I agree that it's no longer time for anyone to posture or bargain. The dealmaking was done months ago. The debate is essentially over. I think we all get that.

But it's also time for the Chiefs to sit the Indians down for a talk really soon and we shouldn't forget that the fact that the only public option that was even up for discussion near the end was so pointless that it wasn't really worth fighting for is a real failure on the part of our party and leadership.

So, um, there aren't any blue dog votes for a public option now, because they don't like it...

but there will be blue dog votes for a public option LATER, because then they will see it as a smart deficit reduction measure?

How about we explain to them NOW that it's smart policy?

Or are you just screwing with us...?

Hell yes.

Tell me who to call and what to do to get the Democrats in line. I will pester until my cell phone minutes run out.

What bothers me most about this entire process is how much the True Believers are willing to sell anything and everything down the river in order to claim "victory".

This President is an utter weakling, and we're all supposed to sit around and go, "Oooohhhh! He looks so manly. What a big codpiece he has. He's our hero and we just love him." And God help the people who point out that the Emporer is standing there in his tightie-whiteys.

We've watched the White House and Dem leadership piss away an entire year on this sorry compromise, and since it still has one or two decent tidbits left we should finish the job while we can. If much more time goes by, doubtless Obama or Reid will give something else to the Rs or ConservaDems looking for bipartisan support.

So yes, it's time HIR was finally passed. Qukickly, before the Dems can make it even weaker.

What she said.

This IS the change we voted for. Life is not a movie with compressed time and a happy ending in 90 minutes. When the civil rights and voting rights bills were signed in the sixties, segregation and racial problems did not end, it took time for society to evolve. In the case of health care it will take time for large corporations to shift to a different dynamic..to restructure. That's the only thing holding America up from the kind of system used in other countries. It is a matter of compassion on our side vs.the corporate bottom line which is morally neutral. Don't give so much weight to television blather.
Obama will become known in years to come as our greatest president.

CATHOLIC PRO-LIFE DEMOCRATS also need to get a grip on core values. Do they -- or the U.S. Catholic Bishops -- really want to be responsible for scuttling access to health care for millions? Many deaths will be on their hands if they do. Scuttling reform over abortion will give the lie to "pro life" claims.

Speaking as a Catholic, anti-abortion Democrat, I could not agree more. I think that anyone who sits down and thinks through the logic of the "pro-life" position with regard to this particular debate cannot escape the conclusion that we compromise none of our real principles by backing the Senate bill with the proposed reconciliation fixes. After all, I currently get my insurance from United Health Care, which does include coverage for abortions in many of their plans (including my own). I dare say this is true of most anti-abortion voters with private health insurance. If we are not morally upset about socializing the costs of abortion through private insurance (and it does not appear to cause anyone any qualms of conscience), then why would we get upset simply because the government fuses those same private plans into a government administered exchange? I see no morally relevant difference before and after the reforms are passed.

Unfortunately, logic aside, I am afraid that you are right to suspect that

Congressman Stupak... really wants to defeat comprehensive health reform; he was conspiring with Republican leaders in the last episode. Other Democrats should not follow Stupak.

Here's hoping that clear thinking and real moral courage will prevail.

"At the risk of irritating people on the left, this is NOT the moment for "progressives" to demand a public option."

Okay Theda, then let me ask you this question: when? When? Will that day ever come? Not if we keep lining up behind weak leaders and bad plans and policies like this.

It is never the time for progressives to demand anything Theda. Have ya not noticed that? For 40 years now it is always time for the progressives or liberals or the Democratic wing of the Democratic Party to shut the fuck up and eat what's being served. And it's always for the same reason: so we can get on a better track to... healthcare reform, education reform, cutting back on the obscenely bloated and malignant annual "defense" budget, etc...

And what do we get in return for this President who you claim is finally leading? We get an obnoxious mandate to buy shitty private health insurance products whose exhorbitant premiums will be difficult for many to pay. there is nothing in the legislation that will get those mandated out of control premiums under control or even rising at a slower pace except that the corporate Democrats are "hoping" that the unconditional delivery of 40 million new customers might satiate the greed of the insurance industry at least for a while. We will be treated to an unending chorus of Republicans and the media telling middle class people that they are having to "pay for" health insurance for the poor and that is what is "exploding" the deficit. We will have no meaningfulcompetition of any kind in the realm of healthcare(Obama's main promise and the premise of his complete capitulation on everything to the drug and insurance industries). There will not be one single new method of actually controlling any healthcare costs except mechanisms designed to make care even more expensive so people will utilize their insurance less. The bottom line is that this "health insurance reform" isn't healthcare reform at all and it isn't reform in any meaningful way at all. What it is, is an unprecedented subsidy of the health insurance industry and it's allied parasitic health related corporations that fundamentally preserves the rotten system we now have in place. Once this rotten scheme is made into law it will be at least 10 years if not more before the Corporate Democrats like Obama will even think about opening up discussions of a public option or any other real healthcare reform. This bill represents no victory at all for our country or our people but the ultimate triumph of greedy special corporate interests over the interests of the nation and her people. It is, in fact, a huge defeat for healthcare reform in the United States and will do little or nothing to address any of the major problems facing our system that are the result of our for profit healthcare system which is universally acknowledged as being broken and having been broken for years.

How do you figure this debacle will be any help to progress in the future. It's as plain as day that this is another faux reform from our Republican Lite President like the toothless credit card reform bill that took effect recently after allowing the thieves almost a year to jack up prices and cook up new and creative ways to rip people off and make loan sharking by the mob look like penny ante poker!

Passage of this shitty legislation that people don't like isn't going to help the Democrats at the polls in November which is what I'm thinking is your real concern here. The only way to rescue the Democrats from a political Waterloo in November is to add a real public option (that our timid leader doesn't have the balls to get behind). The polls are very, very clear about this. And it's certainly the only way a progressive Democrat like myself will get behind this shitty bill.

What we have learned during this entire debacle is sadly that Obama is a poor leader at best. He is weak, timid, and no better than most of the political whores on Capitol Hill when it comes to bowing and scraping before the wealthy and powerful corporate predators. His leadership is more akin to the Pied Piper leader people to disaster than anything else. His instincts are terrible and he doesn't have the guts to fightfor anything. Just look at his cowardly reversal on trying Sheik Khalid Mouhammed in NYC as one example or his pathetic offering to Republicans last week in the hopes of currying their favor. He's the worst Democratic President since Cleveland.

I don't understand why liberals cannot get it thru their skulls that this is just a first step, an important beachhead, and that the laws will undoubtedly be liberalized in the future. No one can know the optimum configuration at this time with complete certainty, so it is important only to get a framework that can be built upon.

I am a progressive who:

1. Thinks that the Democrats made a catastrophic error by not starting out with an "unachieveable" single payer public option plan, so as to get something reasonable though compromise.
2. Thinks that this bill is much weaker than it needed to be.
3. Was thrilled when Bennet issued his letter calling for a public option to be added during reconciliation.
4. Who contacted both of my Seantors repeatedly to sign the letter, and called and thanked them when they did.

BUT I TOTALLY SUPPORT THIS EDITORIAL! WE HAVE TO PASS THIS THING AS SOON AS POSSIBLE, EVEN IF NO FURTHER IMPROVEMENTS ARE MADE IN IT!

Why?

Two reasons:
1. What is done is done. We can't go back, we can only go forward from here.
2. This bill puts us in a FAR, FAR better position for further advances in coverage at a later date.

So, why did I strongly endorse the Bennet letter, when I knew it could not come to pass?

Because that was a crucial way of showing fervent support for health care reform, and one applies pressure by pushing for more than you can get (see the Democarats error at 1., above) and then settling for less, for the moment. When the far right is in a push-frenzy with truly deranged talking points, it necessary to push back from the center-left to nullify their effect.

Much obliged, Theda. Kudos for: keeping your head when all about you are losing theirs and blaming it on you.

I think many of the criticisms about how Obama and the Dems approached this bill are valid, and that they didn't fight hard enough for more progressive legislation. However, we are where we are, what's done is done, and this bill is better than nothing. If it wasn't, why would the insurance industry be fighting it? Real political and social changes aren't achieved in one fight, they are sometimes generations long battles, and this should be seen as one fight of many more to come.

I think many of the criticisms about how Obama and the Dems approached this bill are valid, and that they didn't fight hard enough for more progressive legislation. However, we are where we are, what's done is done...

And yet DURING the process the same arguments are used to PREVENT fighting "hard enough". Funny how that works.

So-called abortion opponents could get anything they want if they could persuade but one Republican Senator to vote for cloture and allow an up or down vote on health care reform -- that Senator wouldn't even have to vote for final passage. Frankly, I distrust their motives.

Fair enough Theda. But when you browbeat the only constituency within your party that is actually saying the same things as the rest of America to follow you in going against our interests, don't expect independents to keep voting for you.

Keep selling us out, and we WILL extract a price. What you propose is electoral death for your party. Look to MA. Independents took that from you - for not being liberal enough. I assure you, we'll do it again, and again, and again. We are not any more frightened of the Republicans than we are of the Democrats. Nothing you can ever say will change that (or we'd already be democrats).

You would be better off passing nothing. Subsidies for the poor on the backs of the middle class is not progressive. It's bullshit.

I will be brief. Far too many people on the left are acting like idiots, failing to see the major benefit of the existing bill and failing to see how bad the political fallout will be if this fails.

1. As Michael Pollan and others have pointed out, if this bill is signed into law, then, for the first time ever, the insurance industry will actually have a substantial financial incentive to ensure that Americans are healthier. Once they are required to accept everyody who applies, without excluding pre-existing conditions, they will have a reason to make sure that people are getting preventative care, and are encouraged to lose weight and exercise, and that will lead to a wide range of positive benefits for all concerned.

2. Adopting Medicare for All was a non-starter in this Congress. Even Medicare for More was blocked by Lieberman and others. Those ideas will be enacted, but only when the playing filed is narrowed from "Health Care Reform with Governmental Involvement v. the System we Have Now" to "Health Care Reform with Governmental Involvement that is very inefficient v. Health Care Reform with Governmental Involvement that is very efficient" Much easier for a Blue Dog to support a public option that saves money and improves delivery of services, when the alternative is a different structure involving substantial governmental involvement, than when the contrast is between a purely private system and a private system with substantial government involvement. I favor single payor, but rome was not built in a day, and we are doomed for another 10-20 years if we fail to get something enacted now.

3. The Dems will get blamed for HCR whether it passes or fails. I would much rather see it pass, and get blamed for its inadequacies (if that's what happened) and credited for the good things it does (see #1, above), than see it fail, and get blamed for imaginary problems that are the byproduct of Faux News and Rush Limbaugh's imagination, and that nobody really knows are real or not. The politics of the situation demands that we suck it up, get it passed, and then improve upon it incrementally, where you might be able to peel off the relatively few Blue Dog and/or GOP votes needed to really take this to the next level.

Any individual mandate makes the bill completely unacceptable.

US Health Care has a public option: No Public Allowed.

Dear Prof. Skocpol,

Congress is already mostly-owned by the insurance industry.

You think we should pass this bill, which gives the industry 30 million new forced customers and hundreds of billions of dollars of new revenue, in the hope that Congress will grow a pair and make incremental improvements, to the detriment of the insurance industry, in the out years?

What planet did you learn about politics on?

"It will be far easier to do so when the other side isn't able to demonize the system"

The other side will always be able to, and will, demonize any proposal that doesn't benefit them, competes with them, or takes away some benefit the government handed them in the past -- and once these "reforms" are in place the powerful interests behind the demonizing will have even more institutional and financial power to devote to the task, and more government supported profits and territory to defend. Passing these measures will make future reform harder, not easier.

Furthermore, the ideological approach to cost savings on which much of this plan is based -- reducing patient use of health care (forcing them to make "better choices") -- has been tried (HMOs, etc,) since the Nixon era. Obviously, from the consumer viewpoint, it hasn't worked. But for insurers and many for-profit hospitals, etc., it has proved very profitable. Providing them, in fact, with the power to make sure that this is the only form of "cost savings" being considered today.

There's a reason why wonks, mistakenly or dishonestly, always insist the last major change to our health care system occurred in 1965, with Medicare, and completely ignore the dramatic changes made in 1973. Because the non-stop inflation in health care and health insurance that arose from those "centrists" reforms in '73 provide little reason for confidence in ideologically similar reforms today.

For instance, although this fact hasn't received much publicity or discussion, those who have seen the largest increases in premiums recently -- as much as 79% -- are individuals and small businesses enrolled in HSAs (Health Saving Accounts coupled with high deductible plans). Republicans have claimed these plans will be the cost savings savior (by forcing consumers to make "better choices") that HMOs were once promised to be. But we now find that the lower premiums that HSA insurers used to lure customers are unsustainable. Insurers now claim that when they set these lower premiums they did not have enough data to determine the true cost of these plans. Costs, it turns out, have greatly exceeded expectations and now they must raise rates dramatically to make up for their losses.

But the President has agreed to encourage the use of HSAs as one of the 4 additional concessions he made to the Republicans after the summit.

Insane is doing the same thing over and over again and expecting that this time it will work. Well, of course this new "reform" will work. But, like past "reforms" it will work for insurers and providers, not for health care consumers.

The US has socialized medicine and has had it for a very long time. The real difference between us and other advanced nations is that we socialize profits, not care.

Y'know, I'm not much given to conspiracy theories, but seeing all the dogged opposition on this thread makes me wonder. Are some of the loudest voices here paid concern trolls for the health insurance industry, sowing doubt and dissension in the opposition ranks? They wouldn't sound any different if they were.

If the industry owns Congress like y'all say it does, and if the industry loves this bill as you say it does, it would be easy for them to pass it. Instead, they've thrown massive resources into demonizing it.

I certainly don't see myself as one of the "elite" that Theda Skocpol is accused of being (slamming people for the crime of being smart has such a nice mavericky ring, no?). I'm just a guy who has been laboring in the vineyards of local progressive politics out here in "flyover country" for almost 40 years. And even I can see that passing this bill is the only logical move available to us right now.

Corporate power in politics, no matter how wealthy and entrenched and untrammeled, has a way of coming undone rather suddenly when things change. Remember how powerful the old TV networks used to be, or IBM, or U.S. Steel, or the railroads?

The difference is that these changes are coming much more rapidly now. And passing this bill is part of forcing those changes. When enacting public option, or expanding Medicare, becomes a straightforward economy measure, which it will, the tactics that insurers used in this fight will be irrelevant, and their voices will be weaker, not stronger.

Whatever else you might say about Obama, he nominated Sandra Sotomayor to the Supreme Court, and the Democratic majority in the Senate got her confirmed. I expect her to be a progressive justice in the tradition of Thurgood Marshall and William Brennan. The 2010 and 2012 elections will decide whether she will be joined by others -- or voted down by an even stronger and more radical right-wing majority.

At the risk of irritating people on the left, this is NOT the moment for "progressives" to demand a public option. Nor is it the moment for either pro-choice feminists or pro-life Democrats to derail reform.

But to be completely honest I haven't cared since Dems amended FISA and bailed out worthless, too-big-to-exist banks.

wow, truly one of the lamest of lame diaries I have seen on this site. Its almost like a purposeful troll its so bad.

All thats ever talked about in this bill is the smidgeon it gives the uninsured. The cost of the mandate is downplayed. I want the deal dead, and no bad deal passed. This is just plain a giveaway-- yet another giveaway in a long line of them-- to big insurance.

I will tell you something though author-- never fear-- this bill is a boon for the insurance companies-- they will make a fortune on this, no matter what people say about this being "sticking it to them". Since its going to be so lucrative for these corporations, it will pass. It will pass with or without our support. We can fight it with our whole being, and it will still pass. We can support it with our whole being, and it will pass. So you can use this down time to maybe take a writing course at wherever you are a professor, and learn to write a compelling essay, with supporting points, etc.

Nonsense. The bill only cements a broken system; it therefore should either be fought to the end or amended to be vastly improved before earning a passing votes. Health Care Reform is not about politics. It's about people's lives!

The CPPA was originally intended to be an umbrella organization network+ certification uniting various elements of the Farmer-Labor political movement around a common program for joint independent political action. In practice, however, invitations to the group's founding conference were issued to members of a wide variety of "progressive" organizations, including those who did not seek a new political organization. As a result, the body was quite scdjws heterogeneous and unable to agree on a program or even a declaration of principles at its initial gathering.

Hey, they're only issues if left unresolved. Far be it from me to point to others fetishes from my own glass house. Vive la difference! (as long as nobody gets hurt... ;-)
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Thinks that the Democrats made a catastrophic error by not starting out with an "unachieveable" single payer public option plan, so as to get something reasonable though compromise.
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