I haven't been blogging very much about health care recently because despite everything, I still consider it likely that we're going to get something that looks like the bill Sen. Max Baucus proposed months ago, except with a different revenue generating scheme (since the House would rather tax the rich rather than unions with cushy medical compensation who might come under pressure from Baucus' excise tax in a few years).

But now there's a groundswell of very prominent liberals -- Howard Dean, echoed by liberal group blogs across the country -- saying we should kill the bill. Why? Because it doesn't have a public option (or a Medicare buy-in). But people, this is a reason to be disappointed, not schizo-kamikaze crazy.


The public option was never going to be the uppercase enter-the-government-bargaining-pressure Public Option. It was going to be limited to the exchanges anyway. There was never evidence that the lowercase p.o. in the bills would actually bring down health care costs. Liberals liked the p.o. because they considered it a necessary step toward a better health care system. 

But you know what's really a necessary step toward a better health care system? Passing health care reform.

It's one thing for liberals to say that health care reform doesn't go far enough. It's quite another to oppose it because it lacks a detail that was mostly metaphorical, anyway. The benefits of health care reform for anybody liberally persuaded are obvious enough, and Kevin Drum helpfully enumerates:

- Insurers have to take all comers. They can't turn you down for a preexisting condition or cut you off after you get sick.
- Community rating. Within a few broad classes, everyone gets charged the same amount for insurance.
- Individual mandate. I know a lot of liberals hate this, but how is it different from a tax? And its purpose is sound: it keeps the insurance pool broad and insurance rates down.
- A significant expansion of Medicaid.
- Subsidies for low and middle income workers that keeps premium costs under 10% of income.
- Limits on ER charges to low-income uninsured emergency patients.
- Caps on out-of-pocket expenses.
- A broad range of cost-containment measures.
- A dedicated revenue stream to support all this.

Nate Silver puts a finer point on the subsidies story with this graph showing the Senate bill's advantages for a family earning $54K. The difference between passing this bill and killing it is the equivalent of saving a family 20 percent of their income on health costs. What, exactly, would be the liberal virtue in defeating that?

As I understand it, nobody in his right mind thought we were could to trash private insurance and build some quixotic system that brilliantly mixed subsidies, health savings accounts and government catastrophic coverage. It was always about getting one big fat Shaq-sized shoe in door. This bill isn't a magical elixir. It's just a big shoe. That should be good enough.

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