ERIf you ask a progressive on the president's left flank, they'll probably tell you that the House health care reform bill that passed the House on Saturday is, in fact, a weak bill with a public option that's doomed to fail.

I don't necessarily agree. The bill clamps down hard on insurance companies by capping out-of-pocket expenses, banning discrimination for pre-existing conditions, banning rescission (rescinding a policy as soon as you become sick or injured), creating health exchanges to encourage competition, stripping the insurance companies of their tasty anti-trust exemption, and, of course, there's a public health insurance program. There are also government subsidies to help us pay for insurance -- offering financial assistance to families earning up to $88,000 annually.

It's a treasure chest filled with regulations the health insurance companies should rightfully be afraid of.

The public option in the bill, much like Social Security and SCHIP before it, can be expanded and made more robust over time, eventually leading to something more closely resembling Medicare for All. Oh, and it reduces the federal budget deficit by $100 billion over ten years, according to the nonpartisan Congressional Budget Office. Not too shabby.

But progressives are angered by the fact that there aren't any enforcement measures to guarantee, for example, that an insurance company won't continue to deny coverage and just pay the fines or seek a loophole. They're also dissatisfied with the public option, since it's based upon negotiated rates rather than Medicare rates. The worry is that this won't create necessary competition. Plus, the CBO reported that the public option could become a dumping ground for sick people, which might force the premiums for the public option to inflate to a level more expensive than private insurance premiums.

And then there's the Stupak amendment, which would prevent lower-income women from paying for an abortion with federal funds. It's a terrible amendment shoved into the bill at the last minute in order to cajole conservadems into voting for the bill -- but they voted against the bill anyway.

All of these downsides are leading progressives to reconsider support for the bill. On Monday, 41 female members of the Democratic caucus in the House have pledged to vote against any bill containing the Stupak amendment. Progressive health care blogger RJ Eskow is pushing for the public option to be entirely killed.

Ultimately, the nature of this bill illustrates the level of reform possible with Democratic majorities and a popular president. I hate to damn the bill with faint praise, but this is as good as it gets. I can't imagine how large the House and Senate majorities would have to be, or how popular and liberal the president would have to be, in order to achieve something like Medicare for All.

But clearly, this is the best possible legislation given today's political realities and the power still held by the lobbyists and special interests. And it's still very historic. Put into perspective, there's a president on Mt. Rushmore who couldn't shepherd health care reform to this stage. FDR, JFK, Truman and Clinton couldn't get us this far either.

But there's still a long way to go. Health care reform, if Congress ever passes a final bill, will be a work in progress with lots of enemies. For example, according to the Center for Responsive Politics, the House members who voted against reform on Saturday have taken an average of $502,650 from the health care lobby since 1989. And fueling the concerns of progressives, the House members who voted for the bill took almost as much -- $437,100.

Frankly, I'm amazed we've gotten this far.


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