The long-term effects of bungling health care, part 2

Building on yesterday's post...I'd originally meant for this to be a part of it, but decided to split it off since it goes off in a little different direction. And it's long too. I'm good at that.

As everyone's been worried about the fate of the public option and whether it will make it to the final bill, there's been a few on the left that have raised a reasonable point: are we making the perfect the enemy of the good? After all, we're pretty good at that - hand us a bill that doesn't give us 100% of what we want, and we're liable to freak out a tad.

So should we be willing to look at a bill that doesn't include a public option? Paul Begala writes what I think is theoretically an extremely good piece, arguing that we shouldn't demand that everything gets done all at once. To make his point, he analogizes the healthcare debate with that of the Social Security Act of 1935:

No self-respecting liberal today would support Franklin Roosevelt's original Social Security Act. It excluded agricultural workers...domestic workers...the self-employed, or state and local government employees, or railroad employees, or federal employees or employees of nonprofits...[it] did not have benefits for dependents or survivors [or] a cost-of-living increase. If you became disabled and couldn't work, you got nothing from Social Security.

If that version of Social Security were introduced today, progressives like me would call it cramped, parsimonious, mean-spirited and even racist. Perhaps it was all those things. But it was also a start. And for 74 years we have built on that start. We added more people to the winner's circle: farmworkers and domestic workers and government workers. We extended benefits to the children of working men and women who died. We granted benefits to the disabled. We mandated annual cost-of-living adjustments. And today Social Security is the bedrock of our progressive vision of the common good.

It's a pretty good line of thinking. Even if you can't get exactly what you want from the outset, you can at least get some of it, and then over time fill in the gaps as the program becomes more popular.

But here's where Begala's argument falls short. Regardless of whether healthcare reform becomes a huge success or not, the current republican party will never get on board with any effort to implement or expand any aspect of it. I'd go so far as to say that, if they get back into power after reform is passed, they'll do everything in their power to undo every aspect of it. So it behooves the Dems to make this bill as perfect as possible, because they may not get another bite of the apple.