David Mizner at Firedoglake says I'm "incoherent" for arguing that health care reform is both a great progressive achievement and a piece of legislation in the traditional moderate Republican mold. I suppose it could look that way at first blush, but not if you really think about the issue. Legislation should be judged not as an ideological abstract but in comparison with the status quo that precedes it. Is it progressive to sign an executive order banning racial discrimination in employment or housing? Not if you did it today. But it would have been 50 years ago.

The outstanding fact of the American health care system is that it's uniquely awful -- among advanced countries it's both the most expensive by far and the least humane by far. Moving from that to a system that provides universal coverage and cost control through means congenial to moderate Republicans is extremely progressive. It is an enormous advance in American social policy. The status quo is so awful that it can be reformed in such a way as to constitute a major improvement from both the moderate Republican and progressive perspective.