Wednesday, December 02, 2009

Howard Dean isn't helping

According to Ezra Klein, Howard Dean, once thought to be a leading health-care guru in the Democratic Party, thinks that "this bill is worthless and should be defeated" -- if it doesn't include a public option.

Like Ezra, and as I've written here many times, I'm a supporter of the public option and want Democrats to push for its inclusion, preferably in a robust form. But Dean's comment is just plain stupid. Klein:

The strongest public option on the table -- the House's version -- would serve a couple million folks and cost a bit more than private insurance. It's worth having, for reasons I've argued over and over again. But a lot of things are worth having. It isn't decisive, or even obviously relevant, to the bill's success or failure. If the bill is "worthless," then it's worthless in the presence of the public option. And if it's not worthless, it's not worthless in the absence of the public option.

Which leaves us arguing over the meaning of the word "worthless," I guess. This is a bill that cuts premiums costs. That extends insurance coverage to more than 30 million Americans. That cuts the deficit. That establishes an expectation for near-universal health-care coverage. That really digs into delivery-system reforms. That takes the first, halting steps away from the fee-for-service system. That makes better insurance cheaper for the poorest Americans. If passed, it will be, without doubt or competition, the largest piece of progressive social policy since Lyndon Johnson established Medicare and Medicaid. If this isn't worthwhile, then progressives should pack up and go home, because nothing Congress passes in the foreseeable future will even come close.

I think that's exactly right. This doesn't mean dropping the public option, just recognizing that the public option (and especially the decidedly non-robust variations that Congress is considering) isn't the be-all and end-all of health-care reform and that there could be significant and even historic reform even without it.

I appreciate and even admire Dean's firm commitment to the public option -- it's just the sort of passion and determination we need from Democrats -- but he isn't helping. Ultimately, Democrats may vote for, and need to defend, because it may be all they can achieve given Republican opposition and their own internal divisions, a bill that either does not include a public option or that includes a severely weakened public option -- or that includes a trigger of some kind. This would be a less-than-desirable bill, to be sure, but also one that results in genuine reform. It would be better for a prominent figure like Dean not to be sniping from the sidelines, calling such a bill "worthless" even when it's actually worth a great deal in terms of changing America's dysfunctional, costly, and unjust health-care system for the better.

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