Is the Senate's health care bill a landmark achievement? Or is it so bad, it should be killed?

"Those on the left dissatisfied with the Senate bill should focus their efforts over the next few weeks on getting as many fixes into it as they can."

-- E. J. Dionne Jr., in his Washington Post column today,

"Democrats: Stop screaming and pass health reform"

by Ken

To the end, large groups of people who would have had to grasp that our health care delivery system is in crisis -- on the verge of bankrupting us without providing adequate health care to the overwhelming majority of Americans -- chose not to get it.

On the NYT website, there's a piece from yesterday, "No Change in Coverage Numbers in Dropping of Public Option," under the standing head, "Prescriptions: Making Sense of the Health Care Debate," in which writer David M. Herszenhorn, while doing a dance of joy over the demise of the public option, essentially kicks and screams, "I will not under any circumstances attempt to understand any aspect of the health care debate, and nobody can make me." It's a piece of such perfectly sublime stupidity that I think this Herszenhorn is a fellow to watch. He should be shooting up the NYT hierarchy.

I avoided writing about the subject of health care reform for a long time, because I knew the complexity of the subject put it way beyond my understanding. When I finally weighed in, in July, it was because it seemed awfully clear that most of the people yammering about health care -- including the heavy hitters in Congress -- were farther out of it than I was.

What I could see, though, was a conceptual sleight of hand that was either embarrassingly inadvertent or slickly convenient. All the yammering, as far as i could see, was aimed at the admittedly serious question of the shockingly large number of Americans who have no health insurance coverage. But that's not a matter of "health care reform," it's "health care coverage extension." Important, but a different issue, though undoubtedly related.

So when Max Baucus, who as chairman of the Senate Finance Committee then was one of the key players, said he saw no need for a public option, according to what he believes, there wasn't any such need. Because he was saying almost exactly the same thing that the Last Standing Senator, Ben Nelson, has been saying to the end. At a Saturday news conference Little Ben laid it out: "“I believe in the free market system as the foundation of our economy and as the primary focus that should drive our health care system and our debate. That’s why I opposed the public option and yet supported the market exchanges.”

The only problem is that to say this, you have to be either a shit-sucking imbecile or a criminal conspirator with the insurance-industry swindlers who have been sucking the financial life out of Americans and watching them get sick and go bankrupt or die (or both). Because yes, the uninsured are a problem, but they are not the problem, which again is that the system -- produced by Senator Ben's cherished free market -- is broken and is a medical and financial death trap for Americans who are insured as well as those who aren't.

I don't remember whether it was coincidence or a natural sequence of events that emboldened me to speak out finally at the very time that Howard Dean's Prescription for Real Healthcare Reform, written with Igor Volsky and Faiz Shakir, was published. If nothing else, what I heard from Dr. Dean sure reinforced my feeling that I wasn't the one who was crazy.

"Don't pretend you're going to do health-insurance reform unless you're really going to change the system," he said. To Keith Olbermann he explained, "This is a battle between the insurance companies and the American people." In the book he explained how real health care reform not only was financially achievable but could be essentially self-financing.

I even offered my own proposed Health Care Legislation Rule: "From now on, no one should be allowed to participate in any way in the drafting of health care legislation without proving that they have read Dr. Dean's book. Proof that they've understood it would be nice too, but that may be beyond the reach of proof."

Of course none of that percolated into the "debate" we kept hearing, or really filtered in in any way. So really the "debate" was about apples vs. photocopied pictures of candied orange slices. And in the end we've got this monster bill that a lot of our friends are telling us we've got to swallow hard and accept. (On the other hand, over at Firedoglake, Jane Hamsher's got a petition going to kill it, with a formidable list of ten reasons why the American people "will revolt" when they "find out what's actually" in it. In today's Post, Ezra Klein tries to prove her list is a scare tactic that misrepresents that facts of the matter.)

The insurance companies had every reason to be pleased by this, and that pleasure didn't come cheap, considering how much money they spent to achieve this outcome. It was worth it to them, self-evidently, because real reform was going to cost them a large chunk of the profits they've been reaping while America gets sicker, physically and fiscally.

Huge sums were spent on public-opinion influencing mechanisms like advertising campaigns, including buying up pol-whores like former Senate majority leader Tom Daschle, who had been slotted in as President-elect Obama's point man on health care reform in his intended job as secretary of health and human services, if not for his little tax problem. Can you imagine of he'd actually been confirmable? Well, I guess the outcome would have been pretty much the same, since we can now see that the Obama administration always intended to seek a solution that was acceptable to, if not actually hammered out by, the insurance industry. (Looking back, it's clearer than ever how little consideration the incoming Obama administration would have given to the recommendation made by some of us, that Dr. Dean be tapped for the job that Tom Daschle had crapped out of.)

So yes, the insurance industry had to really open its wallet this past year. But a shocking amount of amount of its investment, as Howie has reported here at length, was already ongoing: pouring money directly into the coffers of public officials, not least the very members of the House and Senate who would get to decide which health care problem they cared to address -- and who, amazingly, decided by and large that there wasn't any kind of health care crisis that they could see, just this pesky technical issue of a few uninsured Americans. Okay, maybe 40 million, but they were either illegal aliens (um, no) or healthy young people who chose not to have insurance (well, yes, some of them, but that's really not the problem we're talking about).

Even more shockingly, the mighty infotainment news media never saw any kind of story in the massive bribes the insurance industry had paid those see-no-evil Congressfolks. How was it possible that Joe Lieberman could show his face in public to speak on the subject and not be asked, as the first question, about all the money he and the lovely Hadassah, an insurance-industry whore, had collected from the industry he was insisting had to be given a free ride?

Well, I guess it was possible because they were all in on it. Certainly it was no surprise to progressives who always understood that candidate, then president-elect, then President Obama didn't see a health care crisis either, just the glitch of those uninsured folks which could be used as an opportunity to mandate the transfer of zillions more dollars into the coffers of -- who else? -- the insurance companies. Well, the drug companies too, but the president took them out of play early on with a side deal that insured that the subject of exorbitant drug prices, surely a crucial element of the actual health care crisis, would never come up for discussion.

I respect people like Paul Krugman and E. J. Dionne Jr. (though with more reservations -- we'll come back to him) who insist that even the Senate version of health care "reform" (notice how all of official Washington has officially forgotten, with a House-Senate conference yet to hammer out a compromise package, that there actually is a House bill in play, also crappy but just possibly something on which it might be possible to build -- except to snarl warnings not to even think of including any of it in the final bill) is worth fighting for and then building on, as if this system is capable of building on anything.

As I hinted above, I want to be careful not to mischaracterize E. J. Dionne Jr.'s feelings about the Senate bill, about which he has few illusions. He understands, though, how we got boxed into it, and stresses that we have to start fighting now if we hope to have any influence in the next round. After making the recommendation to surly progressives I've quoted at the top of this post, he writes:

And they can do something else: Start organizing for the next health-care fight. Enactment of a single bill will not mark the end of the struggle. It will open a series of new opportunities. It's a lot easier to improve a system premised on the idea that everyone should have health coverage than to create such a system in the first place. Better to take a victory and build on it -- to accept this plan as a "starter home," in Sen. Tom Harkin's apt metaphor -- than to label victory as defeat.

Successful political movements prosper on the confidence that they can sustain themselves over time so they can finish tomorrow what they start today. At this moment, rage is understandable, but hope is what's necessary.

Man has a point. I started this post with the phrase "to the end," and I guess E.J. is right, this isn't the end. Even if it sure feels like it.

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