03/18/2010 05:12 am ET | Updated May 25, 2011

One More Step

Health care reform was always going to be tough as hell, as difficult as any issue that could ever be tackled. As I learned from the agony of the 1993-94 Clinton attempt at health care reform, this issue is so massive, so complicated, so unwieldy that it is prone to be derailed by lobbyists pulling on any one of the hundred hanging threads and unraveling the whole thing. Culture war issues like abortion and immigration combine with issues peculiar to individual districts like having a medical device manufacturer based in a congressperson's district, and all of those things combine with bigger worries about overall ideological and political concerns back home.

When people over the weekend would ask why getting the votes for the health care bill was so hard, I would have to say: it just is -- it is the nature of the beast. Every step along the way will be tough and painful and decidedly not easy. Every time we complete a step, like we did on Saturday night, it is easy to look at how hard it was and say, "Oh my God, the next step is even harder, how we will ever get there?"

Determined leadership can find a way through. In the 1993 budget fight, every step of the way was complete torture, and at numerous times it looked like we were completely done for. But we kept battling, took on one step at a time, and we got it done.

Speaking of determined leadership, Nancy Pelosi deserves enormous credit for finding a way to get this done. Like all progressives, I am deeply unhappy with the abortion language that was allowed to be voted into this bill. That language is unacceptable and has to be changed in conference committee. But I was looking at the vote count on Friday night too, and we really were done unless that vote was allowed. There were literally no good choices at that moment, because to let the bill fail or pull the bill from being voted on would have caused everything to get unraveled. We still have a very good chance at stripping this terribly restrictive anti-abortion language in conference committee, and need to keep fighting to do that.

On the final vote, the whipping process was intense and impressive. Democratic leaders I have known in the past have rarely played this kind of hardball, but some kneecaps were broken Saturday night to get these votes, and the Speaker did a masterful job of doing every little thing that needed to be done. She gave no passes to people, and she was very clear there would have been consequences to all who voted no. She got the job done.

I also wanted to commend the congresspeople from tough districts likely facing very competitive races who did the right thing on this vote. It was a good political move on balance because it will help them turn out the base in the 2010 election, but when you are getting hammered by the big money forces against this bill, it never feels like a tough vote like this is going to help you. As a strong progressive, I give more conservative members of the Democratic caucus a lot of flack sometimes, but these Democrats from tough districts deserve a lot of thanks:

AZ-01 Kirkpatrick, Ann R+6

AZ-05 Mitchell, Harry R+5
AZ-08 Giffords, Gabby R+4
CA-11 McNerney, Jerry R+1
CT-04 Himes, Jim D+5
FL-08 Grayson, Alan R+2
IL-08 Bean, Melissa R+1
IL-11 Halvorson, Debbie R+1
IL-14 Foster, Bill R+1
IN-8 Ellsworth, Brad R+8
KS-03 Moore, Dennis R+3
MI-07 Schauer, Mark R+2
MI-09 Peters, Gary D+2
MN-01 Walz, Tim R+1
NH-01 Shea-Porter, Carol R+0
NV-3 Titus, Dina D+2
NY-01 Bishop, Timothy R+0
NY-19 Hall, John R+3
NY-24 Arcuri, Mike R+2
NY-25 Maffei, Dan D+3
OH-15 Kilroy, Mary D+1
OR-5 Schrader, Kurt D+1
PA-3 Dahlkemper, Kathy R+3
VA-5 Perriello, Tom R+5
WI-08 Kagen, Steve R+2

On the other hand, there are some Democrats I am appalled by. As a 30-year supporter of single-payer, and with full knowledge of the imperfections in this bill, I am angry that single-payer supporters Kucinich and Massa were happy to let any hope of health care reform for a generation die because the bill wasn't everything we hoped it would be. To let another generation go by where tens of thousands of people die every year from being under-insured, and have the insurance companies continue to be allowed to screw people over preexisting conditions, lifetime caps, and recessions is just wrong.

Then there is the large collection of Blue Dogs who care nothing about the President or the Democratic Party's top priority, let alone all those people without insurance. After all that Rahm Emanuel and Nancy Pelosi did for these reps in the 2006 and 2008 elections, all the money and time and staff and consultant help they gave them, for those Blue Dogs to walk away on the biggest issue, when they were needed the most, is a sign of their selfishness. These are Rahm's people, recruited by him and supported by him at every step of the way, and they don't care that they are making him look terrible by leaving him out to dry. They are also dumb about their own political fate: if Democrats don't deliver, Democratic base voters will walk away in massive numbers, and it will be the people in marginal districts that will suffer the most.

The health care debate was always going to be a knock-down, drag-out fight, with every stage a harrowing journey to get through. But we survived another big step on Saturday night, and are alive to fight for another round. We will figure out how to win this one way or the other, making history when we do.