Comprehensive reform of the American health-care system passed the House of Representatives last summer. Then in December, a health-reform bill overcame massive Republican obstructionism and repeated filibusters and passed the U.S. Senate. The country seemed on track for President Barack Obama to sign a landmark bill early in the New Year. And then came Scott Brown’s unexpected defeat of Martha Coakley in the Massachusetts special election. Ever since then, the dominant health-care story has been a process one. How can the House and Senate iron out the differences between their bills in an environment where the GOP can filibuster any bill brought up under regular order? What’s the timing of a reconciliation package? Can Democrats round up the votes needed in the House now that John Murtha is dead and Hawaii's Neil Abercrombie has resigned?
A briefing for bloggers with House Speaker Nancy Pelosi on Monday morning dwelled at length on these issues, including a somewhat mind-boggling list of ways in which the House might pass the Senate’s bill without officially casting a vote on the issue.
At a key moment, however, Pelosi stepped back and waxed a little bit more expansively and philosophically. She observed that with the exception of Michigan's John Dingell, who was around for the Civil Rights Act and the creation of Medicare and Medicaid, no member of the House serving today had been part of any progressive reform this big. For many members, she argued, “this is the most important thing we will do.”
The phrasing of the claim in the future tense was crucial to the larger message she was trying to send—one of determination to pass the health-care bill and confidence that it would be done. At the same time, despite her impressions of confidence it was clear that the votes are not, as of yet, squared away. Twice the meeting was interrupted by Pelosi needing to take urgent calls from other members of Congress who are busy trying to move the process forward. And when the Congressional Budget Office finishes its final score of the legislation, we can expect a furious scramble of arm-twisting to get the ball across the goal line.
The recalcitrant members come in essentially three groups. On the one hand, there’s a handful of hardcore anti-abortion Democrats who’ve joined Bart Stupak in refusing to vote for the bill over abortion. Their stated objection is that they want to ensure that there are no federal subsidies for abortions, but that principle is already entrenched into law and reflected in the bill. Stupak’s actual aim is to create a situation in which the growth of regulated health-insurance exchanges eventually ensures that nobody has abortion coverage. Next comes Dennis Kucinich, a one-man bloc of left-wing opposition to the bill. When Kucinich voted “no” on health-care reform the first time around, most observers saw it as a mere protest—a liberal wanting to go on record as being in favor of a single-payer system like Medicare—and thought he’d come home if his vote was strictly necessary. Recently, though, Kucinich has insisted that’s not the case.
This leaves Pelosi in search of votes from among the block of relatively conservative members representing relatively conservative districts. On the merits, this shouldn’t be that hard a sell. The bill would achieve the vital progressive goal of universal health care. But it does so in an extremely centrist manner, achieving key centrist goals of deficit reduction and cost control and in the Senate has secured support from the likes of Joe Lieberman, Ben Nelson, Evan Bayh, Mary Landrieux, and Blanche Lincoln. If Pelosi could get every House member to the left of Ben Nelson to vote for the bill, there’d be no problem. The real issue is that members from relatively conservative districts are afraid of losing their seats.
In this light, there’s a case to be made that failing to pass reform would be worse politically than passing it. But ultimately the argument from history is probably the best argument that can be made to vulnerable members. Nobody’s career in elected office lasts forever. And that’s especially true if you represent a seat that’s ideologically ill-suited to your party affiliation. Assiduous trimming and constant refusals to cast tough votes can help you, but a vulnerable member is, by definition, vulnerable. Realistically, even if you do everything in your power to minimize your odds of defeat, you’re still going to lose one of these days. After all, if your constituents are the kind of people who think John Boehner would be a better Speaker than Nancy Pelosi, soon enough they’ll figure out that the only way to make that happen is to vote Republican no matter how you vote on any particular issue.
The measure of a politician, however, is not how long he or she lasts in office, but what he or she accomplishes while there. The establishment of a system of universal health care is the sort of achievement that will last for decades.
The measure of a politician, however, is not how long he or she lasts in office, but what he or she accomplishes while there. The establishment of a system of universal health care is the sort of achievement that will last for decades. If it passes, Obama will go down in history along with Franklin Roosevelt and Lyndon Johnson as the key architects of the American welfare state. Those members of Congress who back him will be a part of that history, and those who vote no will be left behind. If reform goes down in flames, members of the Democratic Chicken Caucus may or may not buy themselves another term in office. But to what end? Homeless shelters aren’t filled with former members of the House of Representatives. Anyone who loses this seat, whether over this bill or despite it, will still be fine. The millions of Americans who need health insurance won’t be unless the bill passes. Nobody campaigns for office saying they want to come to Washington to duck the hard issues. Now’s the time for members to live up to their word.
Matthew Yglesias is a fellow at the Center for American Progress Action Fund. He is the author of Heads in the Sand: How the Republicans Screw Up Foreign Policy and Foreign Policy Screws Up the Democrats.