[NOTE: Although I've been one of the most prolific Huffington Post writers on healthcare reform, writing over 25 pieces going back to October, 2007, I haven't written until now about passage of the Democrats' bill since I've been dealing with possible end of life issues with my own Mother. I'm eternally grateful to LBJ and the House and Senate members who passed Medicare in 1965. Medicare is providing hospice services so my Mother can spend what may be her last days in comfort in her own home, surrounded by her family, according to her wishes articulately expressed in an advanced directive written with great thought some years ago. I assure you, there are no death panels.]
As a student and fan of the sport (and profession) of politics, I've got to cheer the Hall of Fame performance of Nancy Pelosi during the last, come-from-behind quarter of this epic health care battle. With the physical size of a small woman (just over 5 feet tall and 120 pounds soaking wet, in high heels, and moving backwards) and the mental and emotional strength of a 300 pound offensive tackle, she held off the invading hordes of charging defensive linebackers -- whether Do-Nothing Republicans or Blue Dog Democrats -- and protected her quarterback, Barack Obama's, blind side, enabling him to throw the game-winning touchdown pass at the buzzer. Pelosi's stand-out performance deserves an Academy Award as much as Sandra Bullock's did for The Blind Side.
(For those who didn't see the movie, the title refers to the fact that, while the highest paid player on a pro football team is usually the quarterback, the next highest paid player is often the left offensive tackle whose job is to protect the quarterback's "blind side" by holding off big and fast defensive linebackers who would otherwise smash the quarterback into the turf and break his legs, as Hall of Fame linebacker Lawrence Taylor did to Hall of Fame quarterback Joe Theismann, prematurely ending Theismann's career.)
I also couldn't help shouting out three cheers and a chant of "hit 'em again, him 'em again, harder, harder" to see the Democrats finally stop playing nice and start playing smash-mouth football, ramming this bill down the throats of the likes of orange-faced John Boehner, jowley old Mitch McConnell, and the other arrogant and obstructionist members of the Party of No and their cheerleaders like Rush Limbaugh, Glen Beck and Sarah Palin.
However, as a student of public policy (with a strong emphasis on health care policy) and longtime supporter of single payer -- or at the very least of a robust public option big enough and powerful enough to restrain the the power of private insurance and drug companies and drive down premium costs (which this bill does far too little to accomplish) -- I can only give about half a cheer for this bill on policy grounds. While I'm cheering for Pelosi's political skill, I wish I could be cheering louder for passage of a bill that actually did more to accomplish universal affordable health care for all Americans. And, as I've written here, I'm disappointed that despite having the votes in the House and in the Senate reconciliation to pass at least a weak form of a public option in the final reconciliation bill, Pelosi protected Obama's deal with the for-profit hospital industry that the final bill would contain no national public option.
And to use another film analogy, during most of this past year, President Obama and Congressional Democrats looked more like "The Bad News Bears" or "The Mighty Ducks", a team of unskilled hapless losers, who, as only in a Hollywood movie, suddenly come together in the final seconds of the game to score a miraculous come-from-behind victory. It didn't need to be this way.
Barack Obama entered office in January, 2009 with a promise of transformational change, approval ratings in the '70s, the largest Democratic majorities in Congress in a generation, and an email list of over 9 million activists who had volunteered and contributed to his campaign and were waiting eagerly to be called upon to help bring about the change they had worked so hard for. A majority of the American people were looking for someone who would provide big solutions to big problems and were willing, after 30 years of Reaganesque anti-government policies, to give government a chance to help solve those problems. If Obama had called for, indeed insisted upon, sweeping policy changes--including fundamental reform of the financial system to prevent the big banks and financial institutions from again bringing the economy to its knees and being bailed out by trillions in taxpayer dollars; direct relief to struggling homeowners; a big enough stimulus bill to really create 4 or 5 million new jobs; a strong energy bill which could make a meaningful impact on climate change; and fundamental health care reform that, if it didn't go as far as single payer, required a large and robust public option to provide real and meaningful competition to the rapacious private insurance industry, and allowed Medicare to use its purchasing power to reduce drug costs--much of the country would have been behind him.
Instead, he demobilized the activist troops and, with the help of Blue Dog Democrat Rahm Emanuel, followed a K Street strategy of joining with Congressional barons in cutting back room deals with special interest lobbyists in return for campaign cash. As a result, a year and a half after Wall Street's collapse, there's been no reform of the financial system; the biggest banks are bigger than ever and back to taking risky bets in the global casino and paying near-record bonuses with taxpayer money; already compromised energy legislation is bottled up in the Senate; and we ended up passing a badly flawed health care bill which, while it does a handful of good things, leaves most Americans in the grips of strengthened private insurance and drug industries. Voters are again disillusioned with the ability of government to solve their problems and seem to be buying the conservative argument that even with 10% unemployment and millions losing their homes, the most important role of government is to cut the deficit. The moment for potential transformational change may have past.
Over a year ago, Rahm Emanuel said that when it came to health care reform, any win is a win, without regard to the substance of the reform. In addition to being a terrible negotiating strategy, it's not true--The substance of health care reform matters very much to tens of millions of Americans and this health care bill is sorely lacking.
For short-term Democratic election prospects, passing a bill is far better than doing nothing, and already polls seem to be moving more positively in a Democratic direction. There are enough immediate small benefits from the bill--ending pre-existing conditions for children, closing the Medicare donut hole, letting children stay on their parents' policies until they're 26, ending lifetime caps--that if Republicans are determined to run on repealing these provisions, Democratic losses in the fall may be lower than expected in the wake of Scott Brown's victory.
But in the medium to long-run, this bill does far too little, and in some areas will do harm. In coming years, Democrats may find it hard to defend many of the outcomes. The bill does almost nothing to control private insurance premiums, so in early 2011 when private insurers again raise their rates by 15%, 25%, or 39% on individual policies, and when more employers drop policies or increase employees co-pays and deductibles in the face of double-digit premium increases, many voters will be asking, what did the Democrats' health reform bill do for me? When individual mandates kick in and middle class families have to pay $9,000 or more a year for policies covering 65%-75% of their medical costs or be fined by the IRS, there could be massive rebellion against Democrats. National Nurse Union head Rose Ann De Moro detailed many of the bill's failings in these pages yesterday in an article entitled "Diary of a Wimply Healthcare Bill", so I'll refer readers there rather than take more space here.
The question is, when, in a few years, millions of Americans still can't afford insurance, face IRS fines, and are getting dropped from their employer-paid policies, will they blame Democrats and look to Republican "free market" solutions, or will they then be open to more fundamental reforms which would align American health care with the rest of the democratic capitalist world?
So, for today, kudos to Nancy Pelosi, who may now go down in history as one of the great Speakers of the House along with Tip O'Neill. And let's enjoy a thrilling come-from-behind victory, as weak as it may be on the substance. But I guarantee, based on this flawed healthcare bill, Barack Obama will not be the last President who will have to deal with reforming America's health care system.