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Health-care reform is progressive

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Reading Chris Bowers's excellent list of the progressive priorities fulfilled or partially fulfilled by the health-care bill's sidecar amendments is a reminder of how peculiar the framing of this debate has been. There's no doubt that progressives have suffered some real losses in the legislative process. The public option, for one. But along the way, a lot of progressives have lost sight of the fact that the very existence of this legislative process is a huge progressive victory.

Five years ago, no one had ever heard the term "public option." But progressives had been talking about the uninsured for decades. There's probably no more constant lament in Democratic campaigns than the plight of the nation's 50 million uninsured. And this bill is, fundamentally, an effort to address that. Once it's up and running, it spends $200 billion a year to help low-income and working-class Americans afford health-care coverage. About 15 million of those people will become eligible for Medicaid, which is public insurance. Another 15 or so million will get private insurance.

But that private insurance will now be a very different beast: It will have to spend 85 percent or 80 percent (depending on the market) of every premium dollar on care. It won't be able to reject people for preexisting conditions. It will be in a regulated exchange where it has to justify premium increases and bad behavior or face exclusion. And those exchanges, regulations and subsidies will also create the core structure of a universal health-care system in this country, which should be comforting to progressives who look to the improvements in Social Security and Medicare and Medicaid and CHIP and the EITC and know that the history of American social policy is that, in general, we build on our imperfect foundations and make them stronger and fairer over time.

I don't want to suggest this bill is all progressive victories. It isn't. It isn't single-payer and there's no public option, and though I think the excise tax is a progressive tax, I grant that reasonable people disagree on this matter. But the fact of it is that this bill represents an enormous leftward shift for American social policy. It is not, in my view, a sufficient leftward shift, but it is unmatched by anything that has passed into law in recent decades. Progressives have lost some very hard battles but are on the cusp of winning an incredibly important war. For all its imperfections, health-care reform itself is deeply, deeply progressive. And if you don't believe me, just ask the conservatives who have made opposing it their top priority.

Photo credit: AP Photo/Charles Dharapak.

By Ezra Klein  |  March 8, 2010; 11:54 AM ET
Categories:  Health Reform  
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Comments

It's pretty pathetic that a post like this one is necessary. Much credit is due to those esteemed health policy experts Arianna Huffington and Jane Hamsher.

Posted by: vvf2 | March 8, 2010 12:04 PM | Report abuse

and for the life of me I cannot figure out why so many self identified "progressives" seem intent on ensuring that this tremendous achievement (just a read of the blogs on firedoglake makes me want to end it all) either through opposition or failure to unite. I am just appalled at the failure to focus on real benefits (e.g. improving quality of care for all, containing costs for the public or covering the uninsured) and instead focusing on specific policy approaches (e.g. the public option, single payer, etc.) which take on the character of a holy grail. The progressive movement is completely missing the forest for a couple of trees and if we fail to achieve health care reform it is us who we should blame not the predictable enemies of progressive social reform.

Posted by: alan24 | March 8, 2010 12:13 PM | Report abuse

The reason we were all psyched about the public option is that it seemed so unopposable. Obviously, universal healthcare is a human right, but the fundamental objection seems to be some Reaganite nostrums about how the free market does things better. We who believe that the government can provide healthcare more efficiently than the private sector should be allowed to set up a program to buy into such care at cost-- the better to demonstrate that it can work, and it can work here. Who, especially those who believe with such faith in the markets, could object on principle to such a program?

And yet, we can't even get the most bare-bones demonstration of this principle, it's been wrung from the bill utterly because of the truth it would imply.

Posted by: adamiani | March 8, 2010 12:14 PM | Report abuse

I think you should probably take some blame for the 'framing,' in the sense that you once wrote a post touting the conservatism of the Senate bill:

http://voices.washingtonpost.com/ezra-klein/2010/02/the_conservative_compromise_th.html

Posted by: gocowboys | March 8, 2010 12:19 PM | Report abuse

As someone who concluded this bill is better than the status quo, but just barely, I can understand the opposition to it from the left. Without the public option or any similar device, we're mandating that people purchase a private product. Subsidies and offsets aside, I can see why that's a dealbreaker for some. Like most things it's about perspective and what you value most. Unlike the first two posters I don't begrudge anyone for being against it, but instead I hope that the detractors look at the cumulative impact of the legislation and reach the conclusion that, on balance, it's worth passing.

Posted by: BigTunaTim | March 8, 2010 12:26 PM | Report abuse

If by "progressive" you mean liberals who are scared of calling themselves liberals or doing anything liberal, ie, like saying the insurance companies and the providers are robbing us blind relative to other countries and that single payer or a public option (the real one, with 100 million potential enrollees) are the most direct means of stopping the robbery. Then, yeah, it's deeply "progressive." But I don't think that leaving unsolved the problem that bankrupts millions of families of families and will continue to bankrupt them, after we've been talking about this issue for 60 years, is terribly liberal. It does some good things and will help around the edges, but making health care affordable for average folks in this country hasn't been done (and (Ezra's the sun-will-come-up-tomorrow Annie! stylings notwithstanding) there's no concrete prospect that it will be done anytime soon. So we took an unprecedented financial and economic crisis that caused millions to question the existing economic order, and our response was to do incremental reform and hope to solve the real problem later. Meh.

Posted by: redscott | March 8, 2010 12:27 PM | Report abuse

This is 100% Progressive Single-Payer all along. The sub-5% mark-up paid to the private insurance company is a small fee to create the federal holding company that is able to launder tax (i.e. mandated insurance premiums) that are effectively paid to the federal government, save for the costs to actually implement the subsidized healthcare system.

The duplicity of this whole effort has been truly astounding. The Public Option would have made the transition away from the holding companies smoother and fater, but tomatoe tom-a-to...who cares....

Private insurance companies will have every rate they set, every fee they payout, and every cost they incur regulated by DC. So what is it that makes them "private" anyway?

Posted by: FastEddieO007 | March 8, 2010 12:32 PM | Report abuse

HCR is about 55% progressive (insurance regulations, subsidies, expansion of medicaid, more public health clinics) and about 45% centrist/conservative (NO PUBLIC OPTION, individual mandate, no employer mandate, no protection against medical bankruptcy--note most people who file for bankruptcy because of medical bills HAD INSURANCE), cadillac tax, subsidies leave out or undersubsidize too many people). In my book that is a pass the damn bill, even if I am underwhelmed with its progressive credentials.

Posted by: srw3 | March 8, 2010 12:41 PM | Report abuse

FE007: This is 100% Progressive Single-Payer all along.

If this were really true (note subjunctive--condition contrary to fact), don't you think that single payer proponents would be supporting this instead of playing purity troll and kill HCR over the lack of a public option?

Posted by: srw3 | March 8, 2010 12:45 PM | Report abuse

The Democrats in the House will either pass this bill or they will self-destruct in November. If they don't pass it this week, we will demand passage twice as loudly next week. And if they try to let it slip from the agenda next week, we'll ratchet up the noise the week after that. The Democratic base is going to get louder and angrier about the inaction of the Democrats in the House with every passing day, right up until the morning of the elections if necessary. We are not going to let this go before health care reform is signed into law, not this time. If Democrats are reluctant to act now, this week will only be the beginning of the debate. It's their choice. They try to let it slip, we'll step up the noise. Those who are opposing health care now and are ganging up with the insurance industry will have a lot of explaining to do in November.

Posted by: opinionpieces | March 8, 2010 12:50 PM | Report abuse

@goco
Here is the money graph from the post you cite...

The subsidies and the individual mandate are aimed at a very liberal goal: universal coverage, or something very near to it. But the road the bill takes to get there is based on a vision of functioning markets rather than government provision. It's a far more conservative take on the issue than most realize.

Goal= liberal
path= moderate/conservative
total= process compromise with liberal goals.

as I said above 55% liberal 45% moderate/conservative.

Posted by: srw3 | March 8, 2010 12:55 PM | Report abuse

Its worth noting that in the spirit of this whole duplicitous effort by Obama & Pelosi, Secretary Sebillius went on Meet the Press and described a rate hike by Anthem that projected an increase in their margin from 2% to 3% as a "50% Rate hike".

Well played!

Posted by: FastEddieO007 | March 8, 2010 12:55 PM | Report abuse

srw3: This biggest supporters of this legislation are people who are on video a short time ago advocating single-payer, starting with Obama.

Jacob Hacker is on video explaining how it morphs into Single-Payer.

They've shredly turned "private insurance companies" into federal puppets, and converted their collected revenues as a ridiculous mandated tax increase on all middle class families enforced by the IRS!

This is single-payer. Period. The private insurance companies become mere holding companies for the federal government.

Posted by: FastEddieO007 | March 8, 2010 12:59 PM | Report abuse

Love the reference to Annie, redscott. Priceless.

My problem with this post, too, is the triumphal note EK once again strikes prematurely, as though the legislation is already signed, sealed and delivered, when odds are better than 50/50 the House won't pass the Senate bill, thanks to the Stupak bloc, or (less likely) will try to include Stupak language in the sidecar but then the Senate will kill it. And if healthcare reform dies (more likely than not), then all of EK's "This bill is progressive! No, it's conservative!" blather will be moot.

Posted by: scarlota | March 8, 2010 1:08 PM | Report abuse

I don't understand why "progressives" are opposed to HSAs. Fundamentally they offer more control over what you get than turning the decisions to the government bureaucracy or a private insurer.

I think the long term effects of this bill could be to create a tax environment that moves a lot of people of out employer funded care, given the inequities in subsidies. That will increase the costs to the taxpayer significantly, as we will naturally adjust our behavior to take advantage of the greatest subsidies (a worker making $30k per year could get $18k in subsidies if they leave their employer plan).

I still say we need to bring back the end of life care reviews. http://drgrumpyinthehouse.blogspot.com/2010/03/checkout-time.html

Posted by: staticvars | March 8, 2010 1:15 PM | Report abuse

@srw3,

Ok, not sure where we disagree (do we?). I just found it interesting that Ezra was decrying the framing of HCR, and yet he himself helped to frame it was more conservative than popular rhetoric suggests. He was right then. He sends mixed messages with these oscillating posts on 'HCR is progressive' and 'the bill is conservative,' etc. Your description is right - which is why both die-hard progressives and die-hard conservatives aren't happy.

Posted by: gocowboys | March 8, 2010 1:19 PM | Report abuse

Progressive? This bill takes some steps forward, but wipes them all out with a mandate for the uninsured to purchase a failed, yet resurrected product from the health insurance cartel.

In my case, it is an insurance industry that has caused me incredible pain and angst. It has brutalized me over the years; denied me services; denied me coverage; ran me into bankruptcy; almost killed my daughter; and most likely will result in my premature death.

The mandate without a public option is like Congress mandating me to reconcile a failed marriage where I've been abused and beaten, only to be told I have to go back and make pretty, because my abusive spouse has to follow some new laws. It's a bad marriage with no escape.

Bullsh*t is what it is, and it is one huge regressive step back. Enough so to wipe out all the other progressive elements of this bill, if you ask me.

Posted by: jc263field | March 8, 2010 1:21 PM | Report abuse


@FastEddieO007: "Secretary Sebillius went on Meet the Press and described a rate hike by Anthem that projected an increase in their margin from 2% to 3% as a "50% Rate hike"."

Margin is profit. Rates are what they charge customers. I appreciate your zeal to carry the GOP's water, but please understand what you're arguing first.

Posted by: BigTunaTim | March 8, 2010 2:10 PM | Report abuse

Pretty funny to see Ezra write a blog one minute chastizing National Review for claiming Obamacare is a massive government take over of the U.S. healthcare system and then the next article goes on an on about how progressive/liberal Obamacare is and how all the left wingers out there should support it. I like every other conservative belive the second article to be the real truth and that's why we and the majority of the country reject Obamacare.

Posted by: RobT1 | March 8, 2010 2:40 PM | Report abuse

In a very broad sense, Ezra is right since one thing the bill does is expand coverage to 30 million uninsured Americans. But, it's not very progressive by also including language that prevents access to coverage for the other 17-plus million uninsured residents of the US. The biggest crime of the bill is that it makes private insurance companies required pieces of medical care in this country. There is no excuse for democrats to pass a bill by themselves that offers no source of government-backed health insurance.

Posted by: goadri | March 8, 2010 2:42 PM | Report abuse

"But that private insurance will now be a very different beast: It will have to spend 85 percent or 80 percent (depending on the market) of every premium dollar on care. It won't be able to reject people for preexisting conditions. It will be in a regulated exchange where it has to justify premium increases and bad behavior or face exclusion. And those exchanges, regulations and subsidies will also create the core structure of a universal health-care system in this country, which should be comforting to progressives who look to the improvements in Social Security and Medicare and Medicaid and CHIP and the EITC and know that the history of American social policy is that, in general, we build on our imperfect foundations and make them stronger and fairer over time."

and you question Steyn's understanding of central and planning. This looks like a lot of planning on top of previous planning from a central authority. Or perhaps it's just "central adjusting", or "central reforming" or "central regulating" -- yes, that's much better than planning.

Posted by: mdfarmer | March 8, 2010 2:54 PM | Report abuse

Making failure to buy junk insurance a federal crime -- what could go wrong?

NOTE Of course, the insurance will be junk. Despite all the talk of "regulation," where's the enforcement mechanism that will make any of this work? Despite the pathetic attempts of career "progressives" like Bowers and Broder's successor, Klein, to put lipstick on this pig of a neo-liberal, market-based solution, a pig is what it is.

Posted by: lambert_strether | March 8, 2010 2:56 PM | Report abuse

If the constitionality of this bill is questioned and SCOTUS rules in favor of the mandate, then the Constitution will be continually enviscerated under the concept that the Government will be allowed to do ANYTHING that promotes the general welfare.

That means, for example that the Gov't could easily decree that: there should be a tax on hamburger because it's not healthy, toilets can be flushed only once per day to conserve water, your 10 year old car must be scrapped because it is not fuel efficient, or that all hourly wage earners have to belong to a union.

Are we so willing to give up the freedoms that we have left?

Posted by: apberusdisvet | March 8, 2010 2:59 PM | Report abuse

"But the fact of it is that this bill represents an enormous leftward shift for American social policy." And then you have the chutzpah to wonder why conservatives oppose it? Absolutely bizarre. Have you spoken up to tell all the commentators who are pointing out how conservative this bill is (which includes you) that they are lying?

Posted by: MikeR4 | March 8, 2010 3:01 PM | Report abuse

BigTunaTim - You're right. I mistated the lie that Sebellius told.

She put it like this: Insurance are increasing their profits by 50%.

While I am conceding that this is in fact true---it is a shameful manipulation of the public by omitting the fact that the insurance companies' margin of profit is still substantially under a total 5% margin and will continually be maintained at around the level.

The worst part is federal regulations demand insurance companies maintain a margin significant enough to cover potential legal expenses, which if unused become profits.

Posted by: FastEddieO007 | March 8, 2010 3:09 PM | Report abuse

Yes, health care reform as now packaged is, indeed, "progressive," in the worst way short of a full federal take-over and elimination of the private health care market.
If Obama thinks the feds can run an insurance scheme better and with lower premiums than our present system can, let him take a billion or two from the unspent "TARP" funds and launch a competing firm. We could then quickly see just how soon a genuine Obamacare plan either goes belly up or proves his accusations against the private system are bogus.

Posted by: Trucker49 | March 8, 2010 3:12 PM | Report abuse

As a true Progressive, I admit that there is much truth in Klein's logic today.

Assuming this bill is passed, the public option will have been the sacrificial lamb for the votes of those still heavily under thumb of the insurance industry, for a giant step of progress.

In that respect the liberal/progressive efforts will not have been in vain.

We also learned that for the GOP and some DINOs(who kneel at the alter of the corporate/insurance idols) nothing will please them, unless it helps profits and comfort of these super rich pigs.

Posted by: owldog | March 8, 2010 3:35 PM | Report abuse

Trucker49-

That's called the Public Option, and conservatives killed it. I agree with you though, it would've been a great idea.

Posted by: etdean1 | March 8, 2010 4:04 PM | Report abuse

srw3,

personally you need to seperate the centrist and conservative.

I'd say its 55% progressive, 35% centrist and 10% conservative.

redscott said:

"If by "progressive" you mean liberals who are scared of calling themselves liberals or doing anything liberal, ie, like saying the insurance companies and the providers are robbing us blind relative to other countries and that single payer or a public option (the real one, with 100 million potential enrollees) are the most direct means of stopping the robbery. Then, yeah, it's deeply "progressive."

Sorry but I think you're confusing insurers with doctors, pharma and hospitals. You know the ones that RECEIVE the payment for services rendered. But other than that little minor faux pas you're right on. Ya right.

Posted by: visionbrkr | March 8, 2010 4:09 PM | Report abuse

No matter how obvious, liberals, progressives, or whatever they're called, have failed to recognize that you can't redistribute wealth and expect to have a functional society. It has been proven over and over again. When government runs things, they don't function well. Why? No incentive to do well - ditto for union workers - tenure for college professors, etc. Just do the minimum, enjoy life, and let the government take care of you. I've seen it first hand, working with people from Amtrak, State workers, etc. Their work ethic is laughable - more concerned with who has the bigger desk than who is doing the better job. This attitude permeates government. Any government worker reading this will say "I worked hard" - but that's relative. Compared to private industry, it's not hard - no 16 hour days, weekends, etc. Automatic raises, private pensions (no SS), etc.
So, libs, next time you want to vilify and mock private industry, conservatives, and a strong work ethic, just remember, without them, you'll have nothing. After all, who's gonna do the work? Not you? You're too good for that. And after all, it's not "fair" (libs, explain "fair" and get back to me).

Posted by: rknapp0205 | March 8, 2010 4:22 PM | Report abuse

Please call your congressman today and get this legislation passed so stories like this can be avoided...how dare the middle class of Canada enjoy USA Medical Services!!!!


Only progressive elites should be allowed to pay doctors!!! We will never stamp out ignorance if mere commoners are allowed to buy their healthcare!!!

http://www.torontosun.com/news/columnists/mark_bonokoski/2010/03/06/13138311.html

Posted by: FastEddieO007 | March 8, 2010 4:55 PM | Report abuse

This makes it sound like the "bill" has the money in its back pocket to "help" poor people "afford" coverage. Where in heaven's name does this pinhead think the money is really coming from! It comes from all of our pockets. Obama has NO money, the government has NO money, it's not like they can increase their profits or sell more widgets. THEY TAKE IT FROM US! And if you believe that the "rich" can afford this, think again nitwits. The rich don't have enough money to cover all this. IT WILL COME FROM THE MIDDLE CLASS.

Posted by: bandmom22 | March 8, 2010 5:06 PM | Report abuse

As a liberal (VERY liberal), the last thing I would ever call Obama's health care reform is "progressive."

It's nothing but a first step towards dismantling Medicare and Medicare.

Weren't you listening to Obama's speech today?

Oh, and how 'bout that $250 in the bill for seniors to help defray the $2500 donut hole! Whoopee, how progressive!!!!!!

Posted by: solsticebelle | March 8, 2010 5:52 PM | Report abuse

Amazing that people can only see the arguments that the players lay out for them. We have been presented with two options for Democrats. If they fail to pass something, they risk looking like failures. If they do pass this bill, they risk their political careers for "the good of the party (comrade)."

Where is the option for Democrats to say no? Where is the option to represent their electorate, to vote with the 150 million Americans that strongly do not want this bill, rather than with the 75 million who do?

We all want changes in health care industry, but the basic difference is liberals want our government, with their proven track record of screwing up everything they touch, calling all the shots.

Just tell us how much taxes will go up in order to expand Medicaid and Medicare, and quit all the lies about "bending the curve" and "spending means savings".

I am sick of the debate, so just pass the damn thing so we can repeal the unconstitutional mandate and move past this "somebody else pay my way - I'm entitled" mentality.

Posted by: duffmeister | March 8, 2010 10:35 PM | Report abuse

duffmeister wrote>>>>Just tell us how much taxes will go up in order to expand Medicaid and Medicare, and quit all the lies about "bending the curve" and "spending means savings".

Medicare is not being expanded, but will be BETTER - more efficiently run for beneficiaries and the government.
Billionaires and janitors pay the SAME Medicare tax rate. Obviously, this hurts janitors more than billionaires - and via the health care bill the Wealthy will pay a higher Medicare tax rate.

Your other comments are erroneous rightwing talking points parroted from Faux News.

Posted by: angie12106 | March 9, 2010 2:55 AM | Report abuse

duffmeister wrote>>>>Just tell us how much taxes will go up in order to expand Medicaid and Medicare, and quit all the lies about "bending the curve" and "spending means savings".

Medicare is not being expanded, but will be BETTER - more efficiently run for beneficiaries and the government.
Billionaires and janitors pay the SAME Medicare tax rate. Obviously, this hurts janitors more than billionaires - and via the health care bill the Wealthy will pay a higher Medicare tax rate.

Your other comments are erroneous rightwing talking points parroted from Faux News - but do you have affordable health care?

Posted by: angie12106 | March 9, 2010 2:56 AM | Report abuse

angie12106 wrote that the comments made by duffmeister were just "erroneous rightwing talking points parroted from Faux News - but do you have affordable health care?"

As one of those "right wing" people who has spent the last 20 years working with "at-risk" youth and adults through government and non-governmental programs let me share what I have discovered:
1) Most government programs don't work. The most successful are "faith based".
2) I was constantly approached by governement groups wanting to provide low income housing to people in the San Jose, Ca, area by giving up some of the property our church owned. When I would ask "What will be the requirements for these low income families to get this housing?" I was always told "Pastor, we can't require anything of these people." Yet groups like Inn Vision and Lutheran Social Services do provide low income housing for people, have requirements to better themselves AND are very successful.
3) The whole health care debate drives me nuts. Especially when it comes to the government running the program. I live in California which has MediCal. One of my children was diagnosed with type 1 diabetes and we had no insurance - our former Kaiser Premium had been $1,700.00 per month and we could no longer afford the premium and all the co-pays. Yes I can hear all you progressives saying "see we need a better system" and I would say "I agree" BUT when it was all said and done, we were approved for MediCal but I made just enough money - less than $3,000.00 per month and my portion that I was required to pay, every month, before MediCal would cover any of our expenses was, hang on to your hat all you progressives $1,700 per month. To be approved for our great state run medical insurance I had to pay out 50% of my income before they would pay for ANYTHING.

Is the system broke - you bet.
Does it need to be fixed - you bet.
Do I trust the Government to do it - no way.

Posted by: pjuhey | March 9, 2010 11:17 AM | Report abuse

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