Like most liberals, I’m disappointed by all the compromises that the Democrats had to make to get their 60th Senate vote1 for health care reform. But make no mistake: even without single-payer, public option, or Medicare buy-in, this law is A Very Good Thing. Kevin Drum summarizes what we are getting:
- Insurers have to take all comers. They can’t turn you down for a preexisting condition or cut you off after you get sick.
- Community rating. Within a few broad classes, everyone gets charged the same amount for insurance.
- Individual mandate. (Remember how we all argued that this was a progressive feature back when John Edwards and Hillary Clinton were championing it during the primaries?)
- A significant expansion of Medicaid.
- Subsidies for low and middle income workers that keeps premium costs under 10% of income.
- Limits on ER charges to low-income uninsured emergency patients.
- Caps on out-of-pocket expenses.
- A broad range of cost-containment measures.
- A dedicated revenue stream to support all this.
The chief objection to the bill, among left-wingers who would rather blow the whole thing up than pass it, is that by requiring everyone to buy insurance and not having any publically sponsored competition to keep prices down, the bill represents a massive giveaway to the for-profit insurance industry. On the one hand, they are absolutely right. On the other hand, letting corporate interests skim off social-welfare programs has been standard operating procedure in American politics for decades, even before Ronaldus Magnus. Food stamps are a wonderful benefit to agribusiness. Federally guaranteed loans for both housing and college education are basically free money for banks. Programs like SBIR funnel government research grants to private firms with the explicit expectation that those firms will turn the research into profitable commercial products.
This is all basically legalized graft, but it does give these programs stakeholders with more political clout than, say, minimum-wage workers. And I don’t see how progressives can push the political system far enough to the left that cutting deals with Big Business becomes unnecessary. To do that, a President Obama wouldn’t be influential enough; we’d need a President Lenin.
1 They passed up a golden opportunity during the Bush years. When Republicans were clamoring for an “up-or-down vote” to get Bush’s Supreme Court nominees in, the Democrats should have doubled down and said, “let’s eliminate the filibuster for everything”.