I heartily agree with Joan Walsh here:

There is a genuine and justified concern among progressives that this bill enshrines an alarming corporatist Democrat view of “reform”: Make nominally liberal social-service expansions safe for the private sector. That is absolutely what is going on.

But that’s as far as the Democrats and the progressive movement have taken us to date. We have a lot more work to do. In my opinion, left and center Democrats need to compromise now, make good on their campaign promise to pass the bill and insure millions more people. And then progressives need to challenge the corporatist pillars of the party in rhetoric, legislation, and in elections, in 2010 and 2012, and beyond.

I said before the 2008 elections that one election would not turn America into progressive paradise. I said it would take many elections and many years of pushing elected officials back to the idea that they represent people and not corporations. The 2006 and 2008 elections were not the culmination of a great progressive effort, but just the beginning. I think we’re going to have to have a substantial turnover in Congress, and not just among Republicans, before we get legislation that doesn’t stink out loud.

However, in the meantime, we have a genuine crisis on our hands. People are dying who shouldn’t have to die. People are being financially ruined by medical bills. The bill as it is, like it or not, will make a huge difference in the lives of millions of people.

It’s as if you see people drowning in the ocean, but in order to save them you’ve got to rent a boat from some unsavory character who will use the money for an unjust cause. As I said in an earlier post, if we had a reasonable expectation that killing the current bill would inspire Congress to go back to the drawing board and come up with a better one, then I’d say kill it. But there’s no way that would happen. The reality is that it’s this bill or the status quo for at least a decade.

I also think that killing the bill plays into the Right’s hands. Killing this bill will do nothing to help the cause of progressivism going forward. Killing this bill is, ultimately, what the corporate interests want. Yes, the corporate interests like the compromised bill better than a progressive bill, but they’d like no bill at all even more.

Someone has said that on the Left, wonks tend to be for the bill and activists against it. Without naming names, it seems to me that many of those activists against it are people who have no personal experience with life without health insurance. Maybe I’m wrong about that. However, for me, living with the status quo for another ten or fifteen years is unbearable, considering the millions of Americans who have no insurance unless this bill is passed.

By all means, let’s complain loudly about the parts of the bill we don’t like, such as the giveaway to Big Pharma. Keep pushing for improvements, before and after the bill is passed. Let President Obama know we are disappointed he didn’t push harder for the public option. But don’t kill the bill.

The Senate bill is flawed, no question. Ezra Klein goes over some of the strengths and weaknesses. Ezra documents that with all its flaws, the bill would still be a huge, positive benefit for millions of Americans, putting them at far less risk of health or financial disaster.

The bill as written should reduce the federal deficit and help rein in spiraling health care costs. “And the bill does all this while covering more than 30 million people, ending the ability of insurers to discriminate based on preexisting conditions, creating a new and more competitive insurance market, taking the first steps away from fee-for-service medicine, and much more,” Ezra writes. He concludes,

In the world where we pass the bill, most everything gets somewhat better, if not good enough. More people have insurance. The insurance industry ditches its worst practices. Fewer families go medically bankrupt. More people catch diseases early, when they can be cured, rather than late, when they become fatal. People who would otherwise have died live. The medical system begins the process of updating itself for the 21st Century, and responding to the cost pressures it’s placing on the rest of the country.

The world in which we kill the bill is a world in which everything just continues to get worse, and politicians are scared away from the issue for decades. A world in which we pass the bill is a world in which things get better, and politicians remember that they can pass big pieces of legislation that take on, or begin taking on, big problems.

If we had a reasonable expectation that Congress would start over and come up with a better bill next year, it would make sense to kill this one. But you know they won’t do that. You know it would be many years before they take up health care reform again. It’s been, what, 15 years since the last attempt?

Think of this bill as a foot in the door. Once provisions begin to go into effect, once people realize their lives are less in jeopardy, there are no death panels, and Soviet tanks don’t appear in the streets, most Americans will support it, and more reforms will be possible. Yes, I agree with Digby that a large portion of Americans are so lost in their mythic fantasy land they wouldn’t recognize reality if it showed up with fireworks and a brass band. But I think that while most Americans can be confused and bamboozled about new or foreign things, once they have direct experience with something they are not so easily fooled. They saw through George Bush’s Social Security privatization scheme, for example.

So, yes, pass the bill.

NOW, Rep. Bart Stupak and the National Right to Life Committee are against the abortion “compromise” that helped put together an apparent 60-vote majority for the Senate health care bill.

The “compromise” allows states to block any insurance policy that offers abortion coverage to be offered on the insurance exchange in that state. Further, in all states if an individual receiving federal help to pay for insurance coverage chooses a policy that covers abortion, she’ll have to pay for the abortion coverage with a separate transaction. Brian Beutler explains,

Put another way: If you’re buying insurance with help from the government, and the policy you want to buy covers abortions, you have to write two checks (or authorize two credit card transactions, etc.) for your plan. If the plan costs $1000 a month, and the insurer plans to sequester $50 to put into a pool that covers abortions, you have to make one payment of $950 and a separate payment of $50.

One of the arguments made against Roe v. Wade over the years is that the decision to criminalize or legalize abortion should be made by states, not the federal government. Just let the states decide, they say, and we’ll abide by that. But does anyone honestly think the Fetus People would respect any state’s decision to legalize abortion?

Further, this morning the Right is still screaming that, somehow, the bill provides for “federal funding of abortion.” Exactly where they are seeing this federal funding is a mystery to me. It must be lurking behind the death panels.

As for the rest of the bill — Nate Silver thinks progressives really did have a positive impact on the bill, even though we may feel everything we wanted was traded away.

For instance: the CLASS Act has survived; the ban on lifetime coverage limits was restored; there was no tinkering with the Medicaid provisions; there’s some Ron Wyden like amendment to permit workers to opt out of their employer-provided coverage and purchase insurance on the exchanges instead; the abortion language in the Senate’s bill is milder than that which is already in the House’s (to an extent that may actually be a problem); a provision to allow people to purchase insurance through non-profit programs organized by the OPM was inserted, and some decent medical loss ratios were established. …

…From a policy standpoint, indeed, I think the kill-bill / public-option-or-bust strategy has helped to push the bill toward an optimal outcome. Certainly not optimal in the sense of “the best bill that the Senate could possibly have passed”, or “the best bill that progressives could have hoped for”. But in terms of the best bill that the Senate was actually going to pass, given the 60-vote requirement, an unpopular Congress, and an inexplicably lackluster performance from the White House, this is probably fairly close — especially if some further concessions can be realized in conference with respect to the magnitude of the subsidies.

Of course, the actual vote hasn’t been taken yet, and we still don’t now what will happen in reconciliation.

See also Eztra Klein, “The Congressional Budget Office scores the amended Senate bill“; Dan Wasserman, “Hey kids — What’s up with health reform?“

Word is that Sen. Ben Nelson has agreed to vote for the current version of the Senate health care reform bill in exchange for a lot of money for Medicaid. The federal government will pay for new Medicaid recipients in Nebraska for ever and ever.

There is also a “compromise” on abortion that dumps the issue of funding elective abortions on the states. States can choose to prohibit abortion funding in the insurance exchanges in their states. Further, health plans that do pay for abortions must segregrate premiums from federal money somehow.

This is not good enough for John McCormack of the Weekly Standard, who complains that at least 13 states would continue to fund abortion, and we can’t have that. So much for states’ rights.

Senate Dems say they now have 60 votes, which means that a Republican filibuster cannot stop a vote on the bill, and maybe they’ll pass it. Of course, then they have to reconcile that bill with the House bill, and that’s going to take another war.

So what’s in the Senate bill? Shailagh Murray and Lori Montgomery write for the Washington Post:

Instead of a public option, the final product would allow private firms for the first time to offer national insurance policies to all Americans, outside the jurisdiction of state regulations. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress.

I want that out of the final bill, for reasons I’ve explained several times in earlier posts.

Starting immediately, insurers would be prohibited from denying children coverage for pre-existing conditions. A complete ban on the practice would take effect in 2014, when the legislation seeks to create a network of state-based insurance exchanges, or marketplaces, where people who lack access to affordable coverage through an insurer can purchase policies.

Insurers competing in the exchanges would be required to justify rate increases, and those who jacked up prices unduly could be barred from the exchange. Reid’s package also would give patients the right to appeal to an independent board if an insurer denies a medical claim. And all insurance companies would be required to spend at least 80 cents of every dollar they collect in premiums on delivering care to their customers.

Every American would be required to obtain coverage under the proposal, and employers would be required to pay a fine if they failed to offer affordable coverage and their workers sought federal subsidies to purchase insurance in the exchanges. Reid’s package would offer additional assistance to the smallest businesses, however, increasing tax credits to purchase coverage by $12 billion over previous versions.

See also Steve Benen.