What Social Security Teaches Us About Health Care
Paul Begala has an op-ed in this morning's Washington Post that's the most important argument you'll read today. I'm going to quote a nice big chunk of it here.
I think my fellow progressives ought to give Max Baucus and other members of the Senate Finance Committee a little breathing room as they labor to produce a health-care bill that can garner enough votes to pass the Senate.
Progressive politics is, in my view, a movement, not a monument. We cannot achieve perfection in this life, and if that is our goal we will always be frustrated. The right has far more modest goals: At every turn, its members seek to advance their power and protect privilege. I've never seen the Republican right oppose a tax cut for the rich because it wasn't generous enough; I've never seen them oppose a set of loopholes for corporate lobbyists because one industry or another wasn't included. The left, on the other hand, too often prefers a glorious defeat to an incremental victory.
Our history teaches us otherwise. No self-respecting liberal today would support Franklin Roosevelt's original Social Security Act. It excluded agricultural workers -- a huge part of the economy in 1935, and one in which Latinos have traditionally worked. It excluded domestic workers, which included countless African Americans and immigrants. It did not cover the self-employed, or state and local government employees, or railroad employees, or federal employees or employees of nonprofits. It didn't even cover the clergy. FDR's Social Security Act did not have benefits for dependents or survivors. It did not have a cost-of-living increase. If you became disabled and couldn't work, you got nothing from Social Security.
If that version of Social Security were introduced today, progressives like me would call it cramped, parsimonious, mean-spirited and even racist. Perhaps it was all those things. But it was also a start. And for 74 years we have built on that start. We added more people to the winner's circle: farm workers and domestic workers and government workers. We extended benefits to the children of working men and women who died. We granted benefits to the disabled. We mandated annual cost-of-living adjustments. And today Social Security is the bedrock of our progressive vision of the common good.
Health care may follow that same trajectory. It would be a bitter disappointment if health reform did not include a public option. A public plan that keeps the insurance companies honest is, I believe, the right policy and the right politics. I believe subsidies should extend to as many Americans as need help and that the hard-earned health benefits of middle-class Americans should not be taxed. I believe insurer abuses like the preexisting-condition rule should be outlawed. The question is not whether I or other progressives will support a health-reform bill that includes everything we want but, rather, whether we will support a bill that doesn't.
Baucus and the others working on health care have earned the right to take their best shot, and we progressives should hold them to a high standard. I carry a heavy burden of regret from my role in setting the bar too high the last time we tried fundamental health reform. I was one of the people who advised President Bill Clinton to wave his pen at Congress in 1994 and declare: "If you send me legislation that does not guarantee every American private health insurance that can never be taken away, you will force me to take this pen, veto the legislation, and we'll come right back here and start all over again." I helped set the bar at 100 percent -- "guarantee every American" -- and after our failure it's taken us 15 years to start all over again.
I would disagree on one point: The original Social Security legislation wasn't "perhaps" a "cramped, parsimonious, mean-spirited and even racist" program. It simply was those things. But it was something else, too. A start. Over the next 50 years, it was built upon. But not only by Democrats. Some of the largest advances came when Republicans saw political opportunity in strengthening the entitlement. Begala implies that progressives eventually added cost-of-living increases to Social Security. In fact, it was Richard Nixon who signed that bill. Similarly, whether you like the structure of Medicare's prescription drug benefit or not, it was a massive expansion of an entitlement program, and it was proposed and signed by George W. Bush.
The trickiest part of my job right now is to balance the desire for a better bill with the need to argue that the bill that's likely to emerge still makes for a better country. You don't want to ease the pressure on Congress too early, but you don't want to see your allies forget that this is about more than the public option. Imagine for a second that health-care reform looks exactly like the House bill, but the public option is excluded. What will be easier over the next 10 years? Passing a simple piece of legislation that establishes a public option? Or starting from scratch with a 1,000-plus-page bill that spends $1.3 trillion expanding coverage, and regulates insurers, and creates health insurance exchanges, and reforms the delivery system, and cuts payments to the private insurers overcharging Medicare ... and all the rest of it?
You don't want to compromise too early. But nor do you want to realize that you should have compromised only to learn that it's too late. I don't know where we are along that continuum. But Begala has seen this fail before, and it has taken us 15 years to return to the place where we can conceive of passing a worse piece of legislation. He's worth listening to.
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