One of the better-sounding arguments for passing the Senate bill is that “we can fix it later.” While this does sound appealing at first glance, I just don't see “fixing it later” happening in the next decade or two. Democrats currently have huge majorities in both Houses and the presidency. I can't imagine there being a time anytime soon where the Democrats have more power.
If progressives can't push for better health care reform now with a huge grassroots push, I don't see them having more success after Washington moves on to other topics. As long as this 60-vote myth persists in the Senate, and progressive are not taken seriously, I don't see how any progressive change (be it on health care or any other issue) will ever happen.
The only way I can see progressives being able to fix the bill later is if they can hold something the big industries really want hostage. Progressives need something important they can trade in exchange for better reform. The only thing progressives can hold hostage for real reform is the individual mandate. The insurers, providers, drug manufacturers, etc., all want the individual mandate. What company wouldn't want the government to force people to be its customers?
Progressives should make the rallying cry of “no public option, no mandate” an unmovable demand, now and in the future. Progressives in Congress should refuse to support the individual mandate until it is accompanied by the government guarantee of a decent, cost-effective public health insurance option.
As many in the “fix it later crowd” have pointed out, reform does not really start until 2014, and the individual mandate does not really start until 2015. Even if you believe an individual mandate is essential to make reforms in the Senate bill work, there is no reason we need to pass it now. We have five years before it would go into effect. That is five years to work out a compromise that includes an individual mandate, better reforms, and a public option.
It is pure fantasy to think if this bill passes they will later push a public option or Medicare buy-in through reconciliation or regular order just because progressives wanted it. If the progressives hold the individual mandate hostage, then it is a different story. Fortunately, most of the improvements that progressives want (public option or Medicare buy-in, Medicaid expansion, increased subsidies) and the individual mandate can be passed with a single reconciliation measure. A true grand compromise
If Congress passes this bill without the individual mandate, the insurers will moan. They will rail about how they need the individual mandate, but if they want it, progressives will have named their price. Standing firm now on “no public option, no mandate” seems to be the only position that will give progressives leverage to “fix it later.” Playing chicken with the health care lobbies on the issue of the individual mandate may not seem like a sure thing, but it is currently the only strategy I see for having leverage after this Senate bill passes.