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It now seems clear, thanks to the reliably egregious Senator Lieberman -- when it comes to being disappointing, he never disappoints -- with the pusillanimous complicity of Senators Nelson, Landrieu, and Lincoln, that genuine health care reform, reform that provides universal affordable care, is probably dead this Congressional session. Which is not to say there will be no legislation at all; I'd be surprised if some sort of health care bill doesn't pass before the end of the year, and I'd be downright gobsmacked if, after such a bill passes, the president doesn't sign it. 

Perhaps it will have an opt-out or opt-in or triggering mechanism whose operation will come into play some years in the future, or perhaps it will have no provision for a public option at all. But in any case, there will, assuredly, be no immediate public option in the bill that reaches the president's desk, or any alternative provision that guarantees affordable health care to everyone. The votes simply aren't there, and the publicly-expressed intransigence of at least two of the four Democratic hold-outs allows no room for maneuver, no face-saving formula permitting them to backtrack without looking like yutzes.

It's a shame. And an affront, too. Anyone who has bothered to listen to any of the debate, in either the House or Senate, has learned yet again how debased our political discourse has become. Frank Luntz's muddy paw prints were all over the opposition's rhetoric. Despite widespread public support for health care reform, the opposition pressed all the buttons their briefing memos assured them remained hot. "The Pelosi plan," every Republican called it.  "Government take-over of the health care system," was a phrase employed so often it ended up sounding like a single word. Any serious discussion of the merits of the various proposals was almost entirely lacking. By and large, shibboleths and focus-group-tested talking points were the best the other side could muster.

This too is a shame; there are serious, responsible arguments, political and economic, to be made in opposition, and a serious debate about the merits of federalized health care could only refine the areas of disagreement and ultimately improve the legislation itself. But has serious argumentation become a quaint concept in contemporary American politics? You betcha.

So, with a watered-down health bill the best one can hope for, should we therefore despair? At the moment, for those of us who believe the United States ought to join the ranks of civilized industrialized nations and make medical care a basic right of every citizen, it's hard to deny that despair is an appropriate reaction. Much of what Presidents Truman, Kennedy, Johnson, and Clinton tried and failed to provide in the past will not be in this bill either. But there's a historical precedent for what's happening now that may, if one is prepared to take the long view, offer some basis for optimism.

I'm just old enough to remember the civil rights bill the U.S. Senate succeeded in passing in 1957. I was a little boy at the time, but it was much-discussed in my household and in the households of many of my friends. By the time Majority Leader Lyndon Johnson got the thing through the Senate, it was a toothless, emasculated vestige of what had originally been envisioned. So many compromises had been necessary to round up the requisite number of votes and overcome the Dixiecrat filibuster, the bill basically failed to actually do anything substantive. Insofar as it was a triumph at all, it was a purely symbolic triumph.

But its passage was still grounds for celebration. It laid down a marker: Civil rights legislation could pass, the heretofore impassable Southern obstructionist bloc could be overcome. And for the first time since Reconstruction, there was, as a result, a new civil rights bill on the books. It didn't do much, but still, a precedent had been established, a corner had been turned, a new set of possibilities could now be glimpsed. Nobody was especially happy with the bill as passed, but anybody who cared about civil rights was heartened by its passage all the same. It laid the groundwork for the great civil rights bills that were to follow several years later.
      
Every Democratic president since Harry Truman has hoped to achieve something resembling universal health care, and thus far, all have been foiled. And so, while the bill Barack Obama ends up signing is likely to be a piss-poor thing, with compromises galore, with almost every element dear to liberal hearts either etiolated beyond recognition or excised from the bill altogether, it still will represent a considerable achievement. For the first time, a foot will have gotten in the door; once that door has been opened a crack, it's much more likely in the future to be opened further than to be slammed shut.

(Photo: Brendan Smialowski/Getty Images)