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Kill It, It’s the Enemy of the Good

Absent a substantial change in direction by Congressional Leadership and the President, I think it’s time to do whatever progressives can to kill the health care reform legislation currently moving through Congress, and then to immediately reset to Medicare for All, single payer.

As HR 3962 bill sits now, it’s worse than no bill at all, and the Senate and Conference versions are likely to make a final bill still worse. If so, that bill will destroy progressive and Democrat credibility by associating us once again with reforms that don’t solve problems, and corporate interests, in opposition to the American people.

Very few evaluations of the emerging reform bill talked about what it is likely to do in the interim “band-aid period” between now and 2013, probably 3.5 long years until the exchange is ready, as if that didn’t matter in evaluating the bill. Many have said that the bill as written would cover 36 million additional people, and cite CBO for that figure. But, that won’t happen for years, and I don’t think CBO’s estimate takes into account the inflation we’ll see in insurance premium costs during the band-aid period and thereafter. By 2013 alone, we can expect a 40-50% increase in those costs. In the years following that, the increase should be similar, and what will these increases do to CBO’s forecast of the number of additional people who will take insurance? 36 million covered seems very unlikely to me without a complete revision of the income/subsidy table.

Even before the fully operational date in 2013 however, how many additional people are likely to be covered? I’ve estimated here, that over the band-aid period perhaps 16,000,000 of the currently uninsured would sign up for the high risk pool. In rough terms, that still leaves us with 31,000,000 uncovered. and roughly an estimate of 31,000 annual fatalities due to lack of insurance, or roughly 108,000 fatalities between now and then. This doesn’t count the toll from the millions of bankruptcies and huge numbers of foreclosures still to be expected because this bill doesn’t solve those problems either.

Pure and simple, given the above expected outcomes for the band-aid period, this is an immoral bill, and it is so because it is inadequate to end the fatality, bankruptcy, and foreclosure problems resulting from the health insurance non-system. This issue is beyond pragmatism. It is beyond expediency. It is beyond cleverness. It is a clear moral issue. The Democrats have had the opportunity to solve these problems with Medicare for All, their response with this laughable bill that they call “a historic achievement,” signals the moral bankruptcy of the Democratic Party.

Some people have acknowledged that what is shaping up is a bad bill, but that it’s not realistic to try to defeat it in the Senate. One of these people is Jane Hamsher. I’ll consider a few of Jane’s arguments culled from recent exchanges occurring in the context of one of her diaries.

Jane says:

“Here in the real world, your choice is between a) this bill with a public plan, or b) this bill without a public plan, or public plan with triggers, or a public plan with an opt-out.”

This is not strictly true. I can’t choose any of these things. What I can do, is to do what I can to support one of these alternatives, or others Jane didn’t list just above including the option of killing this bill. Now, my influence, even in joining with others is pretty small. So why ought I to support any of these three options, since I think they are all bad choices?

Of course, Jane thinks that these are the only options with any chance of being realized, and so it makes the most sense to choose the least of evils. But I don’t agree with this, because I don’t think that killing this bill is impossible — not with 40 Republicans in the Senate willing to kill it, and Harry Reid seemingly unwilling to use either reconciliation, or the nuclear option to pass a bill with less than 60 votes. In particular, If Bernie Sanders filibusters this bill it’s gone. If Jay Rockefeller joins him, it’s gone. If Al Franken decides he’s had enough, it’s gone. If Roland Burris goes through with his stated opposition to a bill without a robust PO, it’s gone.

There are a number of possible votes in the Senate that could kill this, and a number of pressure points we can use to try to kill it. Even if we fail in the Senate, we can go back to the House again, and see if we can pick up those 14 – 20 votes that would kill it in the final floor vote. We may fail in both those things, but right now I don’t think that even with our support, the probability of getting a PO in the Senate that is even as as good as the House’s, is any better, and it may be lower than the probability that we can help to kill this bill.

So my choice, in answer to Jane’s question, is to do the best I can to get progressives to deny Democrats the votes in the House and Senate they will need to finally pass this bill, and to try and get a few progressives in the Senate to filibuster it in hopes that they and the Republicans can defeat it. This is worth doing because, for reasons stated above, this is a very bad bill that I don’t want the Democrats and the progressives to be tagged with responsibility for.

I’d rather that Democrats be blamed for failure to pass any health care reform right now. Obama and the blue dogs will then be faced with defeat in 2010. Then next year, progressives can try again to push health care reform in the right way, by advocating for HR 676, and threatening to vote against any deviations from it. Then let’s see what Obama, Pelosi, Reid, and the blue dogs do, when their backs are against the wall.

And in another reply Jane says:

“1) Do Democrats have a majority in the House & Senate and control of the White House?

2) Do you think this bill would be better without a public option?”

Of course, the Democrats have a majority. They have 58 votes, in fact. But that doesn’t mean that they can surely pass this bill, because unless they can get both Lieberman and Sanders, two Senators diametrically opposed on the PO, they won’t have the super-majority they need for cloture. They can pass it without a super-majority. They can use reconciliation or the nuclear option. I think that progressive Senators who feel strongly about the PO and, perhaps, in a few cases, even Medicare for All, should make the Democrats do that, if only to weaken the filibuster and blue dog control over liberal legislation more generally.

Moving to the second question, I think the bill would be better with no PO, than it would be with a lousy PO. Why?

Simply because the absence of a PO, provides a much better basis for future political action supporting Medicare for All, than a bill that has a clearly inadequate PO, because the opponents of reform will just tell everyone looking for further reform and Medicare for All, that everyone should wait and see how this wonderful PO, that progressives and Democrats fought so hard for, will work.

We have to remember that the idea of the PO has been oversold from the beginning, and since the “bait-and-switch” tactics of Democrats, HCAN, and other "veal pen" organizations have accelerated, more and more outrageous claims have been made for the version of the PO in bills “on the table,” until lately Alan Grayson has been saying that Nancy Pelosi’s wonderful House bill is going to end the fatalities due to lack of insurance. After all the claims they’ve made to get this PO passed, if they succeed, the Democrats are not about to back off those claims and admit that the bill with the PO is one that needs to be greatly strengthened before 2013, because it won’t end the deaths, bankruptcies and foreclosures, as they promised in 2009.

No, passing a bill with a terribly weak PO now, will set the Democrats, and the American people, up perfectly for waiting until roughly 2015 to get anything better. And if the Democrats try to come back again next year to improve the bill, the Republicans and the blue dogs will remind them of their lies and will tell them “give the bill a chance to work. No health care reform again until at least 2015 when we’ll know a little more about how things are working.”

On the other hand, if we succeed in killing this bill because it’s lousy, or even if we weaken the Democrats enough that they can’t get the weak PO in the bill, then progressives can immediately come back with a vengeance and run against the bill that passes, saying that it won’t do the job and advocating again for Medicare for All, single-payer.

In yet another reply Jane offered:

“Here’s the world of options:

1) Try to kill the bill entirely. Which I do not believe will be successful, but anybody who wants to is welcome to try. If I thought we could do it, we would. And if there’s a movement in the House to do that, we’ll support it.

2) Try to make sure a public option stays in the Senate bill.

3) Give up and let Lieberman strip a public option out of the bill.

Which of these do you support? I really should put up a poll.”

I’d say try 1), and if that doesn’t work, then throw our weight behind both 3) and also stripping the mandates and the exchange out of the bill too, leaving only the other elements in. That would be a victory for the Democrats, since it would improve the situation, save some lives, bankruptcies, and foreclosures, in the short run, without compromising future attempts, as early as 2010, to move the system toward Medicare for All, single payer.

And in yet another reply Jane also says:

“Do you think the bill will be stronger with it out? That’s the only question before us. Yes or no.”

The answer is above. It would be better without the lousy PO we have a chance of passing now, and even better if we can use the lack of a PO to strip out the mandates.

This has been a long diary, and I apologize for it. But I think the discussion merited it, and I also think that Jane’s arguments need a very direct response that confronts both her logic and her assessment of the chances of getting certain things done. Again, I think progressives should now support defeating the bills that have emerged from the House and are likely to emerge from the Senate, and after that is done, I think we should immediately switch to Medicare for All, single-payer advocacy and only that, and follow the pattern that libbyliberal has called for.

Let’s make this a a human rights movement and let’s confront the “murder by spreadsheet,” the annual fatalities, the bankruptcies, the foreclosures, and the fundamental inhumanity of the insurance non-system as a moral issue that we will not compromise on. If the Administration and the Democrats will come along with us on this, well and good; but if they insist on continuing to follow their business as usual, bail-out the insurance companies course, then let us fight them, and end both this morally corrupt administration and the existence of the morally bankrupt political party that spawned it, and that now does its bidding.

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Joseph M. Firestone, Ph.D. is Managing Director, CEO of the Knowledge Management Consortium International (KMCI), and Director and co-Instructor of KMCI’s CKIM Certificate program, as well as Director of KMCI’s synchronous, real-time Distance Learning Program. He is also CKO of Executive Information Systems, Inc. a Knowledge and Information Management Consultancy.

Joe is author or co-author of more than 150 articles, white papers, and reports, as well as the following book-length publications: Knowledge Management and Risk Management; A Business Fable, UK: Ark Group, 2008, Risk Intelligence Metrics: An Adaptive Metrics Center Industry Report, Wilmington, DE: KMCI Online Press, 2006, “Has Knowledge management been Done,” Special Issue of The Learning Organization: An International Journal, 12, no. 2, April, 2005, Enterprise Information Portals and Knowledge Management, Burlington, MA: KMCI Press/Butterworth-Heinemann, 2003; Key Issues in The New Knowledge Management, Burlington, MA: KMCI Press/Butterworth-Heinemann, 2003, and Excerpt # 1 from The Open Enterprise, Wilmington, DE: KMCI Online Press, 2003.

Joe is also developer of the web sites,,, and the blog “All Life is Problem Solving” at, and He has taught Political Science at the Graduate and Undergraduate Levels, and has a BA from Cornell University in Government, and MA and Ph.D. degrees in Comparative Politics and International Relations from Michigan State University.