The Toot is going to look past the effete, effeminate and elitist Frenchy last name and quote Scott Lemieux anyway:

[I]f you can construct a plausible scenario under which an actual president, an actual majority of the House of Representatives, and an actual 60th most liberal member of the Senate would vote to create either a single-payer system or even a Swiss-like system of very tightly regulated non-profit private insurance [then the rejectionist argument gains power]. The argument not only fails but is deeply irresponsible because such a scenario is in fact wildly implausible, and while we would be playing Vladimir and Estragon a great deal of preventable suffering and death would occur. The simple fact is that high-veto-point American political institutions protect the status quo in general and powerful vested interests in particular. It’s not just that times when even significant incremental change is possible are rare — the American welfare state was basically constructed in two 2- or 3-year periods following historically unusual landslides in all three branches. It’s that even in those periods, reform involved compromises as bad or worse than what’s being contemplated in the current legislation.

Let’s take the New Deal. The parts of the New Deal that didn’t involve the creation of corporate cartels — the enduring parts — were not only incremental reforms but were all deeply compromised with interests much more morally odious than insurance companies: Southern segregationists…The New Deal not only further entrenched but disproportionately benefited the apartheid power. And yet not only FDR (who, in truth, was even more tepid on civil rights than was politically necessary) but most of his African-American supporters understood that the programs were a good deal on balance: it wasn’t a choice between a discriminatory welfare state and a non-discriminatory one; it was a discriminatory one or nothing. And they were right.

The fact is, compromises with venality and/or evil are almost always necessary in the American political system; it’s virtually impossible to accomplish anything without buying off powerful interests. Getting anything like universal health coverage is going to require giving protection money to insurance interests. This is nothing to be happy about, but arguments that fail to recognize this aren’t going to be very useful.

Right.  I’m not sure what AlternAmerica the Jane Hamshers of the world are dwelling in, but how the fuck exactly are we going to convince Lieberman, Nelson, Landrieu, Lincoln AND a Republican to vote yes on single payer or a robust public option (after they already, essentially, voted against each, and after a grand total of ZERO Republicans would even vote for this flawed bill)?  

Or is it that after health care is defeated, and the Dems lose seats in the House and the Senate in November (which is inevitable either way), that then we’ll have the supermajorities needed to get the public option or single payer?

 And while we all strike our coolest pose, standing around on principle, the 31 million that this imperfect mish-mosh would provide insurance for would be left shit out of the luck.  But we’ll promise to gnash our teeth and write bloggy eulogies in honor of them – our very own martyrs, sacrificed on the altar of purity.