The fight to get America a decent health insurance system

The conventional wisdom and Nate Silver’s analysis seems to show that a public insurance option isn’t going to make it into the bill.  This is rightfully angering many liberals, but I am of the belief that we can live without it in this round.  Kevin Drum notes that world-wide universal health care tends to come incrementally rather than in one grand bargain.

This isn’t to say that liberals should top fighting for it.  Ezra Klein argues that attempts to compromise with all but a handful of Republicans are futile.  The incentives to cooperate just aren’t there.  It will likely be necessary to give up the public plan to get enough votes in the Senate, but giving it up preemptively will just result in a new set of lies about some other part of the proposal.  However, it’s vital that if we can get the principal of universal health care in place that we take a deal public option or no.  I tend to think, despite bluster, that most of the real liberal fighters understand this and I trust they know

What we need is reform such that insurance is available to all and will not abandon them when they need it most.  This is not the case with the present employer based system although many people don’t find that out until it is too late.  Yglesias has a helpful White House summary of the key reforms necessary to remove the worst dysfunction from the system. 

Ultimately, I think in the long term controlling costs probably will mean providing a system that makes more sense than employer based insurance.  I want a robust public option, if it out competes private and non-profit insurance that’s great, if not than so long as costs are contained I don’t really care.  Moreover, I have no desire to place any sort of cap on spending even under my ideal system, I’m happy to have people buy supplemental insurance or putting all their wealth into buying all the care or medical research they want.  There are exceptions but an aversion to caps is the standard American liberal view, let alone the view of Democrats that are electable outside of liberal enclaves.

Finally, for those of you already on board here’s a bit of catharsis via Yglesias who argues against defensive crouches and for hitting back fearlessly.  The level of aggression here is dang satisfying and probably often a good idea, but I think not showing fear is the key take-away.  I don’t think that’s actually a useful lesson in overall strategy, but it’s quite important in the specific instance of public speaking.