Pamela Jean,

Thanks for this. While I am not at all surprised by the reaction to this bill from the right (they would complain if Obama tried to push their version of the plan. They'd say he was stealing from them). But I am amazed at the naivete of those on the left who so vehemently criticize what the Senate bill.

Politics is not the arena where we get everything we want. And, once the bill is passed there it can always be improved. What will likely not be possible is the ability to start from scratch in our lifetimes.

Obama is not carrying the liberal water the way many hoped. That's because he was invested with the hopes and dreams of people who paid no attention to his record or the substance of his speeches during the campaign. What he does represent is the opportunity to begin leveling the playing field. It would not have happened to the extent that he has done it with any other 2008 presidential candidate.

Would I have wanted the public option? YOU BET! Would I have wanted stronger protections against insurance companies profiteering off of the illnesses of Americans? Certainly! But, unfortunately our politics are not there yet. And, to be frank, until those who support Obama become more vigorous and more vocal in our support of the issues that we care about - and not just be threatening to vote for someone else in 2012 - the politics will not change.

Congress also needs to have the certainty that their constituents will support those issues and work to keep in office those who vote their interests. Its the ONLY way to stop the ideologues from short-circuiting the democratic process through sensational fear mongering and distortion.

Some of us "naive" people "...on the left who so vehemently criticize...the Senate bill", as Gerald describes us, think that it is immoral for the government to force people to buy things from private, for profit companies, especially ones that are uncommonly exempt from government control, like the health insurance companies, which even have special immunity from anti-trust laws -- immunity which is increased and perpetuated in this bill.

Despite our naivete, we have apparently done some good. The very latest version of the Senate bill contains some new controls on insurance company care to profit ratios, which, according to the Washington Post, were added as a "consolation prize" for those of us who insist on a public option.

Whether these new controls are a very good consolation prize, we won't have time to see before the bill passes (or fails). But the addition of such language makes me glad that I fought against the last version of the bill.

Pamela Jean knows politics. She waited to weigh in with a verdict until us naive liberals (including her, I think) did as much good as we could do by insisting on a public option. I appreciate that, and I hope and pray that the bill kicks the can uphill, as liberal Senate optimists think it will, rather than downhill, as I think it will.

Great post, Pam. Like everyone else on this site, I was hoping for a public option. I agree that this bill is flawed. But Pam makes a good argument that even a flawed reform bill has enough good things about it to help many of the uninsured to gain access to affordable medical care. Hopefully the cost controls will work, at least in the short run. And future Congresses can work on improving this when it passes.

Past reform movements had shifting tactics, but a fixed goal. If health reform activists can't get a meaningful public option of a single payer system in the federal level, perhaps they could push for it in individual states. During the debates in Congress, Representative Kucinich tried to push through a proposal to allow individual states the right to choose a single payer system for their states. I read somewhere that Conneticut adopted a health care system with a public option. If you can't get either a single payer system or a public option on the federal level, perhaps you could work to get such a system for your home state.

I agree with Britt's assessment of Obama and the Democrats, although I wouldn't use the term "naive liberal" (I consider myself to be liberal too). He wrote:

"And, to be frank, until those who support Obama become more vigorous and more vocal in our support of the issues that we care about - and not just be threatening to vote for someone else in 2012 - the politics will not change.

Congress also needs to have the certainty that their constituents will support those issues and work to keep in office those who vote their interests."

I personally believe that one of the reasons that the public option was jettisoned was that in August, conservative activists were able to make a lot of noise in the health care forums and they were able to define the terms of the debate from that point on.

I have to admit I was disappointed in Obama, but I still like him. He's still learning the ropes, and I hope he's learned some lessons from these past couple of months. I personally think that Obama will only be as progressive as the progressives push him to be. That means learning to make as much noise as our conservative counterparts and persuading the political center to our arguments. If the political center moves to the left, Obama and the Democrats will follow.

Gerald, Peter and Angelo, I agree with what all three of you have said here and I respect you each very much.

I like Gerald's point about how we have to continue to be vocal and, basically, create the political that forces Obama to push the can uphill. Peter, I'm deeply discouraged by the lack of public option in the Senate bill because I saw the public option already as a big step backwards from what I think will do the most good - a single payer system. As both Gerald and Angelo imply, we (all of us naive liberals and yes I am one if it means that I prefer optimism and idealism over discouragement) we, as an aggregate, wrongly hoped that Obama would herald these changes and we, also in the aggregate, didn't mount a strong enough grassroots effort to force his hand.

Still, I think, that much of the Senate bill does include many bedrock concepts that it would never contain if we had not put our energy into our writing, our organizing and our persuading.

Medicare Part D was a big giveaway to insurance companies and now - there's hope it will be amended. At this point, if we have mandates and subsidies without a public option, it will, as Peter points out, be just a big giveaway to insurance corporations - but - if we keep Democrats in office - perhaps it can be amended down the road.

I still think hitting the streets, letters to Congress - and blogging - are powerful tools.

Thanks everybody for your comments. I was a little afraid you might tar and feather me. ;-)

Now, for the argument against the Senate bill.

I have enormous respect for three organizations that have been in the forefront of health care reform.

First, Kaiser Family Foundation for the solid information that it collects and distributes.

Secondly, Dr. Howard Dean and Democracy for America for their 100% support of the Public Option. Dr. Dean is the perfect spokesman for the effort.

And, lastly, FireDogLake Action and Jane Hamsher have really stepped to the front to lead netroots and grassroots efforts to fight for the Public Option.

I am in complete agreement with Howard Dean and DFA - and Jane Hamsher and FDL Action - that the Public Option is the only sustainable way for health care costs, quality and access to improve for Americans.

Though I am glad that the Senate will pass their bill this week, I am not giving up on the Public Option. In fairness to those I respect that are fighting hard for the Public Option, I'm copying a recent e-mail from Jane here in its entirety, followed by the most recent statement by Dr. Dean.

Dear Pam,

The Senate's health care bill must be killed.

It is an ungodly mess of errors, loopholes, and massive giveaways. When the American people find out what's actually in this bill, they will revolt. Congress and President Obama have no choice but to do better for health care than this bill.

Sign our petition: the Senate health care bill must be killed.

How bad is the 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. After being forced to pay thousands in premiums for junk insurance, you can still be on the hook for up to $11,900 a year in out-of-pocket medical expenses.

4. Massive restriction on a woman's right to choose, designed to trigger a challenge to Roe v. Wade in the Supreme Court

5. Paid for by taxes on the middle class insurance plan you have right now through your employer, causing them to cut back benefits and increase co-pays

6. Many of the taxes to pay for the bill start now, but most Americans won't see any benefits -- like an end to discrimination against those with preexisting conditions -- until 2014 when the program begins.

7. Allows insurance companies to charge people who are older 300% more than others

8. Grants monopolies to to drug companies that will keep generic versions of expensive biotech drugs from ever coming to market.

9. No reimportation of prescription drugs, which would save consumers $100 billion over 10 years

10. The cost of medical care will continue to rise, and insurance premiums for a family of 4 will rise an average of $1000 a year -- meaning in 10 years, you family's insurance premium will be $10,000 more annually than it is right now.

I could go on, but it should be clear: this is not reform. This is a con job.

Sign our petition: kill the Senate bill.

Make no mistake, we need health care reform. But the Senate's idea of reform is a disaster, and will make things far worse than they are today.

We will continue to fight for real health care reform. Now, we must kill this fake reform.

Thanks for all you do.

Jane Hamsher,Firedoglake

P.S. Please, after you've signed, forward this email to your friends, family, coworkers - anyone you know. It's critical we act fast to kill the Senate bill, and we need everyone we can on board.

And, now this from Howard Dean:

Health-care bill wouldn't bring real reform

By Howard Dean

If I were a senator, I would not vote for the current health-care bill. Any measure that expands private insurers' monopoly over health care and transfers millions of taxpayer dollars to private corporations is not real health-care reform.

Real reform would insert competition into insurance markets, force insurers to cut unnecessary administrative expenses and spend health-care dollars caring for people.

Real reform would significantly lower costs, improve the delivery of health care and give all Americans a meaningful choice of coverage. The current Senate bill accomplishes none of these.

Real health-care reform is supposed to eliminate discrimination based on preexisting conditions. But the legislation allows insurance companies to charge older Americans up to three times as much as younger Americans, pricing them out of coverage.

The bill was supposed to give Americans choices about what kind of system they wanted to enroll in. Instead, it fines Americans if they do not sign up with an insurance company, which may take up to 30 percent of your premium dollars and spend it on CEO salaries -- in the range of $20 million a year -- and on return on equity for the company's shareholders. Few Americans will see any benefit until 2014, by which time premiums are likely to have doubled. In short, the winners in this bill are insurance companies; the American taxpayer is about to be fleeced with a bailout in a situation that dwarfs even what happened at AIG.

From the very beginning of this debate, progressives have argued that a public option or a Medicare buy-in would restore competition and hold the private health insurance industry accountable.

Progressives understood that a public plan would give Americans real choices about what kind of system they wanted to be in and how they wanted to spend their money. Yet Washington has decided, once again, that the American people cannot be trusted to choose for themselves. Your money goes to insurers, whether or not you want it to.

To be clear, I'm not giving up on health-care reform.

The [Senate] legislation does have some good points, such as expanding Medicaid and permanently increasing the federal government's contribution to it. It invests critical dollars in public health, wellness and prevention programs; extends the life of the Medicare trust fund; and allows young Americans to stay on their parents' health-care plans until they turn 27. Small businesses struggling with rising health-care costs will receive a tax credit, and primary-care physicians will see increases in their Medicare and Medicaid reimbursement rates.

Improvements can still be made in the Senate, and I hope that Senate Democrats will work on this bill as it moves to conference.

If lawmakers are interested in ensuring that government affordability credits are spent on health-care benefits rather than insurers' salaries, they need to require state-based exchanges, which act as prudent purchasers and select only the most efficient insurers. Sen. John Kerry (D-Mass.) offered this amendment during the Finance Committee markup, and Democrats should include it in the final legislation. A stripped-down version of the current bill that included these provisions would be worth passing.

In Washington, when major bills near final passage, an inside-the-Beltway mentality takes hold. Any bill becomes a victory. Clear thinking is thrown out the window for political calculus.

In the heat of battle, decisions are being made that set an irreversible course for how future health reform is done. The result is legislation that has been crafted to get votes, not to reform health care.

I have worked for health-care reform all my political life. In my home state of Vermont, we have accomplished universal health care for children younger than 18 and real insurance reform -- which not only bans discrimination against preexisting conditions but also prevents insurers from charging outrageous sums for policies as a way of keeping out high-risk people.

I know health reform when I see it, and there isn't much left in the Senate bill. I reluctantly conclude that, as it stands, this bill would do more harm than good to the future of America.

(The writer is a former chairman of the Democratic National Committee and was governor of Vermont from 1991 to 2002.)

Pam, perhaps your guarded optimism is correct. Perhaps the bill has already passed; I haven't looked but...

As much as I would like to believe it really is, as Tom Harkins tells it, a good "foundation" on which to build, I am growing more and more cynical. There may be a slim chance the conference committee will incorporate a public option, (which is already a huge concession from the left), but more realistically (cynically, if you will) the private insurance companies and the pharmaceuticals will add to their profits at the taxpayer expense. And the right will dramatize the tax increases and point out correctly "they" had nothing to do with it.

If the polls reporting that 60 pct of the American public wants a public option, and if our senators and representatives truly represented us--it would have been "a done deal."

Unfortunately (what's new?)not all but far too many of those on both sides belly up to the same bars -- and have their drinks and pole dancers paid for by the same interests--and those interests are not particularly concerned about the general public so long as their own profits are stable and growing. At the same time, the corporate propaganda machine fills the airways and byways, gulling a significant and growing slice of brain deficient Americans.
Perhaps I'm just in a sour mood today, but I'm thinking things may well get worse.

I remember a line from Sinclair Lewis's It Can't Happen Here. "When fascism comes to America, it will be wrapped in a flag and carrying a Bible." And I might add, "armed with an assault rifle."

The future of our economy is key here, and if this country does not rebuild its manufacturing base and its middle class, but continues to export jobs for cheaper and cheaper labor (and the political repression that perpetuates it), here in America how will things get better?

The disparity of wealth will widen further, and those in power will become more and more repressive to maintain their power. As Chalmers Johnson has put it, there is a choice to be made between protecting an empire and maintaining a republic.

Yes, today I am not in a good mood, but Merry Christmas to all at Everyday Citizen.

Thank you for all that you do.

Your essay reminds me of some of the things Tom Harkin noted. He also commented that ultimately passing this bill is not the end, even after the compromise form is passed. He said, "We will be looking at health care now, not every 20 yers, but every year." He went on to say, "I love that."

I don't think that Harkin loves the work involved, [maybe he does] but rather the fact that this bill can be tweaked and improved right along.

I know this is the ultimate fear of the Republicans...they think we are hell bent on making everyone suffer substandard care doled out in government run hospitals.

I prefer to hope we can legislate some meaningful care for those who now can't get it and obtain affordable health care for everyone.

I agree with Arianna Huffington's assessment of the Senate bill:

"This typifies the current thinking of the "Don't let the perfect be the enemy of the good" crowd. Unfortunately, there are three faulty premises at work in this line of reasoning. First, that those who oppose the bill do so because it's not perfect (as opposed to because it's a hot health care mess). Second, that the bill is, well, good (as opposed to a total victory for Pharma and the insurance industry -- witness the spectacular spike in health care stocks following Monday's vote).

Third is the premise that this is as good a bill as we can get right now, and we can always go back and improve it later.

It doesn't work that way. We heard the same kinds of sentiments about No Child Left Behind when it passed in 2001. Backers on both sides of the aisle had problems with it, but both sides celebrated it as a major step forward -- and promised to make it better in the future.

[...]But despite the widespread commitment to taking the 'many additional steps' needed, the steps were never taken, the resources were never allocated, the bill was never improved, and, indeed, is now generally regarded as a disaster (or, as Bill Clinton put it last year, 'a train wreck')."