I've assiduously avoided writing about the politics of health care reform for the past couple of months, for a number of reasons. First of all, it has been such a fluid situation that my the time I could put any sensible commentary together it was already out of date. Also, with excellent analysts like Ezra and Jon Cohn and others on the job, I didn't feel that I had a lot of substance to offer beyond linking to them. And finally, since the whole thing was being played out on the big stage in DC, so very far away, it's not like like my voice was going to have any impact on the debate. So I've watched carefully and I've kept mum. Mostly.
I'll make a few observations on the status of things now, in the wake of the MA debacle, then resume radio silence till there's any substantive developments to comment on once more.
Is it time to write Health Reform's post mortem?
Sure seemed like it this morning. Congressional Democrats, in one of their most disgusting displays of political cowardice, started a full-on freak-out, with liberal stalwarts joining jittery centrists in declaring the whole game over. The Senate leadership preemptively declared defeat. Conservadems in the senate like Bayh and Nelson who never wanted reform in the first place also took the opportunity to head for the door and declare the whole thing done. Then Obama implied that the reform bill should be dropped and maybe something smaller could be passed instead. This is the sort of galling weakness that makes it insanely frustrating to be a democrat. These people are contemptible. Talk about a worst-case scenario.
Fortunately, as time passed, cooler heads started to prevail. The White House walked back the implication that they were giving up on the Senate Bill. Barney Frank got over his moment of hysteria. House leadership and labor leaders said they could live with a "fixed" senate bill, passed through reconciliation. Senate leaders expressed openness to using reconciliation. To everybody's surprise, it appears the sun will, in fact, still rise tomorrow.
Whose fault is this mess anyway?
Boy there's plenty of blame to go around. The old saying is that success has a thousand fathers but failure is an orphan; not in this case. It's Martha Chokely's, fault, for blowing a gimme special election. It's Ted Kennedy's, for dying at such an inopportune time (sad joke, not funny). It's the MA Democratic party's fault, for screwing with election laws over and over. It's Harry Reid's and Max Baucus', for wasting months of time in a fruitless quest for GOP cooperation. It's Lieberman's and Nelson's, for being preening egotists and holding the bill hostage. It's Obama's, for not using the bully pulpit to continue to make the moral case for universal coverage. It's FOX's, for cynically and repeatedly lying about the proposed bill and demagoguing the issue relentlessly. It's the feckless Democrats' fault in general, for failing to keep their caucus together and legislate effectively. It's the GOP's, for their nihilistic approach of obstruction and refusal to compromise.
The list could go on for pages. I guess it doesn't matter. We are where we are, and if it works out in the end, all sins will be forgiven -- but not necessarily forgotten.
What comes next?
Best I can tell, the Senate has decided not to do anything till Brown is seated. (Funny how the Senate didn't wait for Al Franken or Roland Burris, though, innit?) Which means that the original strategy of the ping-pong of the Senate bill back to the House and then back to the Senate is dead. There's some suggestion of getting Snowe (or even Brown? He does have to run again in MA in 2012) back on board with some policy compromise, but I suspect that is a fool's hope.
Apparently, the plan is that the Senate bill, which has been passed, will be approved verbatim by the House, then signed into law by the President. House liberals will not agree to this, however, unless the Senate bill is improved, and improved it can be, through the reconciliation process, which as we all now know takes only 51 votes. The good news is that the major items of contention for "fixing" are appropriate for the reconciliation process, because in some way they affect the deficit -- the excise tax, the expansion of Medicaid, the Nelson Nebraska buy-off, etc. The bad news is that this process could take a while, which could be fatal. The opponents of reform smell blood, and the popularity of reform will probably continue to plummet in the face of increased attacks.
Will it work?
I think it will. Not because I'm deranged, or an incurable optimist. But because the electoral calculus for the dems is very clear: pass this thing or it's 1994 again. If this fails, the narrative will be that the Dems tried to do this awful thing and isn't it great that the people gave the GOP back enough power to stop them. That's a formula for electoral disaster. Pass it, and you can take a victory lap, talk about all the goodies in the bill, and gain some time to let the backlash die down before facing the voters. Winning matters in politics. I think in the end, simple self-preservation will compel the democrats to finish what they started. But really, at this point, who the hell knows?
Why is this effort still worth supporting?
This is the case that the supporters of reform need to start making (again) and more forcefully. To this point, we've been so embroiled in policy fights (public option) and internecine warfare (Baucus, Nelson) that Dems have inflicted their worst injuries on themselves. They've not played offense at all. Now there's little possibility of changing the bill -- the cement is poured -- so Dems can and must put aside the squabbling and remind Americans that despite the ugliness of the process, what we have is a relatively centrist, good bill. We can stop apologizing for it and promote it: It's a guarantee that nobody will ever need to worry about losing their health care coverage ever again. It's a promise that exploding health care costs will (start to) be contained. It's an end to some of the worst abuses of the insurance industry. It's the closing of the Medicare Part D donut hole. It gives individual consumers more choice, and fairer choices. It's more funding for primary care and prevention. It extends the solvency of the Medicare program by nine years. It's fully paid for and reduces the deficit. It's a good start, a historic start, that future congresses can build on and improve.
It's time to take a deep breath, get back on the proverbial horse, and get out there and make our case to the American people that this health reform bill is still, after all, what America needs now. And then let the chips fall where they may.