Don't kill the bill!

I wrote a brief response to Ben's anti-HCR post in the comments but I wanted to expand on it a little, because this may be one of the first instances in like a year when there has been much of any daylight between my opinions and those of someone else on this blog. Also, this may be the most important bill the Democratic party has put forward in decades, and I think the kill-the-bill folks are not really taking a sound, reasoned, long-term view. And for the most part, I will stick to the political calculation, because the policy is a) fairly murky and b) still really unknown to us, as the bill still needs to go through reconciliation. Ben's policy objections to the bill are based on the premise that the bill will force people to purchase insurance, only to face hiked-up rates and eventual bankruptcy as a result. My response to this is as follows: Nate Silver, as well as this this but basically most things Ezra Klein has said.

The Obama administration, to the degree that it can actually influence the design and scope of legislation, is focused on a few more big-ticket items: a jobs bill, financial regulation reform, and some kind of cap-and-trade system. These are all "progressive" things, in that each bill is hoping to change something that I assume we would all agree is bad in order to replace it with something better. And in each case, they will require near-Herculean efforts by the Democrats to pass. It's just a simple reality of our times that the Republicans have no real interest in assisting in anything the Democrats do, even if they may privately believe that these efforts are worthwhile. This strategy worked in 1994, and the GOP is betting it will work again.

Now, each of these bills will be difficult to pass. You know what would make them even harder to pass? Killing a bill that's been in the works for 7 months because it doesn't go far enough on an issue that one could and should arguably go very far on. Momentum is a very real thing in politics, and at the end of the day the only way to build momentum is to get results. Pass this bill and move on to the next, and things may just get a little easier. In the long-term, a legislatively successful progressive movement will only develop in America if it produces, you know, actual bills. If the Democrat collapse in a pile of idiocy in the next couple of weeks and the bill fades away, what kind of message does it send the public about the governing abilities of the Democratic party?

Ben's counter-argument here is that if the bill actually worsens the health care situation, then it will have precisely the opposite effect I'm outlining above. Americans will get angrier, the overall progressive legislative agenda will atrophy, and we'll lose our chance to convince the country that progressive policies are both sane and good for the country. This, of course, assumes the American public will suffer as a result of the bill: in reality, most Americans will remain unaffected. The 30 million who get health insurance and a chunk of generous subsidies as a result will be pretty happy, those with insurance already will start getting subsidies as well, and Medicare will stay the same. And let's be honest: after the bill passes, it's unlikely that the Republicans will be able to make much political hay out of it, even if it does the opposite of what the OMB says it will and bankrupts a number of already poor Americans - a still-bad health care environment in 2014 would really only make it clear that more government involvement (in the form of a public option) would be necessary. Think about it: could Republicans really argue that deregulation or a reduction in government subsidies would fix that kind of system? While I've already been convinced that this scenario is highly unlikely (in other words, I think the bill will do what the OMB says it will), even if things do head down this path I don't know how Republicans could do much of anything with it.

So the choice, as I see it now, is as follows: fight and destroy this bill, which is certainly something progressives could do very easily (not without political cost, but it wouldn't be procedurally difficult), or suck it up, accept the realities of American politics, and gear up for the next fight. One option guarantees the demise of the progressive movement as a potential force in Washington, squandering an opportunity that's been decades in the making. The other option means accepting that, at this moment in time, we can't get what we want, but we can still help a lot of people who really need it.

UPDATE:
Two additional pieces of data:
1. The individual mandate, the requirement that insurance is legally required for every individual, is waivable on a state-by-state basis if the state can meet cost containment as efficiently as the mandate is supposed to. In other words, if the individual mandate turns out to do what Ben speculates it might, then states will not have a hard time abandoning it.
2. The senate bill denies insurance companies the ability to cap or limit the amount of money a customer receives for medical expenses on a yearly or lifetime basis. This is actually a case of, as Jonathan Cohn notes, progressive pressure succeeding. Insurance companies will be benefiting from the individual mandate in terms of their customer base but they're probably not salivating over the notion of losing both rescission and their ability to cap.