I think it's fair to say that HCR as passed is a potential path to a path to a better health insurance system, but absent a public option or similar there's no guarantee that we're actually on even the path to the path yet. A public option would have been the simple fix to a lot of potential problems, and also would have been quite difficult to take away.
What is the potential political path to the potential path that Hacker recommends? One of the debates about the health bill was whether it provided such a political path. At best, the path is murky and dubious.
But the bigger question is whether Democrats and progressives even agree that a "greater government role" is critical to health care reform. For all the sturm und drang about firebaggers and whether the health bill was the biggest progressive accomplishment in 30 years, lost was the fundamental issue that people disagreed about the POLICY. While much invective was hurled, in both directions, very few acknowledged that the Ezra Klein/Jon Cohn axis really did not care about "greater government involvement" in health care and health insurance in the form of expanded public health insurance. Ed Kilgore was the exception:
[The Obama Administration exchange] 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[ . . .]
To garner support of public insurance reform advocates, there was the promise of a "next time." Hacker, who supported the health bill, accepted that promise. And his article is indicative of that. Many advocates for the health bill (the Klein/Cohn axis) really do not care if there is a next step for public insurance reform. their goal is an expansion of the exchanges - in essence full implementation of Wyden-Bennet.
The fundamental question is does public insurance reform really have a near term political future? I think the answer is decidedly no. Further expansion of the market based exchange reform is obviously the most likely path for further reform.
The expansion of Medicaid eligibility in the health bill is the end of the line for expansion of public insurance reform for the foreseeable future. Frustrated advocates for this approach were, as Kilgore forthrightly acknowledges, not wrong to complain about the health bill.
The Klein/Cohn axis won the battle of health care reform in the Democratic Party. They should be pleased. Their demand that EVERYONE be pleased however, is wholly unreasonable.
Winners celebrate. Losers commiserate. That's the way of the world.
Speaking for me only
