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Refocusing the Health Reform Debate

As has been the case all year, progressives are giving mixed reviews to the latest legislative step health care reform legislation, the 60-40 Senate vote-to-proceed, which is basically a preliminary cloture vote. While everyone's happy that the vote wasn't lost, there's a fair amount of angst over the threats of some Democrats to vote against the final bill, or against cloture on the final bill, unless actions unacceptable to most progressives are taken to change the bill.

And again, as has been the case all year, nearly all the focus among progressive worriers is over the public option, which Senators Lieberman and Nelson seem to be ruling out categorically.

Let's look at these two issues separately.

If, indeed, wavering Democrats who voted for the motion to proceed nonetheless conclude that they have no obligation to vote for cloture on passage of the bill unless their substantive demands are met, then we might as well start rediscussing the reconciliation strategy, because there is no version of health reform, now or at any point in recent history, that could command 60 votes in the Senate. To get to 60 on cloture (even granting that a Republican or two might still be lured across the line), it will be necessary to convert those who basically said "I hate this bill but I don't want to prevent the debate" to a position of "I hate this bill but I don't want to prevent a vote." And that will require not just moral suasion but pressure and maybe serious threats of reprisals from the Senate leadership, supplemented by a robust public campaign over the next few weeks to demonize the de facto 60-vote requirement, which much of the public knows nothing about. Keep in mind that health reform isn't the only progressive initiative that's doomed if it takes 60 Senate votes to enact anything serious on any subject, and also keep in mind that an increase in Democratic votes in the Senate in the immediate future is exceptionally unlikely.

On the second issue, the public option focus, it's as good a time as any for progressives to finally begin looking at this legislation as a whole, and as compared to what will happen if no legislation is enacted before the 2010 elections. It is entirely possible (particularly if you are a single-payer advocate) to conclude that a reasonably strong public option is more important than covering most of the uninsured, more important than the level of subsidies to make coverage practically affordable, more important than regulation to end highly discriminatory insurance practices, and more important than how and when health reform is phased in, just to mention four competing priorities. But it's equally possible--and more to the point, legitimately progressive--to consider one or more of these factors to be as important as a conventionally constructed public option--again, if you major concern is the practical effects of reform rather than setting the stage for a future single payer system. In any event, an intra-progressive debate on priorities that goes beyond the public option issue needs to happen right away.

Ed Kilgore is Managing Editor of The Democratic Strategist and a senior fellow at the Progressive Policy Institute.