On the Healthcare "Reform" Gorgoyle: It's the Little Things You Treasure

It's a piece of crap, but, you know, they had me anyway at "tax on tanning beds."

Look, single payer never had a chance. And single payer was always the only really sane way to go in all this. Hopes for a public option really seemed to die on the vine in the long Finance Committee stall. Medicare-buy-in was, as Atrios said the second it was proposed, a bright object dangled as a distraction for progressives heartbroken about the loss of the public option to be snatched back at the last second. And what remains is a pork-laden band-aid on a catastrophically failed and frankly immoral for-profit insurance system that cannot ever deliver healthcare in anything remotely like a sane or sustainable way.

Indeed, the fact that Obama's healthcare "reform" initiative has always been predicated on this inaugural and ever-abiding insistence that its outcome, whatever form it might eventually take, be compatible with the continued existence of our for-profit insurance industry has always meant that no outcome much different from the one with which we are now confronted was ever really possible.

I haven't always believed that was true, in part because I'm a sucker, but also because it was hard to believe that we would be put through such a long drawn out spectacle of insanity and effort and Party/Presidential capital dispersal if the present mess of disparate reforms and pork really were all we could hope for from this process.

Don't get me wrong, many (well, some) of the reforms are worthy and lots (well, some) of the cash is going in worthy directions, but taken as a cohort these reforms and funds do not really represent the radical transformation they are being sold as either by their enthusiastic proponents or their histrionic foes.

It's hard to see, then, why this rather monolithic reform package was really the best way to go after all. Certainly it is hard to see why this drama was the way to go if it were not preceded first by changes in Senate procedures (hello, filibuster) that literally ensured nothing transformational could happen (and this was even more true when the process began, after all, before Specter shifted, Franken was seated, and with Kennedy alive but deathly ill). What were they thinking?

Be all that as it may, I have relinquished my initial anguished "kill the bill" repudiation for a reluctant endorsement of this gargoyle. I reserve final judgment, of course, right up to the signing ceremony, given the very real possibilities of traitorous last-minute scuttling and even-worse "compromises" down the road.

I do disagree with those who propose that healthcare will not be revisited for another decade, since it seems to me the structural deficiencies of this bill (if we are to take the present state of the thing in the Senate as a reasonably close approximation of the bill we'll get) will yield problems that demand legislative redress in almost no time at all. I hold little hope for improvement in conference (unless it be in matters of front loading some benefits and plumping the subsidies for a bit of mid-term electoral payoff), although it is true that progressives find themselves in a marginally better bargaining position structurally speaking at that point.

But I don't think it is too much to hope -- especially if fighting liberals start pressuring for such outcomes immediately and never let up, well, that is to say, after having a drunken rant or cry or nap first, immediately after the blasted thing finally gets the Presidential signature -- that perhaps we can get back some key parts of what we've lost through future bills taken up through reconciliation proposing minimal "fixes," you know, in the spirit of "tinkering" rather than, you know, radical re-visitation with all its drama -- in an effort to introduce "better cost containment mechanisms" here and there, "more choice" in the exchanges, stronger "policing mechanisms" to enforce what are, after all, already agreed-upon aspirations and mandated best practices -- as the inevitable bad behaviors ensue for the lack of much check on any of them in this package.

Now it's jobs, jobs, jobs, if you ask me. Then more, and better, democrats at the mid-terms (or at any rate, buck the historical trend of substantial losses and sell it as a third huge Democratic victory in a row in the midst of catastrophic Republican self-marginalization). And, come what may, this time next year start pushing again toward medicare buy-in for all, state by state, age cohort by age cohort, till we get what we want.