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.

 

Comments

[beebletree]

Firstly - nothing was achieved in 1993.

Secondly - you should thank Kucinich and Masa, it would also help to read up on how a group forms it opinions and positions. The role of a single non-conformist can greatly help an entire group sway towards one side. Can you quantify how many democrats felt at ease when looking behind and realizing there are patriots like Kucinich still fighting for whats right, it made their decision easier.

All of life's fights will seem easier when one's on truth's side, and defeats will not be defeating. Complications in getting the number of votes in the house were created by a large number of democrats with way too many snakes in their closet, look inwards for a fight, not outwards.

Lastly - I blame the the the electorate, we get the government we deserve, always. We can't empower a force to protect our property (both domestically and internationally) through all possible means, and not expect the police to steal some.

[leabsting]

Mr Lux:
You have no idea what you stand for anymore. A House of Representatives with a large majority of Dems and the only way to get their health care bill was throw a big constiuency of the party, namely women, under the bus? And this is too bad...but otherwise acceptable? And as if this wasn't bad enough - a majority of the Blue Dogs that insisted on the Stupak amendement STILL didn't vote for the Bill anyway. And this is brilliant politiking to you?

You, Mr Lux, represent the only plank left in the so called Progressive platform - It just feels better to be screwed by democrats than republicans. I can tell you - it doesn't.

Count me out!

[Pablo175]

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-- Its a lousy bill!

No cost control
No tort reform
No interstate competition

Kill the Bill!!!

[toggan]

You stated, "... if Democrats don't deliver, Democratic base voters will walk away in massive numbers..."

This is true. I really don't understand the Blue Dogs' logic. There are staunch Democratic supporters of the Democratic platform, yes even in the Southern states. Health Care Reform is one of the big items. Don't let media-produced controversy fool you. The Blue Dogs will not be invited back again if they vote no on Health Care Reform with the public option. So, they'd better make sure they have completed their sight-seeing tour in D.C. before they return home for re-election.

[FearlessFreep]

If Obama had chosen a single-payer bill, it might have been no easier to pass than the bill he did choose, but it wouldn't have been much harder!

[newpartepae]

I think we are all heading right up the funnel of a tornado, soon to be spit out and forgotten. When funds(as if they haven't already) completely run out we will all be sick and in poverty with no constitution to keep us fair and or free. And we can all look back and call it history "the change". As a registered dem. I am seeing a bunch of children running our government. Children putting there hands in the cookie jar before anyone bought any cookies. Fix the finances first so somethin real can come of all this. Earn then spend is "what works". Hell, I would have been happy just poppin an extra $10.00 a year for the government to pay for people who can't or refuse to pay health care. Can you imagine everyone doing that. There are so many better ways to go than a 2000 page doc. with open loop holes to cushion governmet pockets.

[CalousteGulbenkian]

You are a minority if you were willing to pay $10 more for this program (although it probably would have been more like $400). If the bill meant more taxes for the middle class, the Republicans will jump on it and in the past that has been successful (see Reagan).

But you are right that the real challenge facing America is how to square the fact that middle class Americans want more help from their government (and are thus voting increasingly Democratic) but do not want more taxes (and so will switch to Republican if you increase the taxes to pay for these government programs)

[saveal]

The Godmother made them an offer they could not refuse.

[elkabong]

How many of these complications would have manifest themselves if they offered Medicare to anyone who wanted to buy in for cost plus 5% for subsidies?

How could there have been an effective argument against it? That Bill could have been written in a week and read in two minutes.

The reason they always seem to shovel our money to those who rip us off is because they do.

They believe in big money over a representative, democratic republic. They believe in big money over great governance when it comes to getting themselves re-elected or enriched.

[Pablo175]

Medicare is BROKE already.

[elkabong]

Of course it's broke. People like you thought Al Gore's "Lockbox" was a joke. George Bush replaced the money with "worthless IOU's." He robbed Peter to pay Paul because his fans like wars but don't like to pay taxes to pay for them.

[jade7243]

Reading the pages of Huffington Post the past 10-11 months would have people believe that making law is easy, just a wave of the magic wand and presto! It's done! So-called "well-informed" progressives believed the White House could just invent a coalition to vote for a single-payer bill, or it would be no big whoop to construct a public option rider for the bill, which Obama has had in his hip pocket lo these many months.

You would think these people might have understood how hard it is hold together 218 congressmen and women do not share monolithic thinking on anything.

Nancy Pelosi, Steny Hoyer, Jim Clyburn and all of the House leadership and committee chairs did a masterful job in the face of not only stiff opposition from the GOP, but from very liberal/"p­rogressive­" Dems and their conservative counterparts. Even with the Draconian Stupak amendment. this bill is a milestone.

The Senate will be like climbing Everest and K2 back to back.

[themainpoint]

"Reading the pages of Huffington Post the past 10-11 months would have people believe that making law is easy, just a wave of the magic wand and presto! It's done!"

"You would think these people might have understood how hard it is hold together 218 congressmen and women do not share monolithic thinking on anything."

Sounds rational---but how long did it take to give trillions of tax dollars to banks with no strings attached? Answer: a few weeks. And how long does it take for war funding by the trillions to get passed?

Case closed.

[Ken Nemeth]

Um, case closed? Really? Why don't we keep this in mind:
1. It may be shocking to folks who only get their news from HuffPo, but an October 31 Rasmussen Reports poll showed that only 42% of Americans favored the Pelosi bill. 54% were against it. That may be a lot of the reason why it was difficult to get it passed - because the majority of Americans didn't want the bill.
2. As Otto Van Bismark said, there are 2 things you don't want to see made - sausage and legislation. Complex, controversial, long-debated bills don't get pushed through overnight, especially heavily polarized ones. You want someone's vote? Sometimes you're gonna have to compromise. Neither the Democratic nor the Republican parties are monolithic, homgeneous blocks of votes. Different Congress members represent different consituencies and therefore want different things from a bill.
3. The bank situation is not the proper analogy. The financial system was about to go under big time and there was limited time to sort things out. To their credit, both Houses of Congress and the President recognized this and got it done. For better or worse, we have a functioning (albeit problematic) health care system. If it takes 3 months or a year to pass health care reform the country's not gonna go down in flames. If we didn't pass the TARP and the Stimulus we'd be toast right now from an economic perspective. Apples and oranges.

[Chazet2]

Let me correct your spelling-its millstone, as in the expression "a millstone around our necks."

[Miles Mogulescu - Huffpost Blogger]

Pelosi, Obama and Emanuel apparently didn't break the kneecaps of the anti-abortion Dems but caved to them instead. They didn't break anyone's kneecaps to include a slightly "robust" public option with Medicare plus 5% pricing, after 60 "Progressive" Democrats pledged to vote against any bill without it. In fact it looks like the kneecaps of most of those "Progressives" were broken since 58 of the 60 went back on their pledge, showing that "Progressives" in Congress are paper tigers whose word is not be to be taken seriously. Unfortunately, this Democratic health "reform" bill is not a "good start" but a step in the wrong direction. Medicare, Medicaid, and SCHIP were all good incremental reforms, providing health care to people who need it, even if they didn't get us all the way to universal health care. While there are a few good things in the Bill (e.g. expanding Medicare), its principle solution for covering the uninsured is forcing middle class and working class Americans to buy junk private insurance which they can't afford, with inadequate subsidies, no price controls, and IRS fines for those who can't afford it. As I've written, what's left of the public option is now a sham. http://www.huffingtonpost.com/miles-mogulescu/the-public-option-in-cong_b_340501.html.
I believe passing this Bill will be a disaster for Democrats when the mandates kick in and voters realize their financial impact, and could turn a generation against Democrats and progressives.

[Miles Mogulescu - Huffpost Blogger]

Correction: in the above comment, the good point in the bill should have said "expanding Medicaid", not "expanding Medicare".

[TheMediaRanger]

"While there are a few good things in the Bill (e.g. expanding Medicare), its principle solution for covering the uninsured is forcing middle class and working class Americans to buy junk private insurance which they can't afford, with inadequate subsidies, no price controls, and IRS fines for those who can't afford it."

Well, you can see how much the smart money in the stock market believes we're entering a new competitive landscape: 11/09/09 -- Wellpoint, Up 2.6%; Humana, Up 2.6%; Aetna, Up.13%; Cigna, Up 1.49%; Coventry, Up 3.14%.

[melissamsouza]

Thank you for a great post, as usual. But as I commented on another post, it is absurd for the health care debate to be hijacked by the issue of abortion. This can not derail the process; it Democrats get into an infight over this issue and sink reform because of it, then I, as a woman and a Yellow Dog Democrat, will find it hard to vote for them again.

[DA12]

A group of single payer supporters could have pulled the same trick that Stupak did, if they'd had the guts.

[Ken Nemeth]

No, this is all about votes. The only reason the Stupak Amendment was inserted into the bill was because the bill would not have passed without it. The pro-health­-care-refo­rm side simply didn't have the votes without it. If the single payer supporters had tried to put an Amendment in there that required single payer, the bill would have lost by 100 votes. Single payer is a non-starter except for a very small group of congressmembers.