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The case for moving forward

It's not been the easiest week for health-care reform. The final days of a bill are, almost by definition, the hardest. Critics have had time to mobilize. Industry has had time to lobby. Supporters have endured one painful compromise after another. Enthusiasm ebbs at the exact moment opposition peaks.

And as those who would like to see the bill fail organize, those who would like to see the bill succeed nitpick. Joe Lieberman refused to allow Medicare buy-in. Ben Nelson worries over the abortion language. Susan Collins wants to ensure access to catastrophic plans. Progressives are concerned that insurers will game the individual mandate. Name your interest group or constituency and they will name the provision, or set of provisions, that worries them. The goals of covering the uninsured and bending the cost curve remain popular, but the means are, well, more controversial.

Some of these disagreements are disingenuous, self-interested or parochial. But many of them are not. I've engaged with many of those arguments this week, but there's no doubt my rebuttals could be wrong. Indeed, on an issue this complicated, both sides of the argument might prove in error.

In a bill that tries to think of everything, there’s a provision that tries to think of that, too. Section 1332, to be exact.

Section 1332 is titled “Waivers for State Innovation.” But that’s a terrible name. Call it “the law for the law of unintended consequences.” The idea is simple: If states think they can do better than the language and policies in this bill, and they can make a convincing case that they’re right, they can get a waiver exempting them from the legislation. They still get the money that would be owed to them, but they get to spend it their way.

There are some conditions, of course. The plans the states develop have to offer coverage and out-of-pocket spending protections that are at least as good as what the bill promises. They can’t increase the deficit, either. Beyond that? Go nuts. If a state wants to bring everyone into the exchanges, impose much harsher regulations on insurers, experiment with innovative insurance products, or pretty much anything else, it just needs to write up a proposal explaining why it would be better for people rather than worse. And if the tweak works, if the reforms function better in the absence of the mandate or in the presence of stronger regulations, then other states can copy the innovation.

“The federal government doesn’t have all the answers,” explains Sen. Ron Wyden, the author of Section 1332. “If states are exasperated or frustrated with one provision or another, this is a safety valve. It gives them running room.”

Even the Senate bill’s most cheerful supporters will grant that the legislation is imperfect. There are places where it doesn’t go far enough. There are places where it goes too far. There are places where it’s poorly worded. The problem is that it’s hard to say in advance what those places are.

Wyden’s contribution allows states to wiggle out of the consequences of those imperfections. Rather than having to go back through the Congress and the Senate to change a part of the bill, a state that finds the bill’s language inefficient for achieving the bill’s goals can simply petition the secretary of Health and Human Services for a waiver. No new legislation needed. No filibusters or holds to evade. No national agenda to contend with.

The law for the law of unintended consequences is also an important reminder that this bill represents the beginning, rather than the end, of health-care reform. “I am not the first president to take up this cause,” Obama said back in September, “but I am determined to be the last.” He will not be the last, or even close to it.

But this bill is a start. It gives states the tools – new money, new regulations, new programs, new processes – to begin fixing the health-care system. Maybe just as importantly, it recognizes that, eventually, we’re going to have to fix the fix to the health-care system, too. Passing this flawed-but-important bill is, in part, a leap of faith. It is a bet that we, as a society, can solve our problems. It is an admission that we never get it totally right, but that that’s no excuse not to try. It is a decision to trust ourselves to do our best with what we know now, and apply the hard-won knowledge of experience when we know more later. It says so right in the legislation.

There are those who oppose this bill, and its aims, in its totality. I don’t agree with their opposition, but I respect it. Those who would let their disappointment with a small piece of the bill cancel out their support for the overarching effort are, however, making a far more serious mistake. Chances to take large steps forward on longstanding problems do not come often in American politics. This legislation is not perfect, but it can be moved in that direction. The same cannot be said for the status quo.

By Ezra Klein  |  December 18, 2009; 5:40 PM ET
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I honestly don't understand how any liberal could conclude that this bill is worse than that status quo. This bill could contain nothing but two provisions: 1.) Community rating, and 2.) Every 6 months, an insurance executive gets to knock me down and steal my wallet, and it would still improve my life immensely. I don't like seeing progressives get slapped down for the millionth time either, but the defeat of the bill would be a much bigger blow than the defeat of the public option.

Posted by: CynicalJerk | December 18, 2009 5:54 PM | Report abuse

The waivers for state innovation are a good idea for Sen. Wyden's home state of Washington and places like Massachusetts that are ahead of the curve on providing affordable coverage -- particularly to children and families. The provision for "unintended consequences" could lead to a "series of unfortunate events" in less enlightened areas of the country if we aren't vigilant.

Posted by: gothope | December 18, 2009 5:58 PM | Report abuse


Posted by: fiorehoffmann | December 18, 2009 5:58 PM | Report abuse

Of course Wyden is from Oregon. Both Washington State's senators are women. Cantwell and Murray.

Oregon has a history of innovation in health care, setting up a system that mandates a set amount of money to spend on health care and prioritizing which treatments are going to be covered. This does leave some people out in the cold, but it is a rational first step in controlling costs.

Posted by: srw3 | December 18, 2009 6:04 PM | Report abuse

Have you forgotten how many years and lawsuits (not to mention a new president) it took for California to obtain an auto emissions waiver, even though past requests had been granted for decades. All it takes is another Bush presidency.

Posted by: SamBe | December 18, 2009 6:06 PM | Report abuse

it seems that your exhaustion is palpable on radio interviews now. especially when talking to other progressives....

Posted by: razibk | December 18, 2009 6:11 PM | Report abuse

Ezra: Glenn Greenwald has written an important columnn that lays out what the underlying conflict here on the left is, in a way that I've been struggling to identify during this depressing week:(

The summary: it boils down to whether you can swallow the corporate takeover of the country, or not.

While you have argued all along that the PO was too weak to do much and, though, symbolically important, not substantive, the significant symbolism was that it created an alternative to America becoming a wholly owned captive of yet another corporate power base. Removing the PO but retaining the mandate just plain hands us over, lock, stock and barrel. All the arguments about "if you don't mandate we can't keep costs down" may be true, but they are true only in the universe that says "we will only look for solutions within the corporate model" when plenty of solutions exist outside the corporate model, or in combination with a corporate model.

You've been trying hard -- and I'm not criticizing that -- to find the merits in the bill (potential bill) -- to find the silver linings. You say that passing this is a "leap of faith that we, as a society, can solve our problems". But what the process that has brought us this resulting bill has shown is the opposite: it has shown that our problem is that we are prisoners of the very forces that cause the problems we're trying to solve. This bill, in the end, is an agreement to pay extortion money to an industry in exchange for "protection". By removing even the sliver of a PO, which, (as the bill's reluctant supporters are so fond of saying) would have given us "something to build on" the corporate/government takeover is nearly complete.

Posted by: Melinochis | December 18, 2009 6:17 PM | Report abuse

First @ Ezra:

Dude, i don't know how you can take all this. I'm freaked out as a staunch supporter of this bill.

@ Melinochis

"All the arguments about "if you don't mandate we can't keep costs down" may be true, but they are true only in the universe that says "we will only look for solutions within the corporate model" when plenty of solutions exist outside the corporate model, or in combination with a corporate model."

That's true but have you noticed we live in a society that is based on capitalism, heavily in fact. We do not live in a heaviy socialized democracy like much of Western Europe: What exactly would you propose to change that? A revolution? I'm not even sarcastic here, I'm serious. You are talking deep structural change here, a desire for that I am sympathetic too, but there is a world of a difference between recognizing that desire, and making that desire come to fruition.

Posted by: silentbeep | December 18, 2009 6:33 PM | Report abuse

The Constitution of the United States is what....about 17 pages?

This bill is well over 2,000 pages so far.

Is this Cloward-Piven at work?

Posted by: WrongfulDeath | December 18, 2009 6:47 PM | Report abuse

Your blog has been an invaluable resource to me in understanding health reform.

It seems to me that Clinton and Obama's proposals were always, at most, about 90% health insurance regulation and 10% public plan. I'd like a single payer system as much as anyone, but that's never been in play. Since these reforms are primarily about creating a federal regulatory scheme for insurers and providing subsidies for health insurance for the uninsured, doesn't it make the most sense to work on getting the details of those things right in conference?

I am sympathetic to those who are infuriated with the conservative Democrats and enraged by the duplicity of Joe Lieberman. I share those emotions. But I don't understand how anyone can think that retaining the current system is better than adopting the Senate Bill.

Getting that bill out of the Senate, and improving it in conference in the ways suggested by SIEU President Andy Stern, seem like the best options progressives have at this point.

Posted by: hws999 | December 18, 2009 6:49 PM | Report abuse

As a reader who almost never comments in these sections, I've definitely had my say here over the last couple days. I definitely side with the Dean/Kos crowd in the substance of their criticism, and a lot of direct organizing experience on the way these proposed regulations work out for people in reality has me deeply skeptical of the regulatory legs this whole thing stands on.

That said, I really don't know if it should be passed or not. I do know two things, however. First, Ezra is absolutely right to point out that this is the beginning and not the end. Second, for people who care about these things, the proper response whether a bill passes or not is neither self-congratulation nor righteous indignation. It's further pressure on congress to do something real, combined with a willingness to lose if we don't get it.

Progressives' automatic support for democrats has its consequences. There's no reason their continued mediocrity and excuses shouldn't cost them that support.

Posted by: andrewbaron78 | December 18, 2009 6:52 PM | Report abuse

interesting....the phrase,"move on," is something that one would say to loiterers..."find another place to go."
but" move forward"...implies momentum and a postive and focused direction for moving "forward."
by all means,
let's go with moving forward!

Posted by: jkaren | December 18, 2009 6:53 PM | Report abuse

I strongly supported Obama. But this bill from the senate is an abomination. If the bill is so handy-dandy with all the subsidies than take out the Mandate and lets see if it becomes popular. I also don't buy the argument that if we don't do this then we would not be able to tackle this issue for several generations. Since Medicare is predicted to become broke in 5 years, there will be a time when both parties will have to come together to fix it (for e.g., by eliminating our bases in hundreds of countries worldwide. STOP THIS BILL NOW! I hate it when we are mandated to give 20% or more of our hard-earned income to private insurers who can use over 25% of theirs for non-medical stuff.

Posted by: ns3k | December 18, 2009 6:57 PM | Report abuse

To build on what Melinochis already said:
In addition to finding a corporate/market-based solution for health care, if this bill passes, it will underscore the importance of making backroom deals with the corporate interests in order to pass any kind of bill that is "an improvement" on the status quo. Of course, the improvement can't be scientifically quantified because we also don't know the unexpected problems and consequences of the new bill. But, politicians and bloggers alike will be able to sell it to us because it is an improvement. We don't have leaders anymore in our politics, just good salespeople.

Posted by: goadri | December 18, 2009 7:03 PM | Report abuse

Also, it was stupid and dramatic for Obama to say that he would be the last to deal with health care reform. Normally, it's not so easy to see him being just another politician making promises that he can't keep. I say this as someone who voted for him.

Posted by: goadri | December 18, 2009 7:06 PM | Report abuse

silentbeep: what am I proposing?

When the House released it's version of the bill there was a decent version of the PO and the potential that, over time, the public could decide for itself whether it preferred a government-managed version of coverage, or that provided by a corporation.

I've agonized all week over whether I should join the "better than nothing crowd" or not. But my feeling now is that this isn't better than nothing, it's worse. So, in terms of this specific discussion, my proposal is that this bill needs the PO put back in, or scrap it and go to reconciliation to pass whatever elements can be passed, and start the fight again.

Because, to your larger point about the need for "deep structural change", this bill makes deep structural change even harder. And the question of how we begin to deal with our ever-growing corporatism is a discussion we all need to start having. And its BIG. Seriously big. Even my dear 72-year-old Mom, a diehard Democrat, used the word "revolution" today. Myself, I've been reading about Ghandi's non-violent tactics, trying to at least begin to conceptualize an approach to start tackling "the system".

Posted by: Melinochis | December 18, 2009 7:15 PM | Report abuse

When do the mandates start? When the exchanges start in 2014? So we have years to fix the mandates or make sure there is an alternative. In the meantime pass the bill and go for medicare for all who want it via reconciliation by itself.

Posted by: srw3 | December 18, 2009 7:48 PM | Report abuse

We need healthcare, not insurance.

Posted by: AuthorEditor | December 18, 2009 7:49 PM | Report abuse

As someone who primarily works on state-level health care policy (I've been getting to work on the federal stuff lately, go figure), I can say with 100% confidence that defeat of this bill will make the job of everybody pushing for stronger systems in the states significantly harder.

I -- and lots of folks I know -- am already thinking about all the changes we can make, state-level laws and regs we can pass, to shore up the weaknesses and improve on the good pieces. It's going to be hard work, since the special interests are going to be trying to wriggle out of as much of this as they can.

But if it doesn't pass? My state is going to be running a deficit next year, and with no relief in sight, we're going to see more slashing of the health care safety net, more people falling into uninsurance, and big lobbying dollars continuing to swat down piecemeal efforts at reform. We'll be playing defense again, and for a long time.

Debating the degree to which we want to rely on corporate solutions is all well and good, and it'd be nice if there were a way to get a stronger bill out of Congress, but the choices are on the table right now. And I doubt you'd find many of the people who deal with this stuff on the ground counseling the purist's stance right now.

Posted by: Mike_Russo | December 18, 2009 8:08 PM | Report abuse

Ezra, I know you don't want to read this, but re: this graf:

""those who would like to see the bill succeed nitpick. Joe Lieberman refused to allow Medicare buy-in. Ben Nelson worries over the abortion language. Susan Collins wants to ensure access to catastrophic plans."

Get a grip. You think that Lieberman, Nelson, and Collins want the bill to succeed? What evidence do you see in their actions that they want it to succeed?

You've lived long enough in Washington, DC now (where I lived for 14 years) to understand that words and beliefs have almost no co-dependency.

I write this with all due respect - go read Greenwald's column in Salon today for a realist's view of what's going on.

Posted by: jimol | December 18, 2009 8:17 PM | Report abuse

"Debating the degree to which we want to rely on corporate solutions is all well and good, and it'd be nice if there were a way to get a stronger bill out of Congress, but the choices are on the table right now"

No, these are the choices they are stuffing down our throat right now. You are falling into the trap of "take it or leave it". But as you say the problems that have put HCR on the front burner will continue to worsen. This bill throws money at the problem but doesn't solve it. We will need to throw ever more money at the problem until we reach another crisis point.

There are immediate steps the Pres/Congress could take to help people struggling right now. They could expand both Medicare and/or Medicaid - a far more straightforward step than trying to construct this rube-goldberg solution the primary benefit of which is that it ensures the continued monopoly of private insurance.

They could write a bill that has nothing but restriction on private insurance abuses: no rescission, no pre-existing condition crap, etc.

They are making this stinking bill "the only solution" because they are invested in it and because it doesn't challenge private insurance.

Posted by: Melinochis | December 18, 2009 8:29 PM | Report abuse

Ezra, Great post. I remember back in January or February thinking about what might happen in the whole process of getting this health care bill. Man, it seems like years ago. I remember thinking how the media portrayed things like they always do, by polls, and hyped the fact that because the people wanted health care reform so bad, it was going to just happen. I didn’t hear much consideration for the fact that the senate and house hasn’t changed at all. I thought to myself, what makes people think that things would be different this time, the lobbyists would go away, the campaign contributions would go away, that Joe Lieberman and others with big egos would fall in line, the left wing of the democratic party would not fight for their view, the conservadems would not put up a fight...they would all just get along because "The People want it, they have to pass health care" and many insisted that it had to have a public option because so many people in some poll said they supported it. The expectations were set high, by the media mostly, but the democrats played along to some extent too.

Well it came time to actually "make the sausage", and the same old process kicked in, each special interest went into action. The commercials started running, the talking heads went out with there talking points, the misinformation campaign began...death panels anyone? The fickle public got bombarded with misinformation coming from all directions, like I've never seen. There is no media filter anymore, lies, distortions, exaggerations, fear tactis...every group was targeted. Everyone got pissed off, pitted one against the other, Lieberman decides that Anthony Weiner likes the bill a little too much so he's gonna play his trump card. Ben Nelson revels in his new found power whips out his. Who's next? Is it any wonder the Obama administration is just trying to get something passed?

So those who say the president somehow didn't show leadership and should have, once again, just made it happen somehow because the people "want it", well if they think any person can change a system that has taken 225 plus years to get screwed up, I suggest they run and win the presidency and show us how easy it is, put up or shut up.

Posted by: LiberalForReal | December 18, 2009 8:59 PM | Report abuse

^ I'd think that if we've learned anything from the past week, it's that the President and Congress can't expand Medicare. And really, that is just throwing money at the problem, unless you're pairing it with further substantial reforms.

And they also can't just write a bill that reins in the insurance industry abuses -- get rid of pre-existing condition exclusions, and you need community rating. Do community rating, and you need universal coverage. Do universal coverage, and you need subsidies. Do subsidies, and you've got a trillion-dollar bill, and in for a penny, in for a pound.

Your argument basically boils down to "it needs to get worse before it gets better" -- at some later time the crisis will be so much deeper that somehow the politics will be easier. But I just haven't seen a single example of this happening in modern politics (I say that sincerely -- if you can think of counterexamples, I'd be very interested to hear them!).

The bottom line is that this really is a take it or leave it deal. Legislation takes time. Pelosi is not going to have her members start all over again on health care and stick their necks out again less than a year ahead of election day. The Dems are going to lose seats in the Senate and House next November -- if you think having to water down the bill to get Lieberman's and Nelson's votes is bad, think about what it'll look like if you need Snowe, Collins, and Voinovich, plus Lieberman and Nelson.

This legislation is far, far better than doing nothing -- as, again, I think most everyone who actually works on this stuff will tell you. There is no theory for getting anything remotely comparable in the medium-term, if we don't get anything out of this attempt. There's really not much more to it than that.

Posted by: Mike_Russo | December 18, 2009 9:07 PM | Report abuse

...and we probably won't see a democratic controlled government in many years, so the price of insurance will continue to rise, more and more people will go without, insurance, pharma and medical will get rich. If everyone is giving their money to the above 3, they won't spend that money on other things that might actually create jobs. So called progressives ought to calm down and think this one through to it's possible conclusions. We may never have this chance again.

Posted by: LiberalForReal | December 18, 2009 9:33 PM | Report abuse

Ezra, congratulations for at least recognizing those of us that feel this bill is a mess and should never become law! But, you need to take one more step in that we do not need to stuck with the status quo! We need to put some teeth in healthcare without gnawing it to death. Competition across state lines is a step that EVERYONE can support! We all should support streamlining the administrative processes for insurance companies! It is a no-brainer to put those that defraud the system in jail! Punish those that abuse the system! If we just got serious with some old-fashioned common sense, we can make huge positive changes! Glad to seem to have a little respect for those that view the issue differently than you. Some of your media associates are more narrow minded than you are.

Posted by: my4653 | December 18, 2009 10:04 PM | Report abuse

thank you to bill clinton, john kerry, jay rockefeller and paul krugman for adding their strong voices in support of this bill and refuting those who would join the republicans in watching it wither on the vine.

Posted by: jkaren | December 18, 2009 10:15 PM | Report abuse

Belatedly, it occurs to me that I should clarify: when I say it is take it or leave it, I mean we need to pass the Senate bill in a version close to what it is now, or expect to see health reform fail and not come back for many years. There are still changes that can and should be made to the Senate bill before it is passed; it can and should borrow some pieces from the House bill before coming back from final passage; and we should all be pushing hard on those fronts in the weeks to come. But it is this process or nothing, at this point.

Posted by: Mike_Russo | December 18, 2009 10:35 PM | Report abuse

The case for not moving forward is more compelling: It's a bad bill that actually gets worse over time as subsidies erode and penalties mount. The waiver for state innovation is intentionally crippled. ERISA cannot be waived. Any substantial deviation from the federal plan would be litigated for years. We have to do better.

Posted by: bmull | December 18, 2009 11:02 PM | Report abuse

ns3k: "If the bill is so handy-dandy with all the subsidies than take out the Mandate and lets see if it becomes popular."

As Ezra has pointed out previously, the entire project collapses without the mandate. If there's no mandate, then people will exercise "adverse selection": they won't get insurance until they're sick (and they can drop it when they're better). That means huge costs for insurers with minimal premiums, which will make outlays skyrocket, which will make insurance even more unaffordable. The only way to get things like guaranteed issue (requiring coverage for people with preexisting conditions) is to spread the risk with a mandate.

Posted by: dasimon | December 19, 2009 12:01 AM | Report abuse

Melinochis: "my proposal is that this bill needs the PO put back in, or scrap it and go to reconciliation to pass whatever elements can be passed, and start the fight again."

But it's not an either/or situation. This bill can be passed and then the PO can be put in through reconciliation.

There are aspects in this bill that don't qualify for reconciliation: the exchanges, possibly the mandate, the ban on preexisting conditions denial (which requires the mandate).

Also, reconciliation requires starting all over in committee. No way will it get taken up before the 2010 midterms. And no guarantee it will get taken up afterward, especially if Dems take a big electoral hit for not getting anything done on this issue.

It just seems far better to me to get the private sector reforms passed (which require 60 votes) which will provide a platform for the other aspects which need only 50 (public option and/or Medicare buy-in). Getting the latter seems far more likely if we get the former than if we don't.

Posted by: dasimon | December 19, 2009 12:13 AM | Report abuse

"But it's not an either/or situation. This bill can be passed and then the PO can be put in through reconciliation."

Well, I'll tell you what, if that were to occur it would certainly improve my mood. But do we have any reason to hope for that?

If the admin. is keeping quiet on a plan to do something like that in order to get the votes they need now, well, I'll give them the trophy for a risky but well-played strategy. But do you really think they're going to do anything like that?

Posted by: Melinochis | December 19, 2009 12:24 AM | Report abuse


I don't buy Ezra's argument about the mandate.

In addition, there are provisions in the bill that allow the insurance companies to discriminate based on age or health condition, etc.

Also, no bill should be punitive in nature, especially if it is promoted as solving a social problem.

I don't mind payroll taxes as a way to ensure social security in my later years as well as Medicare. I would like to be given an option to join Medicare now and not forced to buy insurance from a private insurer with really high deductibles (the only way to keep monthly premiums low).

The Senate bill is travesty and must not pass. VOTE IT DOWN!
I was a strong supporter of this president, but over several months it has become so painfully obvious that he has entirely capitulated on the side of wall street bankers, the insurance industry and the pharma lobby (did you hear about the WH was all over the senate to prevent the amendment allowing importation of drugs from passing. This could have saved over 200 billion over the next 10 years. It is disgusting, especially to see the WH use the FDA to concoct the 'anti-importation' letter that many senators used as pretext to vote against the amendment!

As they say, you can fool some of the people some of the time, but not all the people all the time.

Posted by: ns3k | December 19, 2009 12:47 AM | Report abuse

The last week has been incredibly depressing, and I just wanted to say that you and Yglesias and Cohn have been doing a great job of keeping the faith and reminding me why this health care bill needs to move forward.

More than any specific flaw in the bill, I think it's nihilism over the efficacy of government that's driving the left to attack health care reform root-and-branch. I hope you guys can continue to defend it root-and-branch, as well. In some ways, it feels like we're back at square one - what progressives need right now is to be reminded how the bill is supposed to work, and why it's not been fatally compromised. No one cares about, say, Wyden's latest amendment, because they don't even believe it will actually end rescission or prevent bars on preexisting conditions. If you and your bloggy friends can defend the bill's most basic propositions, I think you'll win back some supporters who can pressure the powers-that-be in a constructive way.

You and Krugman and Yglesias and Cohn are probably better situated than anyone in the country to redirect some of the progressive revolt against the bill into positive pressure for a better bill: you have knowledge, the visibility, and, collectively, the credibility. Right now, you have a lot more agency over health care than you ever had when all eyes were on Nelson - I hope you all can make the most of it!

Posted by: WHSTCL | December 19, 2009 3:19 AM | Report abuse

Mike Russo's views seem as sensible as any. Failure of the current Congress to pass some sort of health care legislation will have lousy consequences for years to come.

At the moment, failure seems likely, barring an unexpected burst of arm twisting and patronage. Perhaps Harry Reid could conjure up the ghost of Lyndon Johnson.

Posted by: DaveoftheCoonties | December 19, 2009 3:28 AM | Report abuse

"A Tree starts with a Seed."

Posted by: wdsoulplane | December 19, 2009 8:24 AM | Report abuse

it is always easier to say no to something, than to do the hard work it takes when you say yes.

what part of life came easily, and gave you everything that you wanted?
school? raising children? a job? relationships? spiritual answers?

saying no lets you live in a world of cosmic potential. where anything is possible.
but making things happen in the real world is all about hard work, timing, frequent disappointments and opportunity.
if you lose your moment, if you say no to an is gone and wont return again.
you dont return your baby back to the hospital because parenting didnt work out the way you had hoped.
you make it work.
one has to do the hard work, and plow ahead.
sometimes the effort seems greater than the reward.
sometimes an opportunity seems less than we hoped for....
but all one can do is to move forward.
sometimes, we feel disappointed and as if we are not getting all that we deserve.

dont give up on something that has life or potential.
a small, newborn animal cant run, fly or see takes time to get all things up and running.
nothing begins fully formed.
this is a beginning.....

Posted by: jkaren | December 19, 2009 8:56 AM | Report abuse

Well written.

Posted by: punchaxverulam | December 19, 2009 9:09 AM | Report abuse

I think everyone has to admit that if they don't do it this time, it may never get done. Next year is an election year and more than likely Republicans will make gains, I don't think there will be a better chance to make it happen for a long time. I, personally, wouldn't want to be the one to tell all those folks who currently can't get insurance, for whatever reason, that they are right where they were a year ago. Sorry, you get nothing, your children get nothing, you people with pre-existing...sorry nothing for you, we have principals and they are more important than whether you live or die, sorry.

Posted by: LiberalForReal | December 19, 2009 9:11 AM | Report abuse

I know it's quaint to think that politicians should be held to their own standards and kept accountable for their own statements but i kinda believe in that crap. In fact, Obama's statements about a mandate during the campaign was the primary difference between him and hillary. it was the reason why many of us gravitated towards obama during the campaign.

i don't see how it is so hard to understand the position of many of us that a government enforced mandate to purchase a private product is an inappropriate use of government power and a horrible precedent to set. the public option is what gave mandates legitimacy. a few loophole ridden regulations are not an equal trade off for a fundamental change in the relationship between the State and the citizen. the biggest freakin chip we have is the mandate, giving it away for what amounts to party favors is not a good deal or good negotiating. what enticements are we sposed to have in the future that will help induce these promised further "improvements" (besides continually increasing premiums? we're giving away all our stash for peanuts.

Posted by: PindarPushkin | December 19, 2009 11:47 AM | Report abuse

I heard that this bill would make the healthcare industry stronger, since they will be receiving government support. Should the bill still be passed?

Posted by: stavner17 | December 19, 2009 12:49 PM | Report abuse


I deeply resent both Greenwald's compulsion to define me and his abstract approach. Sure, I care about abstractions like "corporate takeover of America," but I care a hell of a lot more about being able to take medication to retard the progress of my MS. And I have no security on that point until HCR takes effect.

I can play definition, too. What this really comes down to is whether you can swallow ripping away the health insurance from 30 million people, or not.

It's easy to take a firm stand against corporate takeover when you're only sacrificing other people.

@ezra, you can respect people who oppose expanding health insurance? Really? I can't.

Posted by: JaneG | December 19, 2009 3:18 PM | Report abuse

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