Put simply, it's the structure, stupid. The health-care system is like a house. It's easy to add the furnishings later. It's not that hard to upgrade the kitchen, or redo the trim, or re-carpet the floors. Some of that might be expensive, but it's not actually hard. But it's really, really hard to add another room, or rip out all the wiring, or build a bathroom that wasn't previously included.And who, exactly, will be adding these things? Sure, you can add rooms to the house. But you can't walk into somebody's house and start adding things, because you don't have the power and authority to do so. Nobody can do the same thing for your house, either. They don't have the power. And, let's be honest, they don't have the intention, either.
So too with health care. There's a basic structure that's been present in all of the bills, and for good reason. It's a structure that a lot of good and smart people have put a lot of time and energy into thinking through. It creates a universal system through an individual mandate and an employer mandate, and makes that system affordable and dependable through a mix of subsidies, insurance market reforms, and out-of-pocket protections. It creates health insurance exchanges that individuals and companies can choose to enter if they prove more efficient and consumer-friendly, and that offer an array of different insurance options, some public, some private.
So who, exactly, would have the power and intention to make these changes? Liberals? The way that this is moving, they would have practically no power whatsoever. Remember, power is about consequences: it's about getting people to do things they wouldn't otherwise do, and that is all about showing that there are consequences if they don't go along with you. The Republican base has showed that there are consequences to spurning them: you lose primary battles in the House and Senate to people who will go along with you. Pretty soon they don't need to exact any consequences: they can just threaten to do so, and the threat will be credible enough that lawmakers will go along with it. Eventually, you don't even need to threaten, because they know what the base will do and adjust their behavior accordingly.
But the Democratic base won't have that. They can't exact a price for ignoring them, and any attempt to threaten the Dems will lack credibility. They'll be powerless. In fact, they already are powerless, of course—or else Obama, his various White House apparatchiks, and Big Media Types like (tragically) Ezra wouldn't be treating them like a puddle of especially foetid scum that is best avoided when it can't be ignored. Without action, that belief won't change.
What about the people that do have power? Will they have the desire to change things for the better? Well, no, clearly not. The "centrists" won't. Those few who aren't wingers with the wrong letter beside their name are too frightened of the right. The Republicans certainly won't, they'll just change things for the worse. The media won't: their fetish for useless, worthless bipartisanship was half the reason the impressionable, timid Democrats ended up in this horrible mess. And they basically do what the conservative movement tells them to. Corporate America certainly won't.
As for the Obama Administration? If they actually cared, there would be a public option, and this whole debate wouldn't be taking place.
So sorry, Ezra, but your "house" doesn't hold water. Those with the power to change things won't, because they're happy with the way things are.
And those with the desire to change things? We're just scum. Powerless scum. Beneath notice. Beyond contempt.