Is there a limit to where a bill, which is designed to help people, becomes so compromised it is better to let it die? The obvious (and therefore suspect) answer is yes. There are times when the compromises required to pass a piece of legislation are such that it is better to let the bill die than let some of its provisions become law. This is the very definition of a “Poison Pill”. Barring something like the Stupak amendment (a classic poison pill), where does a bill become too compromised by compromises to be worthwhile?

I have heard from several folks on the blogs and in the meat world that the House bill, even without Stupak, is not worth passing. Their arguments are that it is too big a give away to the insurance companies. It does not have a strong public plan, it is nowhere close to single payer or even Medicaid for all and as such, it is not worth enacting. I think these arguments come from loosing sight of what we are trying to achieve. In a fight this big, this complex it is easy to lose sight of the overall goals and get bogged down in the tactics.

This may not be your goal, but this old hound sees the goal of this round of reform as two factors; cover as everyone (or as close as we can get) and establish any kind of not-for-profit insurance company, nationally. Everything else is window dressing. Yes, it would be best if we went to Medicaid for all. Hell it would be really best if we could have a full scale single payer system. And a pony, if we are going to wish, should always wish for a pony for everyone.

The real fight we are fighting here is not what kind of health care system we should have. It is not a fight about government run versus private; it is a fight about whether all citizens should have even have health coverage. This is an issue, which is still up for grabs as far as many on the Right are concerned. If you ask a conservative what they owe their fellow citizens the nearly universal answer will be “Nothing, not a damn thing. I work for what I have, so should they”.

This is part and parcel of their world view, this rugged individualism which looks at those less fortunate (for what ever reason) as losers and slackers who can’t get with the program. The fact these people do not have health insurance because they don’t make enough money or it is not offered at their work place why then it is some kind of moral failing.

It is this issue of whether insurance and access to good health care is a privileged or a right which we have to get past if we are ever to get to single payer or any kind of national health care. Sure it is dressed up as “Socialism” or “Communism” or even “Nazism” but the real argument is should all American citizens have health care, as a right of citizenship.

One of the things we will achieve by passing any bill, is the settlement of this argument. Once the idea of everyone being covered is settled, then we can and will move on to the issues of what that coverage really should be and how we actually pay for it. One of the main reasons the Insurance Cartel wants to kill this bill is they know once everyone is covered there will be no going back from that position. Coverage will become an expected right. The questions will then turn more directly to what we are paying for by using private insurance; they will no longer be muddied by the question of who to cover. This will lead to coming back to the limiting of profit, to the need for more competition to the inevitable realization that a private, for-profit, management of health care is inherently inefficient because it requires profit and marketing and multiple huge bureaucracies. This will allow us to make the changes we can’t seem to get done this time around.

There are other reasons to pass something over pulling the plug and passing nothing. One is the amount of time. The Republicans have done an excellent job of stringing this process out far longer than it needed to be. If we allow this bill to die we hand them a win and then have to start the process all over again. It makes real change even less likely, in fact, it makes any change less likely as the Republicans will know they have a winning strategy and will use it again and again.

Another problem with letting this bill die is the fact it leaves people without coverage in the same position they are in today. Let us not forget 44,000 of our fellow citizens will die this year because they do not have health insurance. 2,200 of them will be U.S. veterans under the age of 65. To me , some level of coverage is always going to be better than none. Of those who will die because they are not covered there are those who could have been treated with something as simple as antibiotics. There are those who could have had serious conditions, which eventually kill them diagnosed early where the chances of avoiding death are much higher.

Yes, there are problems with the cost. We are doing nothing to contain costs in these bills. There will be issues with subsidies for those who cannot afford coverage and sadly, the money goes to one of the most immoral and disgusting business in America. However, there will be progress. People who are not covered will get coverage. We will remove the preexisting condition situation, permanently. We will end the antitrust exemption, which makes it easier for insurance companies to maintain monopolies and keep raising prices.

On a purely political point of view, failing to enact a signature issue like health care reform weakens the Democratic chances in future elections. I am confident the Republicans are going to have their Civil War raging in 2010 and this will help the Democrats, but if we do not have this signature issue to point to, then we will be playing defense. When you are in the majority you never want to play defense, you always want to be trying to gain ground (even if it is not likely to happen). This failure hanging over us will not help.

Another political point is the longer we keep the nation tied up with this debate the less time there is to do other work. All kinds of issues have fallen by the wayside as our Congress proves it can not walk and chew gum at the same time. There is a critical need for a major jobs bill. The time to do it is now, but as long as we are fighting over HRC there will be exactly no serious movement on this. This is a critical need for the people of this nation (many, like the your diarist, are out of work and cannot find a job) and for the Democrats. While the public has made up its mind that the Republicans are crazy, they are the only place to go for a protest vote. People who are out of work and still smarting from the necessary but distasteful bail out of the financial sector are not always going to remember it was the Republicans who got us into this mess in the first place.

Is it frustrating that we cannot achieve the level of change we want? Of course it is. However if we are going even talk about scuttling this bill then we really have to look at all the factors. Is this bill so bad we are willing to leave those without access to health care in that position? Is the bill so bad the win of settling the argument about who gets coverage does not matter? Is the bill so bad it is worth continuing this long fight, to the determent of other agenda items and ballot box peril? These are the questions all of us have to ask ourselves.

The job of legislating is never, ever, done. Part of the reason for this is the near impossibility of getting all you want in any one bite at the apple. The way to long-term success is to get all you can, every time, and then start with that as your baseline and go forward. We have a chance to make a major step forward, to set the ground for the real fight to get to single payer health care in this country.I do not like all the things in this bill. There are major flaws and there are likely to be more flaws added before we get to the end. Nevertheless, given the goals of covering everyone and starting a public insurance plan are achieved the rest can and will be fixed. If the choice is one of having to take longer than we would like but achieving our goals and having the status quo stay, then the choice is clear to this citizen.

The floor is yours.

"Originally posted at Squarestate.net"