Kilgore writes:

This approach was inherently flawed to "single-payer" advocates on the left, who strongly believe that private for-profit health insurers are the main problem in the U.S. health care system. The difference was for a long time papered over by the cleverly devised "public option," which was acceptable to many New Democrat types as a way of ensuring robust competition among private insurers, and which became crucial to single-payer advocates who viewed it as a way to gradually introduce a superior, publicly-operated form of health insurance to those not covered by existing public programs like Medicare and Medicaid. (That's why the effort to substitute a Medicare buy-in for the public option, which Joe Lieberman killed this week, received such a strong positive response from many progressives whose ultimate goal is an expansion of Medicare-style coverage to all Americans).

Now that the public option compromise is apparently no longer on the table, and there's no Medicare buy-in to offer single-payer advocates an alternative path to the kind of system they favor, it's hardly surprising that some progressives have gone into open opposition[ . . .]

Precisely so. And gets at what has bothered me about the Village Wonks of late -- the failure to acknowledge that while they had confidence in the regulatory reform (the exchanges, the no preexisting conditions, the community ratings, etc.) - those on the other side (including myself) - simply do not. Given the BEST interpretation of the existing data, their case for the efficacy of the regulatory reform model is not strong. The short answer is the United States is not Switzerland, the Netherlands or Germany. The longer answer is the current bill does not create anything like the systems in place in those countries.

Incrementalism has always been the watchword of this reform effort. And I do not mean that in a demeaning way. Politics is indeed the art of the possible. But the key question has always been incrementalism towards WHAT?

When the bill contained both the regulatory reform framework (the new regs, community rating, the exchange) and the public insurance framework (the public option, the Medicare Buy-In), even in small, ineffective ways, at least you could feel that the bill was taking the system in the right direction.

But once the public insurance idea was completely eliminated, the bill no longer was taking the system in a way that public insurance reform proponents thought it needed to go. Not surprisingly, the public insurance reform proponents screamed bloody murder.

Not surprisingly, the regulatory reform proponents did not. Their ox was not gored. Somewhat surprisingly, the regulatory reform proponents were surprised by the strong reaction. They figured since they did not really care about the public option, neither would anyone else.

Of course that has lead to a lot of rhetorically bloodletting. But at the heart of it all (and this has been boiling up since the summer) has been the inability of regulatory reform proponents to accept, respect and grasp that there really was NOT agreement among Democrats and the progressives on the best way to reform the American heath insurance and care system.

Whenever I protested Ezra Klein going out and playing the public option proponent on television and on his blog - this was at the heart of it. I knew he really was NOT a proponent of public insurance reform. He was a regulatory reform proponent. His perfect reform was Wyden Bennett, not Single Payer.

Ed Kilgore is right - there is a fundamental policy schism on health care reform:

To put it simply, and perhaps over-simply, on a variety of fronts (most notably financial restructuring and health care reform, but arguably on climate change as well), the Obama administration has chosen the strategy of deploying regulated and subsidized private sector entities to achieve progressive policy results. This approach was a hallmark of the so-called Clintonian, "New Democrat" movement, and the broader international movement sometimes referred to as "the Third Way," which often defended the use of private means for public ends.

Normally, I am in this camp. On health care, after looking at the evidence, I have concluded it will not work. Health care requires the public sector model. I also accept that reasonable progressives can disagree on this.

Speaking for me only