You don’t have to be happy about supporting this bill. But you should support it.


By Joe Campbell
December 17th, 2009

I apologize if this is a bit long – but I felt it was important.


 
When I read and hear and watch the progressive reaction to Obama – calling him a sellout, calling health care reform a scam, calling it a bailout of the insurance industry, claiming Obama has been allying himself with Rush Limbaugh, claiming Obama has betrayed them, asking when it is time to march Obama to the guillotine – I’m reminded of how abolitionists reacted to Abraham Lincoln.

Despite his almost universally praised legacy today, in his time, Lincoln was a polarizing figure – scorned by Confederates and abolitionists, Copperheads and radical Republicans. Yet in time, he came to be seen as our greatest president. One has to wonder why all these involved and motivated individuals who eviscerated his actions as he did them came to see him as a visionary leader when these actions were seen in perspective.

The reason is that Lincoln was ruthlessly pragmatic. He had principles, but was willing to forgo if he didn’t think he could achieve what he wanted. Thus, Confederates seeing what he felt believed he was an abolitionist bent on the destruction of the South and seceded from the Union. The abolitionists derided him as weak-willed and unwilling to stand on principle. The progressives of today might learn something from looking at their precursors, the abolitionists of Lincoln’s time.

Wendell Phillips, a prominent abolitionist, labeled Lincoln “the Slave Hound of Illinois” for his reluctant support of the reviled Fugitive Slave Act, even claiming as Lincoln ran for president that, that he was worse than James Mason, the author of the Fugitive Slave Act. Lincoln won election promising not to end slavery, but that “If I could save the Union without freeing any slave I would do it, and if I could save it by freeing some and leaving others alone I would also do that.” He even refused to expand on his limited remarks to explain his thinking further – afraid that any further revelations might cost him votes that his carefully worded statement preserved.

After his election, Frederick Douglass declared: “Abraham Lincoln is no more fit for the place he holds than was [pro-slavery and worst president ever] James Buchanan…” The aforementioned Wendell Phillips continued to attack Lincoln after his election: “I believe Mr. Lincoln is conducting this war, at present, with the purpose of saving slavery[I]f Mr. Lincoln had been a traitor, he could not have worked better to strengthen one side, and hazard the success of the other…The President…has no mind whatever.

When one of Lincoln’s generals issued an order ending all slavery in the state he was ruling under martial law, Lincoln rescinded the order and fired the general, saying: “I think there is a great danger, confiscation of property, and the liberating of slaves of traitorous owners, will alarm our Southern Union friends, and turn them against us.”

Other abolitionists complained that Lincoln’s “face was turned toward Zion, but he seemed to move with leaden feet.” They declared him, “stumbling, faithless, uncertain.”

Even when Lincoln finally decided to make a dramatic move condemning slavery – his famous Emancipation Proclamation – it did not end slavery in America. Only in those states still in rebellion, because, as Lincoln reasoned: “I hope to have God on my side. But I must have Kentucky.” Even after this Emancipation, the radical abolitionists in his own party sought to impeach him for being too soft on slavery and the rebellious states. All through this, Lincoln was assailed by the abolitionists as weak, as timid, as cowardly, as unmanly. He refused to let his idealism determine his policy – but rather let it guide it when possible.

Lincoln’s legacy is rightly lionized – he proved to be a brilliant leader, pushing and prodding America in the direction he believed in over time, persevering as his supporters gave up hope, and always looking for the opportunity to push the country in the direction he believed it should be going, rather than forcing it into the place where he thought it should be. This is the difference between a leader and a pundit. After Lincoln died, one of his most prominent critics, Frederick Douglass, scolded himself and those other abolitionists:

His accusers, in whose opinion he was always too fast or too slow, too weak or too strong, too conciliatory or too aggressive, would soon become his admirers; it was soon to be seen that he had conducted the affairs of the nation with singular wisdom, and with absolute fidelity to the great trust confided in him. [my emphasis]

It is normal for those watching the day-to-day activities of a leader to be disillusioned, angry, and bitter, as idealistic hopes are broken on pragmatic realities. While our politicians campaign in poetry, as Mario Cuomo said, they must govern in prose. What frustrates me though is the type of short-term thinking and reacting that leads to good policies being destroyed for improvements being derailed because of their imperfections.

The health care bill before Congress is far from ideal – and it has been weakened every step. But it is progress! It is, in the words of progressive Senator Sherrod Brown, “Not a great bill, but a good bill.” It will help millions of Americans. (As well as, unfortunately, the profits of health insurance companies.) Most importantly, it provides a foundation for future reform. Remember that “Social Security was designed to exclude African Americans. Medicare didn’t cover prescription drugs. Medicaid was mainly for pregnant women and their young children. Canada’s system was limited to a single province. There was no University of California at Los Angeles.” Once the funding and system is there, it can be improved upon. This bill takes a huge step to making health care insurance universal and expands access to health insurance more dramatically than any program since Medicare in the 1960s.

As a liberal, I’d rather start reforming health care now and help the insurance companies as part of the bargain, then than fuck over the uninsured to spite the insurance companies. To quote Ezra Klein:

To put this a bit more sharply, if I could construct a system in which insurers…never discriminated against another sick applicant, began exerting real pressure for providers to bring down costs, vastly simplified their billing systems, made it easier to compare plans and access consumer ratings, and generally worked more like companies in a competitive market rather than companies in a non-functional market, I would take that deal. And if you told me that the price of that deal was that insurers would move from being the 86th most profitable industry to being the 53rd most profitable industry, I would still take that deal.

And if getting this done means caving in to a weasel like Joe Lieberman, who is willing to block this bill and let 150,000 die as a result of their lack of access to health insurance, then so be it. I’d rather protect the thousands than, in a display of pique, destroy any chance of reform. (This posturing reminds me of nothing so much as a domestic application of neoconservative foreign policy: It’s better to be strong and get nothing done than appear weak and negotiate.)

So, to my brethren on the left posting at reddit, and on progressive blogs around the nation, remember this: Be angry the bill has been undermined. Be angry that various interest groups have gotten their way at the expense of the majority. But keep perspective, and see which direction the bill moves us. And ask: Does it create a framework of exchanges and subsidies that can improve our health care system? Does it bring us closer to universal health insurance? Will it be easier to add a public option to this structure in the years ahead if, as seems likely, the health insurance industries continue their abusive behaviors, than to start anew?

The answers are clearly, Yes, Yes, and Yes.

As a progressive, as a liberal, you don’t have to be happy about supporting this bill. But you should support it.

Postscript: And to preemptively answer 3 other issues:

I have yet to see an argument which truly makes the case for why this bill should be scrapped from a progressive view that doesn’t focus on insurance company profits – which suck – but there are worse things, or an exaggerated view of what the White House could have done, or an exaggerated view of how important the public option was to the reforms.

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9 Responses to “You don’t have to be happy about supporting this bill. But you should support it.”

  1. MD Says:

    If you think not passing healthcare is bad just think about if it passes and all the middle class voters who had hope in Obama and change get hit with a mandate to buy a non regulated, monopoly ran, cartel insurance plan that is nearly twice as expensive as other developed country’s. Just think real basic like mega basic…

    Obama make my money go bye bye!!

    Me no vote for money go bye bye…

    Seriously that is about the depth of 1/2 of Americas mental discourse.
    Its sad but true. We cant even convince 40% of Americans evolution is real. What hope is there really? we should be standing for nothing less than single payer and instead we are bowing to corporations and teabagers. I for one wont vote Obama again he has turned his back on America and its values. All ive seen is acceptance of Bush’s policies and a reluctance to stand up against anything but progressive ideas. WHY MUST WE COMPROMISE WHEN PEOPLES REAL LIVES ARE ON THE LINE….. The Dems have NO BALLS AT ALL! Heck they are so weak it borders on masochism. A vote for this would just be proof dems are useless if not detrimental.

  2. Joe Campbell Says:

    @MD:

    You ask:

    WHY MUST WE COMPROMISE WHEN PEOPLES REAL LIVES ARE ON THE LINE…..

    But in fact, we must compromise BECAUSE real lives are on the line – and this legislation, for all its faults, would save many of them.

    This isn’t about balls – it is about what is possible. And you are so incredibly wrong when you say that the mandate will force people to buy a “non regulated…insurance plan.” In fact, it provides extra regulation – important, significant regulation – and it provides a forum for the government to monitor these plans more closely and regulate price more thoroughly: the health insurance exchanges. These exchanges have been the core of the plan since the beginning – and they are intact.

  3. JuJu Bean Says:

    There is no compromise in this bill – it represents surrender.

    The solution is universal single-payer, which was compromised out for a strong Public Option, which was compromised out for a weak Public Option, which was compromised out for a Medicare buy-in, which was compromised for Coops or triggered Public Option – and even that was compromised out!

    Please tell me what your definition of compromise is because from my perspective it seems like it means “grab your ankles and hope they are using condoms & lube.”

  4. Joe Campbell Says:

    @Juju Bean:

    Told that way, sure – it’s awful.

    But looked at this way, its not: The plan would further regulate the health insurance industry, ending the worst practices such as their refusal to insure the sick. It would almost put America in the same category as the rest of the world in terms of universal coverage. Our system wouldn’t be a single-payer one like Canada’s – but would be more similar to Germany’s or Switzerland’s. It would create a health insurance exchange to tame the Wild West that is purchasing health insurance outside of employment, including transparency measures like making independent ratings and consumer ratings easily available. It would expand Medicaid more than at any time since it was created. It would insure more people than anything since the 1960s.

    In other words, if you believe single payer is the only way to do health insurance – this plan doesn’t get you there. But if you believe we should try – on behalf of the millions who are suffering under the current system – to make it better, then this plan represents a very good start.

  5. Johnny Says:

    I agree that perspective is important… but man, right now, in the middle of it – it certainly feels like President Obama is letting us down.

    At the same time, perhaps he is simply doing the best he can considering the circumstances. I’d like to believe that (although, that in itself is extremely sad.)

    To me the clear answer is Medicare-for-All. But it seems that corporations have so much power that we can’t move in that direction even when it’s obviously the right way to go.

  6. Jordan Lund Says:

    The key difference is that Abraham Lincoln didn’t promise to abolish slavery, then turn around and back legislation that now only allowed it, but increased slavery and strengthened it. That’s what Obama and the Democrats in the Senate are doing here. They promised to do away with the dysfunctional status quo and instead are allowing the status quo to become even more entrenched than it ever was before.

  7. Joe Campbell Says:

    @Jordan Lund –

    1. Abraham Lincoln was accused of exactly that by abolitionists. But he wasn’t doing so. He was destroying it slowly, taking tactical victories where he could.

    2. What this bill changes from the status quo:

    • Forcing health insurance companies to increase their medical loss ratio to 85% – meaning they can’t just jack up the prices.
    • Forcing health insurance companies to provide health care to sick people, instead of knocking them off the rolls.
    • Creating a health insurance exchange for people not on government or employer-sponsored health insurance – which would be able to disqualify insurance companies from participating in if they didn’t meet certain criteria. The exchange would also create an Amazon.com style rating system for consumers, as well as providing in clear language what benefits each plan had.
    • Expanding Medicaid substantially.
    • Giving subsidies to those who do not qualify for Medicaid and yet cannot afford insurance – subsidies which (I believe, though I’m not sure) need to be used in the exchange.
    • Creating dozens of pilot programs to collect data and realign incentives to reduce the growth of health care costs.
  8. John Rose Says:

    Until last night, I’d felt pretty torn about this health care bill. I respect and admire people like Howard Dean, Jane Hamsher, Markos Moulitsas, etc. And I respect and admire Obama, Russ Feingold, Nate Silver, etc. But, like Johnny above, I felt very let down at the whole public option collapse, and at hearing about more and more important loopholes being thrust into the bill. But last night, I tried to explain as best I could to my fiance what this bill would do:

    It would take a bunch of money from wasteful programs in Medicare and from mostly wealthy people (either through a tax on high-cost plans or a tax on upper incomes), and it would use that money to make health care affordable for tens of millions of poor and/or sick Americans. And it would make health insurance plans a lot more reliable when it comes to providing you with what you actually need when you actually need it. The downsides are that insurance companies, which are a big part of the problem in our current system, are going to get a lot bigger, and some people are going to be forced to buy insurance with still very little help.

    She told me, well that doesn’t sound bad- I think we SHOULD have a mandate.

    Put that way, I realized that most of the “problems” with this bill represent things that I hoped would be in the bill that aren’t. My disappointment here is mainly with the fact that progressive groups with whom I identify got so little out of their efforts the past six months. Looked at purely from a power perspective, this is still mostly a huge shift from the wealthy to the poor. And politically, insurance companies aren’t getting that much out of it, and their positioning will be compromised by the fact that having everyone mandated to purchase coverage puts a lot of pressure on legislators to improve the cost and quality of that coverage.

    Today, the most discouraging thing to me is not the bill- it’s thinking about how radically the popularity of Democrats has declined over the last six months, and what that means for them in 2010. It turns out that a lot of Democrats simply didn’t have the stomach for the kind of horse-trading Obama had to pursue to get this done. The disillusionment these Obama supporters have felt has become contagious, and they’re already starting to forget just how big of a difference this is from 4-8 years ago. If there’s one thing I think these people need to hear it’s this: McCain Palin got 46% of the vote! 46!!!!!

  9. Joe Campbell Says:

    @John Rose –

    I know how you feel. Though I suppose I was a lot less concerned with the public option from the beginning. I thought it was a good idea – but I was quite taken with Ezra Klein’s analysis in which the health insurance exchange was the central mechanism of the bill. The idea of an Amazon.com (or as I wrote earlier and slightly less accurately, an ebay) for health insurance – with those insurance companies participating needing to list what they offer in a standardized way, to give a public reason for increasing premiums (and if not found satisfactory, getting them banned from the exchange), with consumer ratings of these insurance programs. This would only apply to the individual insurance market of a few million people, but it seems a much better model than the employer-provided one we have. What I like are the pilot programs – of which this is by far the largest – all of which are small attempts to tinker with the system to bring down costs.

    But for this really to work, insurance needs to be universal. And for insurance to be universal, we need to bring down costs to afford it.

    As to the disillusionment of Obama supporters: it is contagious – and it could destroy any chance Obama has of being a successful president and getting through progressive goals.

    But at this point its his own fault that he’s failed to bring his supporters along. He needs to do something about that.

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