So health care reform in the US has finally been passed and signed into law. It’s been a long time coming, see Ted Kennedy below, and it’s been greeted as a great achievement by many on the left, including here on Bright Green. My colleague Peter described it as a vindication of why triangulation doesn’t work. Obama took a principled stand and set the groundwork for a real public option in the future. Adam thinks he’s re-framing the debate around the American dream and Gary informed us on twitter that health care reform makes him embarrassingly proud. So why am I rather less overjoyed than my compatriots? Let’s examine a little more closely what’s actually been passed and how the White House achieved it.

Let’s start with what Democrats actually managed to get through congress and onto the statutes. There’s no public option, no medicare buy-in, definitely nothing like single payer let alone a proper national health service. There’s no drug re-importation, no national exchanges, no federal commissioner to hold insurance companies to account. There will be expanded coverage, maybe another 31 million Americans, that’s not nothing, but it’ll be provided, mainly, by the same private insurance companies that we’ve been told have been doing such a bad job up till now. There’ll be little in the way of cost control but millions of working and middle class people will be fined up to 2% of their income if they don’t buy coverage. There are other, less ambiguously, good parts to the bill; there are important provisions to stop people with pre-existing conditions being denied coverage, some expansion of medicaid and SCHIP. But, fundamentally, as Michael Moore said on Democracy Now! this is a victory for capitalism, it changes nothing in the way health care is delivered in the US.
And the individual mandate isn’t the only problem with what’s been passed. The bill also included restrictions on funding for abortion services, and the executive order Obama signed to ensure the Stupak block in the house backed the bill goes even further. NOW president Terry O’Neill:

The National Organization for Women is incensed that President Barack Obama agreed today to issue an executive order designed to appease a handful of anti-choice Democrats who have held up health care reform in an effort to restrict women’s access to abortion. Through this order, the president has announced he will lend the weight of his office and the entire executive branch to the anti-abortion measures included in the Senate bill, which the House is now prepared to pass.
President Obama campaigned as a pro-choice president, but his actions today suggest that his commitment to reproductive health care is shaky at best. Contrary to language in the draft of the executive order and repeated assertions in the news, the Hyde Amendment is not settled law — it is an illegitimate tack-on to an annual must – pass appropriations bill. NOW has a longstanding objection to Hyde and, in fact, was looking forward to working with this president and Congress to bring an end to these restrictions. We see now that we have our work cut out for us far beyond what we ever anticipated. The message we have received today is that it is acceptable to negotiate health care on the backs of women, and we couldn’t disagree more.

And undocumented immigrants wouldn’t be allowed to buy insurance on the exchanges. As the good people over at FireDogLake (who seem to be the only ones not to have jumped into the pro hcr group recently) say in their six flaws that need fixing for meaningful reform “[t]his policy is not only cruel and immoral, but fiscally irresponsible.”
So, not really a policy that I’d say is terribly inspiring. But what of the argument that some reform is better than none? That compromise is different than triangulation and while there are problems the bill is a good first step, an advancement after decades of inaction that will set the stage for more extensive reforms to come whilst increasing coverage at the moment. Well, as FDL again point out, 23 senators had signed a letter urging a public option through reconciliation, and perhaps two dozen more had indicated they’d vote in favour of such an option since. The version passed by the house last year also contained a public option, which over 60 members of the house pledged to defend, so why didn’t the white house even attempt to pass one?
Perhaps, it has something to do with Rahm Emmanuel’s strategy, reported in Politico, that the democratic leadership should ignore the progressive opposition to the bill and focus on securing the centre, safe in the knowledge that the left of the party, the unions and the netroots would fall into line eventually. And so they did, almost without exception. Glenn Greenwald over at Salon:

For almost a full year, scores of progressive House members vowed — publicly and unequivocally — that they would never support a health care bill without a robust public option. They collectively accepted hundreds of thousands of dollars based on this pledge. Up until a few weeks ago, many progressive opinion leaders — such as Moulitsas, Howard Dean, Keith Olbermann and many others — were insisting that the Senate bill was worse than the status quo and should be defeated. But now? All of those progressives House members are doing exactly what they swore they would never do — vote for a health care bill with no public option — and virtually every progressive opinion leader is not only now supportive of the bill, but vehemently so. In other words, exactly what Rahm said would happen — ignore the progressives, we don’t need to give them anything because they’ll get into line — is exactly what happened.

A principled stand against triangulation and for a new version of the American Dream? Or a missed opportunity to really alter the structure of American politics?