Health Care Reform: Where do we Stand?


Well, here we go. It looks like this Sunday, the Democrats will take their best shot at finally passing a health care reform bill. There’s been lots of anxious hemming and hawing on the left about this bill. We all agree that it’s pretty lousy, and pretty far from what we really want. But the question is, should we reluctantly support it anyway? With Dennis Kucinich’s recent defection from the anti- to pro-bill side, I thought I’d reopen this debate.

It seems to me that if you oppose passage of this bill from the left, you have to believe at least one of the following three things:

  1. Killing this bill will make it easier to get something better (i.e. single payer) in the future.
  2. Passing this bill will strengthen the far right, because it will be so unpopular.
  3. Passing this bill will make the health care situation in this country even worse than it is now.

The argument against (1) is that we’ve seen what happens when health care fails: the issue gets frozen in carbonite for 15 years, while everyone buries their heads in the sand and ignores the accelerating crisis. The argument in favor of it is that this time is different, because we’re going to hit the wall pretty soon: the growth in health care costs and the attendant fiscal crisis of the state will become genuinely unsustainable very soon if nothing is done. If the current reform passes, it may be possible to cobble together a solution that preserves the private insurance industry. If it fails, we may be forced into a more radical and better solution.

The argument for (2) mostly turns on the individual mandate that forces people to buy insurance. If you think that the combination of the mandate and inadequate subsidies will outweigh the other things in the bill (like the ban on recissions and denial for pre-existing conditions) in the minds of voters, then you believe this point. If not, then you don’t.

As for (3), I direct you to these talking points from Physicians for a National Health Program, which go into the many problems with the bill–including not only the mandates and subsidies issue, but the prospect that the regulations on insurers may not work. If you accept this critique, and you believe that it will be harder to fix this bill in the future than it will be to fight for a totally different bill if this one fails, then you can oppose health care for reason (3).

My personal view is still kind of ambivalent, though leaning toward being pro-passage of the bill. Of the reasons to be opposed, I’m most drawn to (1), but I ultimately think that if we wait for the crisis to overtake us we’ll end up with an even more reactionary solution based on austerity rather than expanded coverage. (2) I think is really implausible–this bill will only become more popular if it passes, and less popular if it fails. I think I accept the first part of the justification for (3)–the bill really does suck a lot–but not the second part, because I think fighting to fix this bill will be easier than starting from scratch.

But by no means am I certain about any of this. So I want to open this up to all our commenters and regular contributors: where do you stand on all this?

Tagged as: ,


  1. I am with you Peter. I think the damage passage would do to right-wing morale and the doors it opens for other progressive (or at least moderate) reforms are both positives. It certainly is easier to expand healthcare coverage with this than from scratch decades down the line. After getting my COBRA partly subsidized through the ARRA, I realize even not perfect (ideally, I should live in a single-payer system) reforms are better than the system as it is today.

  2. I agree wholeheartedly with the passage of the bill, for the sole reason that it’s doing Something. I believe that the most important thing that we can do in order to move towards a single payer system is to jam our foot in the door. By putting our support behind this bill, we may be able to establish an eventual overhaul of the system as a whole without significant opposition from many of the centrists who have done so much to derail previous attempts at healthcare reform.

  3. Just an FYI: Fire Dog Lake’s list of reasons to kill the bill:

    Worth reading regardless of where one stands.

  4. While I don’t think it’ll be as awful as Hamsher says, if this were up for the American people to decide, I’d vote no or write in for single payer.

  5. I agree, the bill does not go nearly far enough with reform, but it is still a step in the right direction. And once it actually takes effect, hopefully ordinary Americans will realize that the insurance industry is a huge parasite on society and more directly support single-payer reform.

  6. I am with you, I stand on the line but am leaning pro-passage. The bill isn’t impressive, but it is better than nothing. And like you said, It is easier to improve a bill than to start over from scratch. Also, if this bill doesn’t pass it could further discredit the Democrats, leaving the Republicans up to fixing health care in 2012, which probably means no bill at all or a bill far, far worse. Ky Socialist, I sort of disagree with what your saying. If this bill improves conditions of health care at all, I think the general population could begin to see the private insurance companies as a more positive force and a preferable system to government intervention or takeover, possibly temporarily closing the doors to more radical reform in future years. This bill puts us in a pretty big bind whether it turns out to be positive or negative.

  7. I can see the reasoning behind a lot of the arguments made here, but I am still personally against the bill (not that it actually makes any difference). I think that this bill will have the effect of strengthening the financial and political power of the for-profit insurance industry, making it harder to “fix” the bill after it gets passed, which is looking likely right now on Sunday morning. Recently, a former aide to Olympia Snow acknowledged in a New York Times op-ed that if this current reform effort does not pass, we’d likely get single-payer in a decade because by that point it would be the only reform option that would make sense from a fiscal standpoint because healthcare costs will have ballooned to the point where the private system would be completely unsustainable. While I think that Peter’s point about future reform efforts potentially occurring on a terrain of even greater austerity is well taken, I think that the aide is right. If we’re socialists we should be fighting to take things like healthcare out of the marketplace, and this plan doesn’t do that. Quite the opposite.

  8. Thanks for the devil’s advocacy, Chris. You pretty much nailed all the reasons I’m so ambivalent about all this. I can’t remember seeing a piece of legislation whose political implications were so unclear.

    Of course you’re right that it ultimately doesn’t matter what we think, although I think having these discussions is useful for us in clarifying our own strategic thinking. And having it out on the blog sure beats the old way, where YDS would try to take an official position and we’d all waste weeks fighting with each other about something we didn’t have any influence over anyway.

    • I, for one, want to echo Peter’s happiness over YDS’s abandonment of the “resolutionary” road to socialism. I think The Activist is a great place for just to hammer out our ideas about important and timely issues. YDS now realizes that maybe a unified statement on legislation we have nominal (being generous here) impact on might not be the best use of our time. An intellectual discussion, on the other hand, is nice.

  9. However, the fact remains that a conservative victory in this legislative battle would be a huge blow to the left as a whole. And as the conservatives have tried so much to attach the label of socialism to this bill, the least we can do is oblige them. I agree, the bill is far from perfect. But it is far FAR better than any bill that the republicans could come up with in the future. And while I understand that the imperfections in this bill may make it hard to stomach for some of you, it is my firm belief that it will help this country along the road to the preferable, single payer, system.

    • I find it hard to believe that a bill that legitimizes and strengthens the existence of the for-profit insurance industry by forcing most of us to buy their products will somehow make the road to single payer easier. Who knows, I could be wrong but on its face it seems like a nonsensical argument to me. And who says the Republicans would be the ones coming up with a new healthcare bill in the future? I’m tired of people using the specter of Republican craziness as an inducement to accept whatever crap the Democrats try to pass, whether it’s healthcare or anything else.

  10. I’m going to lay it out simple. This bill sucks, but I am so pleased that it passed. Think about what this bill represents. For the first time since neoliberalism went into effect, the Democrats have done something that expands the pro-human regulatory infrastructure of the embryonic US welfare state.

    The bill doesn’t kill the insurance industry by any stretch of the imagination and does put into place a health insurance mandate that is distasteful. However, for the first time in many of our life times the government is putting into effect new regulations on how capital is allowed to operate (doing away with pre-existing conditions, etc) instead of stripping regulations away. This is a seachange.

    I’m not going to say anything ridiculous about this creating an opening for the left in the US, because frankly we don’t have an organized left political force in America. I’m a proud DSA member, but as the largest socialist organization in the United States we are less than small potatoes. The fact the bill was based in market-loving fantasy ideology is a function of our weakness, not of an insidious Democratic plot to stop the rising tide of Single Payer.

    We don’t get to define the political landscape. What happened last night was not a question of Obamacare 2.0 vs. Single Payer, but rather a question of Obamacare 2.0 vs…. well, no reform.

  11. This isn’t a case of one step forward, one step back. The passage of this bill amounts to political Hokey Pokey, and I fear that despite some gains, the ultimate legacy here will simply be to further cement the Democratic party’s centrist position.

    Pragmatically, and purely politically, I must be in favor of this bill. Still, think that Chris is right when he remains skeptical that this will help us on the way to single payer.

    I see no alternative to a single payer system, and will continue to believe in and speak of its necessity.

    If the left is to pull Dems our way, we’ve failed with health care. If a united left is non-existent, and our organization amounts to less than small potatoes we have to remember that this is more of a voice than most people have in the world as it stands.

Leave a Response

Spam Protection by WP-SpamFree