And anyway, we all pay for them now anyway when they show up in the Emergency Room. Until we allow people who can’t pay to DIE then we’ll pay for them one way or another.

Every vote over the minimum necessary to secure passage represents compromises that the Democrats as a group would prefer not to make… the Democrats wrote the strongest bill they could that would get enough votes to pass.

Sounds like you’re writing from a more-or-less progressive perspective. If so, however, you may be giving the House Democrats more credit than they’re due. The bill might just as well or better be characterized as “the weakest bill that would get enough votes to pass” — at least in terms of Democratic votes.

The bill is a de facto abortion ban for many women and a massive, oppressive subsidy to the insurance and pharmaceutical industries. Pelosi couldn’t let the bill get any worse and still keep the progressives she got, so she left in some basic, incremental regulatory language, like the ban on “pre-existing” condition denials. Far from the best the Dems could get, it’s the worst that the Dems could push through. Your overall point is still valid, of course.

I think that in the end, the problem that is causing the rise in health care costs is “fee for service” and this bill doesn’t even try to take that on.

…does anyone feel that this bill will actually solve any problems? That in 2012, 2016 and beyond health care “reform” won’t once again be a huge issue?

The latest concession was horrific and disruptive and destructive of the women’s right to choose and women’s reproductive health. The Stupak-Pitts Amendment is a travesty and needs to be stripped out of the final bill and the bill introduced to the Senate.

The other concession that has me VERY TROUBLED is the provision to pay for health insurance for illegal aliens. This is just wrong on all levels. You are stripping women’s health insurance and giving lawbreakers health insurance. What is not understood about the prefix il (not legal). We owe NOTHING TO PEOPLE WHO DO NOT HONOR ANY AND ALL OF OUR LAWS.

I don’t think it’s any surprise that one of the casualties of this process has been the requirement that the public option pay Medicare’s reimbursement rates rather than negotiating its own rates separately.

The key to getting what you want is to start with more than you think you can get away with, not to immediately jump to what you think can pass.

Pelosi and the rest are amateurs.

The fact that the Democrats couldn’t get everyone on board is being treated as a flaw in their strategy when in fact I’m sure their leadership sees it as the key

I don’t know who’s making the observation you refer to, presumably the DC beltway press, but the actual problem is not that it was close, but that a much better bill was possible in the House. Repeat: we could have gotten a much better bill, with an identical vote total. The holdouts against the bill weren’t holding out because of principle or reelection concerns. Public opinion polls show that voters overwhelmingly support single payer (when they know what it is), for chrissake. These politicians held out because they were paid by insurance companies to obstruct the bill (look at the donation records for those voting against and also for those holding out for the more odious provisions).

It’s such a huge compromise of a compromise of a compromise of progressive principles it only applies to people who can’t otherwise get coverage — under this legislation, you and I are too rich to opt in to the government plan, which means it will inevitably meet the same fate as the “Great Society” social programs: maligned as “entitlements,” neglected and corrupt until the right wing “reforms” arrive in 30 years and gut whatever effectiveness of the program ever did have. By forcing insurance plans (even private ones) to avoid covering abortion, it drastically regresses access to abortion in the US. There’s a fine story by Harlan Ellison on the subject, “Neither Your Jenny Nor Mine.” That’s what we go back to.

Progressives strongly believe we could have gotten a much better bill through the House had (a) Obama demonstrated stronger leadership or (b) the progressives in Congress had their shit together. The key to getting what you want is to start with more than you think you can get away with, not to immediately jump to what you think will pass. This is the art of negotiation and it absofrigginlutely applies here. They should have started with a single-payer bill and compromised with a strong public option. Instead, they started with a weak public option and had to blow their wad by sacrificing all those pro-choice votes in 2010.

Here’s the thing: Democrats are going to lose big in 2010 if this bill doesn’t show immediate benefits for everyone, and those obstructing made it more difficult to do so, and Obama didn’t lift a fat-cat finger to help make it a better bill. He’ll abandon his principles on domestic spying, gay rights, and illegal torture, but not on separation of powers. He never had any stated principles on executive compensation or “too big to fail” banks being propped up by taxpayer gelt. Awesome. If you want the US to be ruled by crazed Christianist zealots that will make you pine for Dubya, by all means, celebrate the art of the compromise with this flawed-but-oh-so-practical bill.

I’m a bit disgusted by the insularity and naivete of Obama’s team. You need insider hacks to navigate DC (ask Bill Clinton), but you don’t ever listen to them on policy if you really want to make changes rather than preserve the status quo, especially in a time where the status quo is deteriorating rapidly.