Progressive opposition to the health reform likely to emerge from Congress has intensified with Howard Dean's attack on the Senate bill. (He made the same points on radio and TV earlier in the week.) His criticisms go beyond regretting the things that aren't in the bill (mainly, an undiluted public option) and the fact that it gives more business to private insurers: he says that the measure "would do more harm than good".

In Washington, when major bills near final passage, an inside-the-Beltway mentality takes hold. Any bill becomes a victory. Clear thinking is thrown out the window for political calculus. In the heat of battle, decisions are being made that set an irreversible course for how future health reform is done. The result is legislation that has been crafted to get votes, not to reform health care.

I have worked for health-care reform all my political life. In my home state of Vermont, we have accomplished universal health care for children younger than 18 and real insurance reform -- which not only bans discrimination against preexisting conditions but also prevents insurers from charging outrageous sums for policies as a way of keeping out high-risk people. I know health reform when I see it, and there isn't much left in the Senate bill. I reluctantly conclude that, as it stands, this bill would do more harm than good to the future of America.

Dean is right on that first point: if a bill does pass, good or bad it will be declared a victory, just as he says. Still his conviction that a law like the Senate bill would be worse than nothing is  hard to understand--if you're a liberal, I mean. The bill has two core features: it greatly widens insurance coverage and pays enormous sums in subsidies to less prosperous families. From the progressive point of view, that is worse than doing nothing?

Ruth Marcus writes an effective reply to Dean. She asks if he's lost his mind, and makes this point:

[W]hen Dean was running for president in 2004 -- and he launched his campaign in significant part on a platform of health-care reform -- the public option was nowhere to be found in his proposal. He wanted to give tax credits to help the uninsured afford coverage and let the uninsured and small businesses join together in insurance pools. Sound familiar? Like, for example, the plan he's now trashing?

"With my plan, we'll organize a system identical to the one federal workers and members of Congress have," he said back then.

That proposal, of course, is in the Senate bill--and Dean now derides it as less than a real public option.

This post by Nate Silver, noted expert on political stats, briefs slow-learning progressives on what's in this bill for them. He concludes:

So, we've talked a lot about what the bill is not. It's not structural reform. What is it, then? At the end of the day, it's a big bleeping social welfare program -- the largest social welfare program to be implemented since the Great Society. And that's really what it's been all along: fundamental reform like single-payer or Wyden-Bennett was never really on the table. The bill comes very close, indeed, to establishing what might be thought of as a right to access to health care: once it's been determined that people with pre-existing conditions cannot be denied health care coverage, and that working class people ought to receive assistance so that they can afford health care coverage, it will be very hard to remove those benefits. It's the sort of opportunity that comes around rarely -- and one that liberals will greatly regret if they turn down.

That seems about right to me.

Update: EJ Dionne discusses the political implications of the Democrats' "fractiousness":

[It] is dispiriting their supporters, which set off this urgent warning bell in the latest Washington Post-ABC News poll: For the first time in his presidency, more Americans strongly disapprove of Obama's performance in office (33 percent) than strongly approve (31 percent).

Put aside margins of error and the fact that the Dec. 10-13 poll showed a sudden bump in Republican identification that might be a statistical anomaly. The point is that the trend is perilous. In June, strong approvers of Obama outnumbered strong disapprovers by 36 percent to 22 percent. Ardor and energy are switching sides.

There are no instant cures, but there is one thing that must be done fast: Democrats need to agree on a health bill and start selling it with enthusiasm and conviction. Their own turmoil and back-stabbing are making what is a rather good plan look like a failure while persuading political independents that they are a feuding gang rather than a governing party.

 

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.