Over at Open Left, Chris Bowers lays out the system through which progressive Democrats in Congress are being squeezed by Democratic elites out of support for the public option in healthcare reform. Bowers’ understanding of the forces at play is about as comprehensive as any written analysis of legislative wrangling I’ve seen on this issue. Sadly, the path we are headed on doesn’t seem to favor the progressive block holding together and thus the public option and a high-quality piece of reform legislation does not seem very likely.

I was at Netroots Nation this past week (hence the lack of posting). On Thursday night President Bill Clinton spoke to the gathering. One of his strongest points was that change takes time; he views progress in government policies and legislation as the work of decades and does not think using political power to expedite the process or help more people sooner is advisable. As such, he advocated that the progressive online community stop criticizing Obama and Democrats for their work on healthcare reform, even if it ends up not being exactly what we’d like to see. Clinton urged the outright celebration of anything being passed, regardless of its content. This sort of attitude, Clinton proposed, would enable Obama to retain political strength and help Democrats electorally, thereby ensuring the continued opportunity to achieve more meaningful reform.

I’ve had many conversations with political friends – operatives, activists, and bloggers – that have included defenses of doing something regardless of its quality. The argument often goes, “Well what if we can’t get the public option or strong affordability or employer responsibility, but we can get a piece of legislation that will cover 15 or 20 million more Americans than today. Can we not help those people because the bill wasn’t what we really wanted?” This is, at best, an only marginally persuasive argument. The reason we may not be able to do more is a political one – we lack the votes to achieve everything liberal Democrats want to achieve. And passing reform now is likely to preclude us from pursuing healthcare reform again in the Obama administration. After all, he is going to take anything that passes, call it “landmark reform” and not touch the issue again — how could he after running for reelection on his “landmark reform” of healthcare? Thus, further reform of healthcare will be forestalled for at least another eight years when we can only hope the political climate will be better suited for liberal reforms.

What happens next in this fight is going to be a question of what the President and leaders of the Democratic Party believe. Are they willing to lead now to get the best possible reform today and not delay meaningful change for decades? Or will the President’s support for the public option, which has really become a stand-in for real progressive reform and not a solitary issue, be translated into fighting for it, as David Sirota asks on Twitter? These are questions that connect the political landscape to policy beliefs about what is best for the country. At a certain level, Obama must answer Clinton’s challenge. Will he lead to make sure change happens now, or will he pass the buck to future presidents and hope that the situation becomes so dire that the bunk Sarah Palin and Chuck Grassley spit out about death panels has no effect on the media nor the public.

Maybe reform will be easier in another fifteen or twenty years. Maybe there will be something marginally better than our current system, which may add some percentage of the uninsured to the rolls of the insured. But whatever reform comes out is almost certainly going to be a huge boon to the bottom lines of the health insurance industry, thereby making change down the line even less likely. Leadership may be hard, but the cost of not pursuing the most aggressive path for reform now is even more frightening. Hopefully complacency will not win out and what is possible is redefined through leadership, as opposed to being determinative of where leadership dare not go.