Reading Chris Bowers's excellent list of the progressive priorities fulfilled or partially fulfilled by the health-care bill's sidecar amendments is a reminder of how peculiar the framing of this debate has been. There's no doubt that progressives have suffered some real losses in the legislative process. The public option, for one. But along the way, a lot of progressives have lost sight of the fact that the very existence of this legislative process is a huge progressive victory.
Five years ago, no one had ever heard the term "public option." But progressives had been talking about the uninsured for decades. There's probably no more constant lament in Democratic campaigns than the plight of the nation's 50 million uninsured. And this bill is, fundamentally, an effort to address that. Once it's up and running, it spends $200 billion a year to help low-income and working-class Americans afford health-care coverage. About 15 million of those people will become eligible for Medicaid, which is public insurance. Another 15 or so million will get private insurance.
But that private insurance will now be a very different beast: It will have to spend 85 percent or 80 percent (depending on the market) of every premium dollar on care. It won't be able to reject people for preexisting conditions. It will be in a regulated exchange where it has to justify premium increases and bad behavior or face exclusion. And those exchanges, regulations and subsidies will also create the core structure of a universal health-care system in this country, which should be comforting to progressives who look to the improvements in Social Security and Medicare and Medicaid and CHIP and the EITC and know that the history of American social policy is that, in general, we build on our imperfect foundations and make them stronger and fairer over time.
I don't want to suggest this bill is all progressive victories. It isn't. It isn't single-payer and there's no public option, and though I think the excise tax is a progressive tax, I grant that reasonable people disagree on this matter. But the fact of it is that this bill represents an enormous leftward shift for American social policy. It is not, in my view, a sufficient leftward shift, but it is unmatched by anything that has passed into law in recent decades. Progressives have lost some very hard battles but are on the cusp of winning an incredibly important war. For all its imperfections, health-care reform itself is deeply, deeply progressive. And if you don't believe me, just ask the conservatives who have made opposing it their top priority.