It's Too Early to Celebrate the Senate Health Care Vote

[This article also appears on Huffingtonpost.com. You can access it from my author page here.]

I swear, I find no no joy in being Debbie Downer. I really wish I could celebrate the Senate's 60-39 vote to begin the debate on health care legislation, narrowly holding off the blocking tactic of the Republicans. I am 100 percent in favor of health care reform (I'm a fan of Rep. Anthony Weiner's proposal to extend Medicare to everyone). But a realistic view of what happened (and what has happened leading up to the vote) reveals far more things to be concerned about than to cheer for.

For starters, to get to an up-or-down vote on the final bill in the Senate, this 60-vote procedural hurdle will have to be jumped over again to close debate, and Sen. Joe Lieberman has already promised to join the Republicans in filibustering any bill that contains a public option. There are also several other centrist Democrats in the Senate who may not vote for cloture if there is a public option in the bill. Since the Democrats were only able to secure the minimum 60 votes to get past the Republicans this time, without Lieberman's vote (and all of the centrists'), if no Republican jumps ship, a bill containing a public option cannot get to the floor.

Also, it is easy to forget that a health care bill only barely made it through the House (220-215), and did so only after Democrats agreed to pass the bill despite the inclusion of the anti-abortion Stupak Amendment, which wouldn't just prevent the government from funding abortions, but would actually have the effect of making it harder for many women to exercise their constitutional right to choose under health care reform than it is today. True, the Senate's version has a less onerous anti-abortion provision, but if the House anti-choice Democrats stand firm again, even if a bill gets through the Senate, when it comes out of conference, the House will have two options, neither of which is good: pass the bill with the odious Stupak Amendment intact, or watch the bill go down to defeat at the hands of the anti-choice Democrats.

So what am I supposed to celebrate, exactly? That a health care bill will be debated? Even though, to get past a 60-vote cloture motion, it will have to be gutted even beyond the shadow of a bill it is now (the current bill has a weak public option, no other mechanism to really cut costs, and hands billions of dollars to the insurance companies who are a big part of the original problem)? I'm not saying I don't support this weak bill (it's better than nothing), but if it gets any weaker and cuts into the constitutional right of women to choose, really, does the good still outweigh the bad?

And the whole notion that there will be a debate is really hard to take seriously. There has been no honest health care debate up to this point. There has be a flood of outright lies from the right (two words for you: "death panels"), and if you think it's getting any better, as the vote neared, Sen. Kit Bond compared health care reform to one of the biggest Ponzi schemes ever: "Move over, Bernie Madoff. Tip your hat to a trillion-dollar scheme." This is the level of debate. Paranoid ramblings about government takeovers and hidden agendas of doing the bidding for insurance companies, hospitals and pharmaceutical companies that line the pockets of those opposing reform. The nonpartisan Congressional Budget Office can report that the Senate health care bill will cut the deficit by $130 billion over the next ten years without raising taxes on the middle class, but Republicans will still scream about expanding deficits and massive tax increases. Some debate.

You know, there is one thing I really like about the health care legislation that will now be debated in the Senate, and, oddly enough, it's something that most of my fellow progressives oppose: the ability of states to opt out of the public option. Honestly, I think this part of the bill is spectacularly brilliant. Why? It's simple, actually. It's democracy at work.

Consider that in the last months since the health care debate took off, we have been treated to the following:

- Rep. Joe Wilson of South Carolina screamed "You lie!" during President Obama's health care address to a joint session of Congress.

- Sen. Mitch McConnell of Kentucky said that passing health care reform with a public option could "cost you your life."

- Rep. Paul Broun of Georgia, who, by the way, is a physician, said that health care reform with a public option "is gonna kill people."

- Sen. James Inhofe of Oklahoma said, regarding the health care bill: "I don't have to read it or know what's in it. I'm going to oppose it anyways."

- Sen. Richard Shelby wrote to one of his constituents that health care legislation would "directly subsidize abortion-on-demand," "rations health care so that our citizens are withheld important and potentially life-saving treatments," and "requires taxpayer dollars to fund health benefits for illegal immigrants," all scare tactics that he knew (or, as a U.S. senator, should have known) is patently false.

Unfortunately, I could go on a lot longer, but you get the point. All of these politicians have many things in common, but there are two I would like to point out here: 1) They represent states that would likely opt out of a public option, and 2) they were duly elected by their constituents to serve in Congress.

Item 2 is really something important to remember. These men did not stage coups d'etat. No, they were elected by the majority of the voters of their states or districts. They were chosen by their constituents in democratic elections. And now it's time for democracy to do its job, so that the citizens of these states get exactly what they voted for. Why should we, as a country, spend taxpayer money to improve the health care of citizens who would send to Congress men capable of uttering baldfaced lies, all in the name of politics (trying to prevent the president from getting a "win") or protecting the special interests that fill their campaign accounts? And if they are telling their lies in defense of some kind of pure ideology that abhors the government's involvement in anything (except the bedrooms of its citizens, of course, but that's another issue for another day ...), well, then, let's give their constituents what they want. Hell, Shelby went after Medicare in his constituent letter, so I would be happy to let the states opt out of Medicare and Medicaid, too

In Shelby's state, Blue Cross Blue Shield controls 83 percent of the health insurance market, with more than 600,000 people living without health insurance and another more than 175,000 who cannot obtain group coverage and are forced to buy insurance on their own. Under health care reform, most would have access to health care, more than 400,000 Alabama residents would be eligible for government subsidies to help pay for health insurance, and the 175,000 plus not on group plans could get more affordable insurance. But these people also voted for Shelby. I respect the democratic process, and the people of the good state of Alabama should be free to get exactly what they voted for. I wouldn't dream of standing in their way. And the same can be said for the folks in South Carolina, Kentucky, Georgia, Oklahoma and all the other states who have sent representatives to Washington to obstruct health care reform.

This is the country in which we live now. This is what passes for debate. So you will forgive me if I am not optimistic that a worthwhile health care reform bill will make its way past another cloture vote in the Senate, past an up-down vote in Senate, through a post-conference vote in the House, through yet another cloture vote in the Senate, and finally through a final up-down vote in the Senate, all while the Stupaks, Liebermans, and Lincolns of the world are standing in the way, not to mention the stop-at-nothing lies and scare tactics employed by the right. I am sorry, but I am firmly in I'll-believe-it-when-I-see-it mode.

The bottom line is that I don't want to be the messenger of doom. I would love to celebrate a health care reform victory. And when a real one arrives, I will.