Neera Tanden, the CEO of the Center for American Progress, wrote an article in The New Republic this weekend echoing much of what I have been hearing across the progressive blogosphere recently. Ms. Tanden, like many prominent progressives, wants those of us with lingering doubts about the Senate's health care bill to "stop the bluster and get with the program." I'd like to take a stab at explaining why I am finding such requests misplaced.

Ms. Tanden is certainly correct to point out that most self-described progressive members of the House will vote for the Senate bill. Speaker Pelosi has done an excellent job of drumming up support for this legislation, even if doing so required her to reverse herself on the importance of public option and break promises that the final bill would contain a public option.

As Ms. Tanden notes, there remains a small collection of dissenting voices among House progressives. She seems utterly shocked by this, noting, "those liberals may be the difference between success and failure."

Why would any liberal vote against this bill, a bill that Democrats have spent a year toiling on? Because at its core, the legislation is a centrist plan that achieves liberal ends. Rather than creating a single payer system, it builds on the system we have.

The Senate bill certainly appears to be a centrist plan, but it is not sufficiently clear that it achieves liberal ends. But then again, that really isn't the problem. The problem is that, like Ms. Tanden acknowledges, it attempts to build on the current system. To the degree that the current system is broken, it is difficult to justify building on it rather than replacing it with a functioning system.

What I find most upsetting about how health care reform has unfolded is that the sort of single-payer system that dominates Western industrialized nations with better health care rankings than the United States was never seriously considered. We had a model of effective health care, one which certainly would have achieved liberal ends, that we chose to ignore. Why?

The frustration of the left is understandable. But at the end of the day progressive members have to ask themselves whether the ends justify the means.

Well, we know that the proposed legislation will not cover all Americans so the U.S. will still be one of the few Western nations without universal health care. We also know that the proposed legislation uses a system of cost controls that have been rated as less effective than a public option such as Medicare for all. What we do not yet know is whether the Senate bill will provide a solid foundation on which to build later or will delay the single-payer system we obviously need even further.

When Ms. Tanden and other pundits say that our only choice is between the Senate bill and the status quo, I must disagree. Nobody likes the idea of scrapping the bill and starting over (except Republicans), but I do not believe that passing a bad bill is really our only option.

It has always struck me as incredibly problematic that we in the U.S. must rely on a for-profit health care system. Health care is one of the few industries where this for-profit model has never made any sense and continues to strike me as cruel to the point of being inhuman. The Senate bill seems like too much of a giveaway to the insurance industry for me to feel good about it.

If I was in the shoes of a progressive member of Congress who was considering whether to vote for or against this bill, my primary question at this point would be whether it provides a suitable foundation on which to build going forward. If so, I could probably be persuaded to vote for it. But if passing such a bill now would make it that much harder to achieve a single-payer system down the road, I'm not sure I would "get with the program."

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