As we go to press, Congress is approaching the climax of its nearly yearlong battle over healthcare reform. This can be called, without melodrama, a do-or-die moment–not only for the cause of healthcare reform but for a host of other progressive goals. As House Speaker Nancy Pelosi said, "This is the most important initiative that most of us in Congress…will ever do in our legislative lifetimes." It represents a milestone in a struggle for reform that goes back not only to the Clinton era but to President Truman’s declaration that healthcare is a basic right of all Americans. As one Democratic strategist pointed out, under Clinton, "when healthcare died, every progressive instinct died along with it." If this bill fails, Obama will probably be forced to abandon the issue for the duration of his presidency, as will most mainstream Democrats. A defeat could also further disenchant and demobilize the base that gave reform-minded Democrats dramatic advances in the 2006 and 2008 elections.
Conversely, a victory would suggest that the Obama administration and Democrats in Congress have the wind at their back and are moving their agenda. And it raises the prospect that more can be done–to improve the healthcare legislation, certainly, but also on everything from immigration reform to climate change/green economy legislation to mortgage relief to financial industry reform. Contrary to the cynical crowing of Republicans, who say they plan to use passage of the bill against Democrats this fall, a careful study of the latest polling indicates that passage could help Democrats.
What about the legislation itself–what does it accomplish? On a concrete level, it expands health insurance to as many as 30 million Americans who are currently not covered; on a symbolic one, it makes clear that the government–not the market–is responsible for healthcare. Those are no small achievements.
And yet, there can be no question that the bill is deeply flawed. Readers of this magazine know that for many years we have supported some version of a single-payer system, or–a much better term whose adoption we urge–Medicare for All. This bill falls far short of that vision. It also encodes restrictions on abortion coverage that are a major setback for the prochoice movement (see Katha Pollitt in this issue). Moreover, it’s unclear whether the consumer subsidies the bill provides will be sufficient to cover the cost of plans offered on the new insurance exchanges, which may include uncomfortably high deductibles, co-insurance fees and premium burdens. In that context, the mandate that people buy insurance could create serious political blowback.
On the plus side, the bill includes protections against insurance industry abuses, including the odious practice of cutting off access for patients with pre-existing conditions, and puts in place a framework for further regulation of the industry. Insurance companies will no doubt use every trick in their playbook to weaken the already shaky consumer protections and shift risk and costs to providers or consumers or both. But the prospect that tens of millions of Americans could rest a little easier–and have someplace to turn for support in seeking and attaining care–is too important a goal to dismiss simply because the coverage may need to be strengthened.