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

Democratic Party Out of Bounds

Who's to blame when situations degenerate?
Disgusting things you'd never anticipate.
People get sick, they play the wrong games
Ya know, it can ruin your name!

- The B-52s, "Party Out of Bounds"

Would I have voted for the House health reform bill? Probably, although I'm not sure. Would I have celebrated its passage with a festive party atmosphere, as some Democrats did? Definitely not. And here's a word to the House Dems who reportedly chanted "Fired up! Ready to go!": This isn't a pep rally. You guys traded more than you needed to trade, partially as a result of the White House's laissez-faire approach to this process, and you're gonna pay for it eventually.

This situation calls for a little less partying and a little more party leadership, a few less amendments and a lot more amends. And forgive me if I'm not bringing much "health analyst" gravitas to this discussion, but Democrats need to understand how deep the reaction is likely to be among the base voters -- the same voters who failed to show last week in Virginia.

What went wrong? Why did we get such a weak bill, compounded by the violation of women's rights and dignity that has come to be called the "Stupak Amendment"? To a certain extent it represents the messiness of the legislative process, made more difficult by Rahm Emanuel's misguided strategy of recruiting conservative candidates and calling them Democrats. To borrow a neologism from the above-quoted B-52s song, you can call it "House-a-tosis."

Then there was the White House's cynical, hands-off approach to the process. After all, if you don't commit to any particular policy plank as being "the president's reform," you win no matter what passes. My heart sank during the president's health care speech when he said "I am not the first president to take up this cause, but I am determined to be the last." I felt then that he would not fight for the best bill, but was determined to win any old bill, as long as it could be called "health reform."

"Any old bill" is pretty much what we got -- and it's likely to get even worse once the Senate is through with it. How bad is it? I've said my piece before (see links below), so I'll defer to someone far more distinguished. Unlike me, Dr. Marcia Angell, the longtime editor of the New England Journal of Medicine, would definitely not have voted for the bill, for excellent reasons. Read her piece for a wise perspective on what the House has done.

Many Democrats and progressives will disagree with her conclusions, of course, and with my slightly milder ones. That's fine. But one argument that will not be persuasive is the overused talking point that critics are too "naive" about politics. On the contrary -- most objections to this version of "health reform" are deeply rooted in pragmatism. That practical mindset applies both to health policy (ref. Angell and others) and street-level politics. And about the politics ...

I don't think many Democrats, especially male Democrats, have any idea how profoundly the House has alienated Democratic women by accepting the Stupak Amendment. The level of pain and outrage I've seen from women writers (and women I know personally) is profound and deep. Women are a core constituency for Dems, and many of them may choose to stay at home in 2010 and even 2012 if the Stupak Amendment is retained in the final bill.

I've already gone on at length about how the lack of a real public option or premium price controls will hurt working families once the mandate goes into effect. That will translate into voter anger, too.

That's why the celebrating seemed not only unseemly, but tactically foolish. The rumor from connections on the Hill is that Nancy Pelosi wept after being forced to accept the Stupak Amendment. I don't know if that's true or a well-placed story, but it certainly strikes a more appropriate tone than the jock-like chant that erupted after the president addressed House members.

You guys want to be "fired up"? Fine.

  • Get "fired up" over a woman's right to autonomy over her own body.
  • Get "fired up" over really "bending the cost curve" so that families can afford those mandates.
  • Get "fired up" over re-inserting Medicare-based rates in the public option, rather than throwing voters' money away by giving too much to the insurance companies.
  • Get "fired up" about finding ways to control runaway premiums, which show no signs of slowing down.
  • Get "fired up" about the double standard that would allow states to "opt out" of the public option, but (without the Kucinich Amendment) unable to "opt out" of the private system.
  • Get "fired up" over ensuring that your bill doesn't result in a massive transfer of wealth from hard-working middle class families to the insurance industry.

This isn't "ideological purity" or "naive idealism" talking. These are the words of pragmatism. Your base will desert you in droves next year if you don't fix this thing. In fact, I say this with no pleasure, but with a pretty high degree of certainty:

If you don't fix this bill before it becomes law you won't be "fired up" -- you'll be fired. And you won't be "ready to go" -- you'll be gone.

Base to Obama: Come In, Please
Time to Kill the Pseudo-Public Option -- and Other Things to Tell Your Representative
Three Reasons You May Be Uneasy With Health Reform

RJ Eskow blogs when he can at:

A Night Light
The Sentinel Effect: Healthcare Blog

Website: Eskow and Associates