The dilemma facing progressives on health care is simply that the indifference in the face of suffering that the Joe Liebermans of the world have greatly increases their negotiating leverage. His threats to blow up health care reform are simply going to be more credible than those of people who actually care about whether people have access to health insurance. When combine this asymmetry with the Senate’s malapportionment and supermajority rules, this produces legislation that will produce a system vastly inferior — far more expensive with less access and no more effectiveness — to the health care framework of any comparable democracy.
But unlike Paul, I don’t really consider the question of whether the bill is worth supporting terribly difficult. Is the bill better than the status quo? It quite clearly is. And not just in a purely symbolic way, like the 1957 Civil Rights Act, but in a way that provides real, tangible benefits. So the only reason to oppose the bill is if you think that abandoning this bill would lead to a better one. Alas, it would be understating the case considerably to say that this is implausible. Lieberman, Nelson, Lincoln et al. aren’t suddenly going to become progressives. Congress will almost certainly be less progressive, not more, after the 2010 midterms. As the fact that even people like Russ Feingold oppose reconciliation for health care makes clear, most Democratic senators are going continue to support various countermajoritarian rules that increase their individual leverage even though they undermine progressive change in the long-run. For those of who believe in the Green Lantern Theory of Presidential Power Over Domestic Policy, Obama’s going to be here until 2012, and if he loses, it will be to someone much worse.
Given what’s at stake, playing heighten-the-contradictions would be grossly irresponsible unless one has a very convincing story about how a better reform bill is going to happen in the foreseeable future. Given that there isn’t one, the bill should clearly be supported even in its current form.