Bill Killers and Good Enoughers: A quick guide to the online left's health care debate

There is, you may have noticed, a fairly raging debate taking place amongst those progressives armed with a computer and a high-speed Internet connection over the future of the health care bill. On the chance that you haven't been closely tracking the blow-by-blow, we present to you a quick guide to the players and the arguments they're making over whether the health care package emerging from the Senate's legislative process is something worth saving, or a botched mess deserving of a quick and merciless death.

But first, a brief synopsis of the state of things. It's facile to frame this debate as one between political activists and policy wonks. Firedoglake, the liberal blog hub that most fully fleshes out the vision of an activist/journalistic hybrid operating in the progressive space, a.k.a. the "netroots," has become ground zero for the debate. FDL's Jane Hamsher has been a dominant voice in what's being called the "Kill the Bill" camp. And certainly, arrayed on the other side of the spectrum are those folks who probably consider themselves journalists before activists, like the Washington Post's Ezra Klein and Mother Jones' Kevin Drum.

But that quick and dirty division points to something broader. The Better-than-Nothingers see the Senate reform bill as a starting point, fixating on the details of the package to make the case that passage now is demonstrably better for the country, the poor, the underinsured, and the uninsured than no legislative package at all. The political system will turn crude progress into more elegant reform as it goes about its business. The Bill Killers, on the other hand, seem to see this package as entrenching a political system, one that is largely unresponsive to activist influence. They want an overhaul. They want justice. A just system isn't one that further builds up health insurance behemoths and adds fertilizer to the entwinement of government and corporate America. And now, in their judgment, is the right moment to push for a different political and social reality.

With that, here's your quick guide to the intra-left debate taking place over whether health care reform is better than nothing -- or not.

First up is Firedoglake's Jane Hamsher encapsulated many of the objections of the Bill Killers in a Top Ten post. The Senate package, she argued, not only drops the public option or Medicare buy-in that would have opened affordable access to many, it includes a mandate that is a considerable burden to many working people. Even worse, perhaps, is that it unacceptably rewards health insurance corporations:

Top 10 Reasons to Kill Senate Health Care Bill
1. Forces you to pay up to 8% of your income to private insurance corporations -- whether you want to or not.
2. If you refuse to buy the insurance, you'll have to pay penalties of up to 2% of your annual income to the IRS.
3. Many will be forced to buy poor-quality insurance they can't afford to use, with $11,900 in annual out-of-pocket expenses over and above their annual premiums.

Also on Firedoglake, Jon Walker argued that passing a bill now cannibalizes the momentum towards real reform:

This bill may be a small step forward toward better reform. It might end up a new welfare program that is slowly pared down to near uselessness over the years (and health reform is not starting from a robust place to begin with). Or by empowering the enemies of real reform, it could be the political equivalent of a starving farmer feeding his children the seed stock.

AmericaBlog's Joe Sudbay argued that the mere fact that health insurers are pleased with the Senate health care package means that it does not do the job of rebalancing the health care system:

But, hey, the insurance companies are happy that the public option was dropped and they get millions of new customers because of the mandate. And, the drug companies are really, really pleased with the sweetheart deal they got from Team Obama. During the campaign, did any Obama voter really think the insurers and Pharma would love his insurance bill? I sure didn't.

Fellow AmericaBlog blogger John Aravosis, while stopping short of arguing that the bill should be killed, is offended that an expansion of how health care works today should be sold to the public as the monumental reform candidate Obama pledge to deliver:

It's not a success when you could have had an A, and instead get a D+, strive for a D+, and then have the nerve to say "look mom!" It's really getting tiresome hearing Democrats suggest that because their bill does more than George Bush would have done, but otherwise they've gutted their most important campaign promises, we should suck it up and be happy. I voted for change, not pennies. You had the best chance in decades to make a difference in all of our lives, and you chose to blow it. You don't deserve our praise. Or our votes.

Daily Kos' Markos Moulitsas takes particular issue with the bill's mandate, especially considering that what the federal government is ordering is that the American public buy a product that only private sellers provide:

My take is that it's unconscionable to force people to buy a product from a private insurer that enjoys sanctioned monopoly status. It'd be like forcing everyone to attend baseball games, but instead of watching the Yankees, they were forced to watch the Kansas City Royals. Or Washington Nationals. It would effectively be a tax -- and a huge one -- paid directly to a private industry.

Former congressional candidate and Progressive Congress' Executive Director Darcy Burner argues directly that the Senate bill is more damaging than no bill at all:

The first rule of medicine is, "Do no harm." The post-Joe Lieberman version of the Senate health care bill fails that basic criterion. Unless Democratic leadership steps up to fix this misguided proposal, our only recourse will be to kill it.

And Arianna Huffington has made the case that the idea that crude legislation gets refined down the road is belied by the fate of the No Child Left Behind Act:

If the miserable Senate health care bill becomes the law of the land, it's only going to encourage the preservation of a hideously broken system.

(Former presidential candidate and Democratic National Committee chair Howard Dean has also made the kill the bill case, though he has since walked that back quite a bit.)

Okay, from here we move onto the folks who judge that the health care reform package emerging from the Senate is better than the alternative, when the alternative is no legislative package at all. Mother Jones' Kevin Drum sees the merits of a public option, but doesn't see its absence as a deal breaker:

So I guess we come back to where we started: I'd love to have a public option in the Senate bill, but the ground-level benefits seem pretty modest. I just can't see deep-sixing the whole package over it. Better to pass it now and work on tightening the insurance reforms and expanding the subsidies in the future. And maybe adding a public option someday too.

The New Republic's Jonathan Cohn looks at where we are now, and the boost in insurance coverage and patient rights that the bill would engender, and decides that even with the trade-offs the trip is worthwhile:

Could the deal be better still? Of course it could. The House bill, for example, offers substantially better protection from out-of-pocket expenses. That's an argument for improving the Senate bill in conference committee, when its members meet with their House of Representatives counterparts, and for improving the law if and when it goes into effect. Those of us on the left can, and should, fight for both. But we should also recognize the Senate bill for what it is: A measure that will make people's lives significantly better. Surely that's worth a little enthusiasm.

The Washington Post's Ezra Klein has written that some of the "facts" underlying the Bill Killers' parade of horribles lack a basis in reality, and that the legislation's failure would not only cause real public damage, but also shake politicians' belief in their abilities to bring about big, meaningful change:

I've gotten a lot of requests to respond to Jane Hamsher's list of 10 reasons to kill the Senate bill. At this point, I'm not sure there's much in the way of productive dialogue to be had here. Some of the list is purposefully misleading and is clearly aimed more at helping activists kill the bill than actually informing anyone about what is in the bill. Some of it points out things that really should be changed in the bill but aren't central to the legislation itself, and are simply being leveraged to help activists kill the bill.

...

The world in which we kill the bill is a world in which everything just continues to get worse, and politicians are scared away from the issue for decades. A world in which we pass the bill is a world in which things get better, and politicians remember that they can pass big pieces of legislation that take on, or begin taking on, big problems.

Finally, FiveThirtyEight's Nate Silver has made the case that the folks on the left side of the political spectrum who have been making the case -- online and off -- for killing the bill simply don't have consistent, reasoned analysis on their side:

I'm sorry, but debating the kill-billers on the policy merits of their position has become a bit like debating the global warming denialists. The denalists operate by picking and choosing which evidence they cite and what arguments they respond to. Sometimes, they raise fairly good points or expose legitimately sloppy work on behalf of "consensus" scientists. Sometimes, they are being contrarian for contrarianism's sake. And sometimes, they're just throwing a bunch of sh*t at the wall and seeing what sticks, hoping that the underlying truth or lack thereof is lost in the fog of debate.

It's a fascinating debate, really, that points to the continuing evolution of the progressive left. The calculus of policy and of politics -- carried out live and in public -- will continue, and it seems fair to predict that it won't stop simply when this health care reform package is all said and done. (Photo credit: seiuhealthcare775nw)