The New Normal

Once it's policy, there's no going back.

by Jeffrey C. Billman

The bill sucks.

Pass the bill.

No, it's not single-payer. It doesn't have a public option. It doesn't expand Medicare. It doesn't even have a co-op. It will force millions of people into the outstretched arms of that soulless bastion of greed and guile, the American health insurance industry.

Doesn't matter. Pass the bill.

The sausage-making spectacle of the past year has produced a convoluted, forest-killing mess. The process was infuriating: the foot-dragging, the futile hand-holding of Republican "moderates," the ego-stroking, the backroom deals, the summer of Tea Parties, the winter of Scott Brown. The White House's arrangement with Pharma was offensive. The Senate bill's abortion restrictions are insane (unless you're U.S. Rep. Bart Stupak, in which case they're not insane enough). The excise tax is unfairly targeted. The promised fixes may not materialize. You have every right to worry.

Screw it. It's game time. Pass the bill.

Ultimately, the importance of the health-care legislation isn't so much what it does, but what it represents. And that's why we should pass the bill, no matter its shortcomings. But I'll get to that in a second.

First, let's dispatch with the politics. If House Democrats don't muster the collective gumption to act, this is, as U.S. Sen. Jim DeMint so famously put it, President Obama's Waterloo: Failure dooms any and all legislative proposals, big or small, for the rest of the year, and guarantees almost certain catastrophe in November. Climate change, Supreme Court appointments, banking reform, jobs bills — they all hang in the balance. Failure would embolden the right, demoralize the left and lead to a Republican tsunami this fall. Bank on that: Democrats, even the weak-kneed, wet-finger-in-the-air types, vote against this at their peril.

More importantly, the legislation is, for all its imperfections, a net positive. It reduces the deficit. It will halt the grossest abuses of Big Insurance. It will end denials based on pre-existing conditions and lifetime caps. And, indeed, no industry this side of Big Tobacco is more deserving of a regulatory spanking — in the form of pitiless, tenacious oversight — than Big Insurance.

But even that isn't the best reason to pass the bill, whatever its eventual form. This is: Passing health care reform now moves what's called the Overton Window. Named for Joseph P. Overton, who until his death in a plane crash in 2003 was the senior vice president of the Mackinac Center for Public Policy, the theory argues that before you change public policy, you have to first change the political climate: "Move the window of what is politically possible and those policies previously impractical can become the next great popular and legislative rage," the Mackinac Center's Web site explains.

In other words, big changes happen only after the baseline of public acceptability shifts. This is clearly happening with health care: Just a few decades ago, universal health care was nothing more than a pipe dream. Then it became the white whale of the Clinton administration. But as the years passed and the debates raged, the notion that the richest country in the word had an obligation to provide all of its citizens with access to basic health care moved into the realm of the feasible. There's one step left: Pass the bill, and it becomes policy.

Once it's policy, there's no going back.

Social Security and Medicare, for all the rhetorical grenades lobbed at them, are as entrenched in our societal fabric as the National Health Service is in the United Kingdom and Canada Health Act is to our northerly neighbors — that is, they're not going anywhere, no matter what party takes power. Passing the bill makes universal health care the new normal; once it's the new normal — once it's an expectation — any effort to repeal it will fail. The currently unviable things that will truly improve health care — the public option, or Medicare-for-all — all spring from the foundation that it is a moral imperative to provide all of our citizens, no matter their station or bank account, with access to decent, affordable health care.

Shift the Overton Window, and those things move closer to feasibility.

Pass the damn bill.

(jeffrey.billman@citypaper.net)