My take is that the bill was already eviscerated before the public option was removed. The version of the public option included in Reid's bill was not robust enough to compete with private insurance, and would have done very little, if anything, to contain costs. In other words, this fight was already lost by the time the bill got to the Senate. Even the house version is merely "pretty good." So in a sense, progressives are angry about the most recent compromises to the right wing of the party, yet those compromises are probably meaningless because what is lost was already lost.
That said, obviously you should not have mandates to buy private insurance, and taxpayor subsidies to help buy that insurance, without any real cost containment, or else it is just corporate welfare for the insurance industry. This isn't half a loaf. Half a loaf is still half a loaf, but this is more like a body missing a couple of its limbs. It's a defective idea.
There's a legitimate debate over whether passing or killing this current bill is good or bad for America, and also whether it is good or bad for democrats. That debate turns on which scenario will get us real reform sooner: a bad bill that lays some groundwork but has to be fixed, or no bill and an eventual crisis in healthare costs that will mean we will have to have real reform. I don't know the answer to that question and I don't pretend to.
I'd rather talk about this concept of reconciliation. I think I partially understand what it is, but not fully. As I understand it, the Senate can get this passed with 51 votes, but only if it jettisons the insurance reform portions of the bill and sticks with those portions that involve spending and revenues, right?
If I've gotten that correct, then the Senate can pass a bill that provides subsidies to buy insurance, a very robust public option, medicaid and medicare expansions, and revenue provisions to pay for it all, so long as they dump out all the insurance reform? If that is correct, then I don't understand why they just don't do it. The reform provisions are actually far less controversial and can be tackled at some later time. Do the reform provisions even matter so much if you have a robust public option, and one which won't, for example, deny coverage for pre-existing conditions?
In the alternative, assuming that there is some good reason to not go the way of budget reconciliation that I am not aware of, they can go the opposite route: dump the subsidies and the mandates, and just pass the reform portions of the bill. It won't cover that many more people, but the reform provisions are generally pretty good, and it gets rid of the core defect here, which is to have mandates and subsidies with no cost control. That really would be a legitimate half loaf, good reform without the downsides. Covering more people can come later.
I guess I just don't understand why these two broad aspects of the bill must be linked in a way that is causing the entire package to become deformed through this process of political compromise. It seems to me they should either use reconciliation, or else break out the non-controversial reform stuff and get that passed instead.
- wolf