Ian Welsh kindly posted a link to my previous post on his blog as a separate post of his own, but rather than come here, most of his commentariat decided to respond over there. Since I promised not to respond directly on this issue on his site, I am going to make a GREAT SACRIFICE and break my promise to forget this moribund joint and respond to some common threads in his comments here, in a new post. (I responded to Paul Lukasiak who kindly commented in the previous thread, and I'll respond to Helena if this post doesn't manage to cover her objections.)
It appears at this point that the Senate bill is likely to pass. For all that it is full of FAIL, I haven't made any secret of the idea that I'm mostly convinced that it is a good thing. The underlying motivation of the table of outcomes in the last post is the sense that, on health care, the US political system is like a highly constipated patient. We want it to poop out the golden brick of a Canadian-style single-payer system, but for many electoral cycles, now, it has been completely unable to poop out anything at all. The reasons for this are the usual: money and media and money-in-media.
Those are big problems, and they are the reason why the bill is so failtastic. But until the surgical suite is ready to fix these problems---a long project---the patient still needs a laxative. The Senate bill has the potential to be that laxative.
With that, here are some of the major classes of objections:
Objection #1: Failure to pass a bill would leave the door open for better bill
I responded to this one in the comments to the previous post. Very briefly, regardless of what Obama wants, failing to pass a bill means that Congress is simply not going to try again any time soon. The official narrative is already ready: no one has done it before, and it's too hard. Clinton failed. The official narrative is part and parcel of the political constipation problem. So, no, failure to pass a bill would mean/have meant that the effort is dead for another electoral cycle or two. There's no evidence to believe that single-payer is going to happen at that point either.
Objection #2: Bad bills never lead to better legislation later on
My first reaction to this idea was a certain amount of incredulity. So I'll farm this one out to Cogitamus, first and foremost.
More importantly, though, American progressives seem not to have learned something that the American right has known for a long time: that apart from actual policy, rhetorical metavictories actually have real, long-term value. For example: even when they can't actually destroy Social Security or other progressive programs and priorities, they can create an overall cultural milieu in which "entitlements" are perceived to eat the future earnings of our descendants.
This bill has the potential to create the perception, once again, that health care reform is both possible and desirable as a matter of conventional wisdom. It may not, but passing no bill doesn't even try.
Objection #3: The public will hate the individual mandate
I can hardly argue that a public-option-less mandate is a great idea for controlling consumer-end costs. This is by far the strongest argument against the Senate bill. But my response is roughly the same. Alright, let's say that it is unpopular. Than the worst-case scenario is that a Republican Congress and President repeals it, leaving the USA back where it was before, roughly. One way or another, if the systemic breakdown of the existing health care arrangement is reaching catastrophic proportions, the only question is time; and this bill could either speed it up or slow it down by a small amount---at worst.
Objection #4: Adopting this bill is a failure to negotiate effectively
This is one of Ian's favorite themes, and it depends on some assumptions, including who the negotiating partner actually is. The negotiating partner is the insurance industry, and what is being negotiated in any health care reform package that might actually be serious is the very existence of a large chunk of that industry if not all of it as we know it. So, they have no incentive to negotiate.
If you doubt that the negotiating partner is the insurance industry, consider the very fact that a public-optionless Senate bill with mandates is likely to pass. With 60 votes. Even with Bernie Sanders (I-VT), regardless of how he really feels.
In conclusion
Progressives from Markos to Jane Hamsher to Ian Welsh have quite well articulated the reasons why the Senate bill is terrible and does not lead in itself to a signficantly improved health care system. This is probably all true. What it does is open a door. The cost to not opening that door at all isn't pretty. Opening that door may not be pretty either. But at least there is a chance of movement. A slim one, but a chance.
One thing I have not so far seen is an account of how and when a better health care system would be instituted for the USA on hypothetical failure of this bill---aside from Objection #1, which I've dealt with. It's really easy to sit around running a creepy drive-by psychoanalysis of Jacob Hacker, and another to explain a political plan given current conditions for accomplishing something via the legislative system. One of these is more fun, I guess.
Otherwise, the best thing to do is to let the bill pass and then claim a rhetorical metavictory---because the meta in all of this is actually important until you have a plan to get yourself to the clean, ideal politics in which good policy is honestly debated.
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