverage and ultimately $2,000 is an acceptable price to you, even if it's more than you were hoping to pay.


But to me, there is a logical flaw in that argument. As I wrote in G.D.'s comment section:

People say it's a good first draft. But the government is not a school, and there are no deadlines for completion of these things. Much legislation has been deemed "a first draft" – then left alone for 20- 50 years before the next crisis comes up.

I quoted Nez this morning, but as I have said before – as an uninsured person, I am hoping against hope that this thing would turn out well. But as it stands now (and we haven't even had the big House/Senate throwdown!) the only guarantees are that (1) insurance companies can't turn me down (good) and (2) health care coverage will be mandatory, regardless of what they come up with (WTF?) There are other good things in the bill, but most of that has been hijacked. They are asking for too much trade and not enough reward.

[That being said, I] Disagree with Silver's analogy. It's like I walked into a dealership, mindful of cost but looking for a decent four door sedan. It doesn't mean we weren't flexible, but the conversation is more like:

Dealer: The price of the car is $2,000.
You: For that beat-up Honda Accord? I'll give you $1,200.
Dealer: Nope, it's $2,000.
You: Wait a sec…Blue Book on that is only $1,000!
Dealer: I'm going to stick with $2,000.
You: (Walk away, not trying to be robbed)

There's no Blue Book for Health Care Reform, but this cost/benefit isn't looking right.


In essence, we are being asked to support a bill that may be a lemon.

G.D. pointed to Social Security as an example of a first draft that evolved. This morning, Paul Krugman weighed in to the New York Times op-ed page with the same analogy:

Bear in mind also the lessons of history: social insurance programs tend to start out highly imperfect and incomplete, but get better and more comprehensive as the years go by. Thus Social Security originally had huge gaps in coverage - and a majority of African-Americans, in particular, fell through those gaps. But it was improved over time, and it's now the bedrock of retirement stability for the vast majority of Americans.


There are two key things wrong with that assumption.

Social Security Act was signed into law in 1935. But many people did not benefit from the laws until 1954, when a lot of the groups originally discriminated against were explicitly covered under the bill. According to The Color of Wealth, it was almost two decades before Social Security was workable and benefiting the most vulnerable groups:

As the U.S. Congress debated and the passed the Social Security Act of 1933, millions of workers were required to fill out applications where the choices were limited to white, Negro, and other: Indian, Mexican, and Asian. The Social Security Act disallowed coverage for farm workers, laborers, housemaids, and others in the service sectors. [...]

Social Security did not explicitly exclude blacks and Latinos, but by excluding agricultural and service work, the effect was the same. (p.146, p. 289)


Wealth goes on to explain how, after the 1950s era reforms, Social Security became the most effective social program we have. It doesn't mean that it is perfect. But Social Security, as we know it today, allows for many seniors to stay out of poverty. While we do have a 10% poverty rate for seniors, it is estimated that rate would be close to 50% without the program. In addition, the program that initially excluded minorities was transformed into a lifeline, especially for African American communities:

Because people of color have less income from stock holdings or capital gains than whites, social security is especially important to them: it is the sole source of income for 40% of elderly African Americans. The shorter life span of African American men mean that both survivor and disability benefits go disproportionately to African Americans. While African Americans make up 12% of the U.S. population, 23 percent of children receiving social security survivor benefits are African American, as are about 17% of disability beneficiaries. (p. 284)


So, it while we can look at the long term on this bill, it is important to note that it was close to two decades before most people were allowed to benefit. And as this debate has worn on, the goal posts seem to shifted from "getting Americans affordable coverage" to getting "most people affordable coverage" to "taking a first step." But if the American people need reform now, as many of the initial speeches on the subject proposed, why would be want an incremental change - particularly as history has shown that governmental change creeps like a glacier?

Secondly, the Social Security Act was not revisited because of the good will of Congress, but because people were being actively denied benefits due to discrimination, on many different fronts. It was because of the agitation of groups like the NAACP that change occurred - and I, for one, do not believe the bill will be revisited unless pressure continues to mount. Why do we need to wait for insurance companies to prove they are not acting in good faith to take reform seriously? If columnists like Krugman want to invoke historical trends, they need to look at the whole picture - if the American public has learned that bills are frequently inadequate when they pass, the lesson we need to learn is to get things right the first time.


However, many Democrats disagree. Former President Bill Clinton flexed his political might in support of the bill yesterday, saying:

Our only responsible choice is the path of action. Does this bill read exactly how I would write it? No. Does it contain everything everyone wants? Of course not. But America can't afford to let the perfect be the enemy of the good.

And this is a good bill: it increases the security of those who already have insurance and gives every American access to affordable coverage; and contains comprehensive efforts to control costs and improve quality, with more information on best practices, and comparative costs and results. The bill will shift the power away from the insurance companies and into the hands of consumers.


David Axelrod agrees, warning:

"We're on the verge of doing something that would make an enormously positive difference for people," Axelrod said, adding later, "I don't think you want this moment to pass. It will not come back again."


Axelrod - and by extension, the Obama Administration - argues that this is a bill "about the American people."

This debate isn't completely polarized. There are many, many people who fall somewhere within the opposing calls for all-in or all-out on the legislation. Andy Stern, president of the SEIU, who represents a large majority of America's unionized workers, says that we don't need to kill the bill. What we need to do is to fix it:

Our message is that it's time for the Senate to finish its job. We probably have the best we are going to do, and trying to improve the Senate bill doesn't seem realistic right now. The real final chapter in this story is going to be written in the conference committee. That's where all of us have to push together—to try to improve the affordability issues that, we think, the Senate did not handle as appropriately as the House. [...]

We have an organizational culture that allows individual senators to stop a vote from happening or stop a debate from taking place. I think that is morally wrong. It hurts America, diminishes its ability to solve problems. No single senator is so important, their ideas so important, that they should be able to stop us from having a debate over critical issues.


But somehow, as pressures mount to pass the bill according to the original timetable, and Republicans lock ranks in hopes to delay the bill, the concrete idea of why Congress started this process in the first place feels farther and farther away.

"It's unfair" [Salon]
Keith Olbermann joins call to kill bill [Politico]
Special Comment: Not Health, Not Care, Not Reform [Daily Kos]
20 Questions, 20 Responses [FiveThirtyEight]
A Good, Imperfect First Draft [Postbourgie]
The Public Option Fight May Not Have Been Winnable [FiveThirtyEight]
Pass the Bill [NY Times]
The Color of Wealth: The Story Behind the U.S. Racial Wealth Divide (Paperback)
Social Security Act [Wikipedia]
Bill Clinton on Health Care [Time]
Axelrod: 'Insane' for Democrats to oppose health-reform bill [Washington Post]
Andy Stern: Don't Kill the Bill. Fix It. [The New Republic]
Health care time line still on track [Politico]
Senate Republicans vow to delay health-care vote [Washington Post]


Earlier: "Kill The Bill": Is Real Health Care Reform Still Worth Fighting For?