What progressives have to do to sustain health reform

Most readers in the U.S. will note that the U.S. has passed health reform. The Senate will soon vote on a package of fixes that take out certain parochial deals and make some changes, especially on the tax side, but it's basically done.

Public opinion is likely to shift in favor of the bill, and the bill does contain some good provisions that impact immediately, such as narrowing the donut hole in Medicare Part D (for non-US readers, the donut hole means that seniors buying prescription drugs have to pay the whole sum out of pocket between $2,700 and $6,100 - that may sound like a lot, but a lot of seniors fall into it), eliminating pre-existing condition exclusions for children, making funds available for a national high-risk pool so that adults with chronic conditions can get insurance, and a few others. However, the most disliked provision in the bill is the individual mandate - all adults will be required to buy insurance unless it costs more than 8% of income. Progressives will have to continue to make the case to the country that the bill is worth it, that the plan will not work properly without the mandate, and that the benefits are worth the cost. Additionally, the Federal government and the state governments will have to work very hard to implement the bill. Some state governments have passed bills purporting to opt out of health reform, and some Attorneys General (like my own state AG, Ken Cucinneli of Virginia) are filing suit against the mandate. Progressives will have to demand that their legislators implement the provisions, such as the Medicaid expansion and setting up the insurance exchanges. If legislators balk, heavy pressure must be applied.

There are two other priorities that are perhaps even more pressing: immigration reform and climate change. The immigration system must be reformed. Guest workers must be admitted on a reasonable basis, and they should preferably have a reasonable means to gain citizenship if they improve their skills here and develop ties to the nation and their communities. Furthermore, we seem to have punted on making sure that same-sex partners can receive full health care benefits, because at least people who aren't currently eligible for workplace benefits through their partner can shop on the exchanges and likely receive subsidies. However, we cannot punt on making sure that same-sex partners receive the same immigration benefits as everyone else - Canada, the UK, and most other OECD countries do this.

Climate change can start with government regulation of pollutants, but at some point either a cap and trade system or a carbon tax is vital. These, unfortunately, will be harder to sell to the American public.