The usually observant Ezra Klein apparently thinks the problem we’re having with health care reform is that Congressional "centrists" are more likely indifferent or hostile to whether reforms succeed than are the reform activists. He then concludes that you can’t beat the centrists by pretending to be equally indifferent to failure, because that just leads to . . . failure.

Given the assumptions about peoples’ relative indifference, the logic is fine. And if "centrists" actually support reform to some degree, as some likely do, then the argument is weaker. But more important, the analysis misses the point.

Klein seems to think the goal is to turn around the Blue Dogs in Congress, as though they are the principal obstacles to reform. It’s true some are not helpful, but given the public’s long-held support for health care reform, and their overwhelming support across the board for having the choice of a public option, peeling off the few Blue Dogs we’d need to support a modest reform isn’t the main problem. (And it’s not Olympia Snowe’s "trigger" either.)

The main opposition to genuine reforms in health care is located in the White House, just as the critical opposition to genuine reform of the financial sector, or the energy sector, or the military-war complex that keeps driving empire/nation building, is firmly ensconced in the White House.

If one looks only at the symptoms of our predatory health care/insurance system, we see tens of millions uninsured or underinsured, millions denied care, millions more forced into bankruptcy, and thousands left to die.

But the underlying cause of these shameful results isn’t that not enough people have health insurance. It’s that we have a predatory profit-driven insurance system, conjoined through non-competitive profit-driven network provider relationships, that have made it extremely lucrative to ration health care and keep raising prices well above affordable levels, let alone levels defined by some unattainable model of efficient competition.

There is no doubt we could find additional federal revenues, either through reducing Medicare expenditures or additional taxes, to subsidize insurance premiums for more people. And in exchange for us handing them more customers with subsidized premiums, the insurance industry could agree not to exclude some new customers. Much of the provider industry would be fine with this, since the mandates and subsidies would increase the prospects for more guaranteed payments from the now subsidized insurance industry.

But if getting health care to more people were the goal, then we could more easily give them access to a functioning care delivery system, like Medicare, and forget the costly, unnecessary rent extraction by the middlemen.

None of the "insurance reforms" would reform or significantly ameliorate the predatory core of the health delivery and payment system. The industry’s financial success would still depend on forcing people into accepting and paying for a system of insurance and delivery that doesn’t serve the public’s need for quality care at an affordable cost.

The Obama Administration has consistently shown its unwillingness to confront the predatory nature of America’s health care industry. It cuts deals to ensure the profits of a drug industry that has a long history — and daily reminders it’s getting worse — of bribing doctors, surpressing generic and near-like competition and shielding price gouging through patents and exclusion of generics. It cuts deals with private insurers that preclude Americans getting expanded access to public alternatives.

And even on the issue of universal access, which the President says he cares about, the White House is willing to trade off the lives and health of millions of Americans just so Obama is not seen as "failing." The White House even admits it:

White House officials said Congress could also drop proposals requiring the government to create school-based health clinics and collect nationwide data on health and health care by race, sex, sexual orientation and “gender identity.”

Supporters of the House bill said such data would help reduce “health disparities,” but critics said they feared the government could assemble a database that posed a threat to personal privacy.

If Mr. Obama does not gain traction by making these concessions, his allies on Capitol Hill said, they may have to consider bigger changes. For example, they said, rather than requiring all Americans to carry health insurance, Congress might start by requiring coverage of children, or families with children. . . .

“It’s so important to get a deal,” a White House official said, speaking on the condition of anonymity in order to be candid about strategy. “He will do almost anything it takes to get one.”

The Progressive strategy is to stop being the patsy for a compromising White House, while genuine reform is given away yet again. So this not about playing chicken with Mike Ross. Even if it’s true that some Blue Dogs don’t care whether we get health reform — and I believe many do care — the point is that the White House cares. And they care not so much about genuine reform but about not being seen as losers, because that means this is a one-term, failed Presidency.

The Progressives’ clear-eyed strategy says that a winning Presidency depends on demanding and fighting for real reforms. And if the White House can’t see that, the progressives are telling this President that they won’t be used again if the White House acts as if it only cares about itself.

And never mind waiting for next Wednesday’s speech, because the White House has been damaging its credibilty all week. The President has a chance every day to tell us what he really cares about. But if the message every day is it’s only him, he’s on his own.

More:
Open Left/Chris Bowers, Blue Dogs Have More to Lose than Progressives