Politics

The Realities Of Passing Health Care & The Risks Of Not

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Time and time again during this grand debate, I’ve said that compromise was not only appropriate, but also absolutely necessary if we wanted anything passed. Yes, this legislation is flawed. But all important legislation is. Eventually, we’ll build on this and create something that works for every single American, but for now we’ve got a good start.

Still, what did we hear from the left throughout this process? “You’re not doing enough! This isn’t reform! Give us a public option or give us nothing! Obama is breaking promises!” Perhaps they forgot this during the Bush years, but politics is the art of the possible and a public option wasn’t possible with this Senate. Neither was not having a mandate. Sorry folks. Thems the breaks. And it’s not like the Dems will have a better chance to pass this because it’s likely that Dems will lose their 60 votes next year.

Thankfully, liberals like Ezra Klein get it…


Passing legislation, it turns out, is a long and ugly process. God, is it ugly. The compromises, both with powerful special interests and decisive senators. The trimming of ambitions and the budget gimmicks and the worship of Congressional Budget Office scores. By the end, you’re passing a compromise of a deal of a negotiation of a concession.

But bad a system as it might be, it’s the only one we’ve got. At least for now, this is what victory looks like. The slow, grinding, ineluctable advance of legislation that is quite similar, albeit not identical, to what you began with. It’s not pretty, and it doesn’t necessarily feel like winning is supposed to feel. But this bill will do most of the things supporters hoped it would do: cover about 95 percent of all legal residents, regulate insurers, set up competitive exchanges, pretty much end risk selection, institute a universal structure that we can improve and enhance as the years go on, and vastly reduce both medical and financial risk for families.

It’s been a long time since the legislative system did anything this big, and people have forgotten how awful the victories are. But these are the victories, and if they feel bad to many, they will do good for more. As that comes clearer and clearer, this bill will come to feel more and more like the historic advance it actually is.

And from the right, well, there was basically a consensus early on that defeating the health care bill was more important than being involved in the process. I thought that was foolish, and still do. Sure, they’ll pick up some seats next year, but they weren’t involved in the most important legislation they’ll ever vote on. And all because they wanted to pick up some seats? Not smart.

Let’s see what they voted against:

  • Removing lifetime caps on how much care you can get.
  • No more denying people insurance based on pre-existing conditions, which has the net effect of making health care a right, not a privilege.
  • Insurance companies can’t charge higher premiums based on gender or medical history.
  • Subsidization of private health insurance for Americans who make up to 400% of the poverty level.
  • Medicaid will be extended to those who make 133% of the poverty level.
  • Health insurance exchanges (co-ops) will be established in all 50 states that give people and businesses the opportunity to pool together and force down premiums.
  • Antitrust exemptions for health insurance companies are now gone. That means the monopolies that exist all across the country will eventually go away.

That’s a hell of list to oppose. Think that won’t hurt Republicans down the road? I can’t help but think it’ll seriously hamstring them, especially after 2014 when a lot of the reforms kick in.

So, those are some of the realities and the risks. And, at least to me, Americans got one hell of a gift this holiday season with this legislation. Tell me what you think.