It's hard to feel confident after how up-and-down the process has been for the last several months, but it looks like we've finally got enough votes to get health care reform past a filibuster and into conference, which is the biggest hurdle in the whole process. Jacob Hacker and Paul Krugman will take the deal we've got, and so will I. The public option that mattered was the one that could negotiate rates somewhere close to Medicare, and I've been convinced by Ezra that the weak public option we had at the end thing was a good thing not worth dying for. Regulated competition on the exchanges is what we'll have to count on to keep private insurers under control. Sounds plausible enough.
I don't want to be too tough on the Public Option Or Nothing ultimatum that Jane Hamsher and other activists were pushing people in Congress to accept -- I think they had an ultimately positive effect on the process, and they were using the only tools available. What they didn't do, however, was get the public option through the Senate. And here it's a good time to reflect on why the tools they had aren't especially effective in passing major domestic legislation.
History suggests that the costs of not passing health care reform once you've made a big push for it are devastating. I don't just mean that you lose the next election badly like in 1994 -- you get knocked out of the game for 15 years, and then you crawl back with a proposal half as strong as you had the last time. The gap between success and failure is tremendous, and the gap between half-success and failure is pretty huge too.
Under these conditions, people who are indispensable to your efforts but can credibly claim that they don't care about the outcomes have the bargaining power to demand huge concessions. That's Ben Nelson and Joe Lieberman. Blue Dogs in the House are in a slightly worse position, as they may not have the deep public support to hold onto their seats if the bill fails and post hoc rationalizations of failure make Democrats look bad. But Nelson and Lieberman can force ultimatums that you have to accept if you don't want to wait another 15 years for something half as good.
You can try to push counter-ultimatums as the public option activists did, and maybe you'll have some success as long as you keep your goals small and achievable (no Stupak in the Senate bill, for example). But you just can't go up against the Nelsons and Liebermans when they've dug in and expect your ultimatums to beat theirs. Everybody knows that progressives have a lot more to lose if a bill doesn't pass than egoistic nth term policy nihilists do. There's not much you can hold over the nihilists' heads, because they don't care about policy outcomes. So progressives have to fold or be crushed. Again, I'm not faulting the activists for trying to push progressive representatives into ultimatum games -- at the time, that's the only tool they had. But at this point you have to come out and say that it's not a great tool.
What we need, first, is a bunch of reforms inside the caucus that will give mainstream Democrats leverage over the policy nihilists. Most importantly, we can't keep going with a system that assigns committee assignments and chairmanships on the basis of seniority. That just rewards people who care about staying in power and are never willing to take one for their principles or the team. Allowing Democratic Senators to vote for their committee chairs, as Republicans do, and perhaps also having an option by which a recalcitrant Senator could have his seniority reset to 0 for the purpose of committee assignments by a vote of the caucus would be an excellent idea. Ideally, this would involve the creation of a new Senate Butt Committee, dedicated specifically to legislation pertaining to the butt, which could be Lieberman's lone committee assignment. But even without this additional proposal, the idea has merit.
As for large-scale reforms, abolishing the Senate > eliminating the filibuster > using reconciliation for more stuff. The first of those is basically impossible, given that such a bill would have to pass the Senate with a Constitutional Amendment size majority, but it's the kind of Overton Window move that one has to wholeheartedly support because it is in fact the right proposal. (Tell me again why states each need 2 votes whether they have a million people or 20 million?)
So how do you and I as grassroots progressive Democrats influence our Senators enough to do something to move all this stuff forward? As usual, Matt Yglesias has a bunch of good ideas. I have a nifty idea too, which involves this dude, and if some stuff works out right I'll be posting about it pretty soon.