The political hero of health-care reform has turned out to be Speaker of the House Nancy Pelosi. Had Pelosi’s allies in the Senate and the White House shown as much tenacity and toughness as she, a health-care bill much stronger than the one now about to be enacted would have been passed months ago. Without her, the current bill certainly would not have succeeded. And her achievement is of larger historical significance, as no other speaker in modern times can claim to have done so much to bring to the brink of passage a bill of such broad significance.
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As early as last July, Speaker Pelosi announced that there were sufficient votes in the House to pass a bill mandating sweeping health-care reform. Less than four months later, she proved as good as her word, as the House approved a bill far stronger than the one that would finally gain congressional approval. But in Washington, the speaker and the House majority were singular in their firmness. Even with a filibuster-proof majority, the Democratic Senate urged the White House to go slow. Playing the Senate’s game, the Obama team did just that, placing the issue in the hands of conservative Democratic Senator Max Baucus of Montana and the “Gang of Six,” consisting of three unrepresentative Republicans and two unrepresentative Democrats besides Baucus, all from small states—a strange show of bipartisanship that prolonged the process far beyond the original target date in August set for passage and finally abandoned.
All along, the White House, in efforts overseen by Chief of Staff Rahm Emanuel and Deputy Chief of Staff Jim Messina (Baucus’s former chief of staff, who calls the senator his “father”) cut deals with the pharmaceuticals lobby that removed certain key provisions that President Obama had touted earlier, including negotiations over Medicare drug prices and importation of less-expensive medications from Canada and Europe. By mid-August, the White House had backed off its support for the public option, which Emanuel was looking to ditch from the start. The Senate Democrats finally passed a much weaker bill than the House version on Christmas Eve on a strict party-line vote—so much for bipartisanship—only to lose their filibuster-proof majority in the shocking Massachusetts special election on January 19 through political malpractice at all levels including a complacent White House.
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• More historians on Obama’s legacy nowFrustrated by the protracted delays and backroom bargaining that began long before and continued several weeks after the House acted, Pelosi conceded publicly on March 11 that health-care reform had been “hijacked by a concerted effort on the part of the insurance companies and their supporters to make sure we don’t [have] a bill.” But neither she nor the House Democrats bore responsibility for the debacle in the making; and in the final push, she stayed as tough as nails, swatting down all attempts within her own caucus, from the left and the right, to obstruct final passage of the now much diluted though worthy reform bill. She also shocked a drifting President Obama into supporting his own bill rather than stripping it down to a “kiddie care” version, as Pelosi characterized to him Emanuel’s latest ploy.
It is rare for a speaker of the House to assert much independent authority and will to achieve a major piece of legislation. No speaker in modern times has performed as powerfully as Pelosi has over health care; for an apt comparison, one might have to go all the way back to Speaker Henry Clay of Kentucky, who, with an iron grip on procedures as well as personnel, rammed through the compromise that resolved the Missouri crisis of 1819 to 1821 and delayed by nearly four decades the crisis over slavery that led to Civil War. Curiously, the modern political figure who has most often cited Clay as a role model is Newt Gingrich, whose performance as speaker proved disastrous for his party and himself. We may, though, at last have seen the emergence of a speaker with Clay’s talents in Nancy Pelosi. The tough, resilient woman has saved the day.
Sean Wilentz is a history professor at Princeton University whose books include The Rise of American Democracy: Jefferson to Lincoln and The Age of Reagan: A History, 1974-2008. He is a contributing editor at The New Republic, and historian-in residence at Bob Dylan's official Web site.