Sam Smith, Progressive Review - Pass Obamacare and get some important restrictions placed on the predatory practices of insurance companies. It will also increase by several tens of millions those receiving free or subsidized health insurance.
On the other hand:
- The proposed cuts in Medicare would, despite the president's claim to the contrary, reduce the program's services to seniors to an uncertain degree.
- The proposed "efficiency" programs would result in some reduction in end of life services. Whether this would be as significant as the restrictions currently imposed by insurance companies is uncertain.
- The government's real and de facto subsidy to health insurance companies (either through helping people pay for their insurance or through the mandatory purchase of insurance) would be among the greatest government pork ever, similar to that in the bank bailout or in the subsidy of the defense industry by our military budget. It amount to $100 to $200 billion a year given largely to an industry that serves no social purpose that couldn't be better and more cheaply handled by the government.
- The mandated purchase of health insurance is probably unconstitutional.
- The public option has either faded into a choice for the poorest or is dead.
So what does a conscientious member of Congress do? In many ways, these legislators find themselves in the situation of someone doing business in a Mafia neighborhood. They can achieve some of their objectives, but only after paying off the hoods from the insurance company mob.
One can be moral, refuse the payoff and leave health reform to another year or one can be pragmatic, make the payoffs, and hope that on balance it works out for the best. Neither approach is satisfactory.
Another way to look at it is that either passing the bill or not passing it will cause a reaction. The nature of this reaction is uncertain. For example, one could argue that failing this time would set things in motion for real health reform. Bipartisanship, centrism and all the other cons of the Washington establishment would have betrayed us again and the argument for single payer would be stronger.
But one could also argue that passing a bad bill would also lay the groundwork for real reform as the fallacies and failures of the bill would soon be apparent to all, laying the groundwork for something better.
Depending on the time of day and what I'm reading, I can go with either approach. And I doubt that I am alone. One thing, however, is certain. Obama and the Democrats - with their cynical and false centrism - have left us with a patchwork of good and evil as bad as Wasington ever sees, forcing us to choose between doing nothing or paying off the hoods in order to do a little good.
