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Amy Smoucha, health care organizer for Jobs with Justice in Missouri, is taking the long view of health care reform. Not that she doesn’t believe that the country needs a health care reform bill this year. She absolutely does. But she knows the bill will have areas that need significant improvement, so she’s into organizing for the long haul.

On Monday, speaking at the West County Democrats meeting in St. Louis, she said that even if–god forbid–we don’t get a public option on this bill, that doesn’t mean we’ve failed. It means that we’ll get hugely valuable changes and that we’ll organize and start pushing again for a public option. The difficulty in getting the public option is that even if we get it into the conference bill, we’ll need sixty votes to get it out of the Senate. And Ted Kennedy died. The latest on getting a temporary replacement for him this fall is that it’s iffy:

Within the solidly Democratic Massachusetts political establishment, there’s widespread desire to fill the vacancy with a placeholder who can give the state a second Democratic vote in the Senate until a replacement for Kennedy is selected in the January special election. But the idea of scrapping the state’s 2004 succession law — and the message it would send to voters — is troubling many lawmakers and giving them pause. […]

Overriding that law so soon afterwards with another one, again with an overt political design-to provide a possibly critical vote in favor of President Barack Obama’s agenda this fall-is proving too much for some legislators to swallow.

“Should our loyalty be to being protective of the democratic process rather than to our partisan positions?” asked Democratic state Sen. Stephen Buoniconti. “A lot of members are uncomfortable and leaning toward saying we did a good job in 2004.”

While I can sympathize with their reservations, I agree with Steven Benen’s point that Republicans have never had any such hesitation. And anyway, call me unprincipled, but I’d change the law, on the assumption that the health care of millions is more important than behaving in a non partisan fashion on this.

Democrats can get a bill passed if they replace Kennedy; or if they forgo a public option, thus luring one or two Republicans to vote in favor; or if they use reconciliation. (But that could only be used for the budgetary aspects and something like forbidding insurance companies to drop people for pre-existing conditions might not make it through the legislative maze on its own.)

Smoucha urges people not to underestimate the importance of controlling the “pre-existing condition” scam or the importance of other aspects of the bill:  

  • The current bill forbids insurance companies to dump people for pre-existing conditions. Michael Bersin wrote recently about a family whose child was born with congenital heart disease. Although the mother had insurance that paid for the baby’s delivery, the insurance company then claimed that the child had a pre-existing condition and refused to pay for any treatment.

    Here’s another jaw-dropper: “[I]n eight states, plus the District of Columbia, getting beaten up by your spouse is a pre-existing condition.”

    If we can stop such immoral, outrageously greedy behavior, we haven’t exactly failed.

  • Medicaid will cover more people. Eleven million Americans currently without health care would get it through Medicaid. That’s not failure.
  • We lack enough health care professionals. Rural Americans, for example, even if they have coverage, often find it difficult to get treated because we don’t have enough doctors to supply rural areas. The bill provides for funds to pay for medical and nursing school for students, contingent on their willingness to work a number of years after graduation in underserved areas. Rural and inner city Americans would not feel the bill had failed them.
  • Insurance companies would not be allowed to drop people because they got sick. If they’re forced to stop doing that, we haven’t failed.
  • Hard caps would exist on out-of-pocket expenses to stop bankruptcy that many people with catastrophic illnesses face even if they have coverage. We could succeed in stopping hundreds of thousands of bankruptcies a year.
  • The bill would require insurance companies to spend a given percentage of the premiums they collect–say, 85 percent–on actual health care. Currently they spend as much as 40 percent of the premiums on other costs–like the paperwork involved in denying claims. They often have a policy of denying one out of every five claims. Requiring companies to pay for treatment is success.
  • There would be no more cherry picking. If someone applies for insurance, he gets it. Does that sound like failure to you?

So the bill so far is full of boffo reforms. Still, you know we need that public option. And we have to push hard for it this next month. More on Smoucha’s ideas about that tomorrow.