The Fretting Over Health Care Reform

Talk to progressives on the subject of health care, and you will find they've gotten more and more nervous in the last couple of weeks. They are acutely aware that momentum for health-care reform seems to gain sufficient speed to make real change a possibility only every 15 or 20 years. Screw it up now, and it'll be a long time before there's another chance at it.

Why the gathering gloom? In part because the legislative process is so complex, anyone looking for reasons to be pessimistic as the reform effort wends its way through Congress need not look far. A Congressional Budget Office score here, a newly unified Republican message there, and it begins to seem as though the stars will never align for reform to succeed.

On the House side, the three relevant committee chairs -- Henry Waxman, George Miller, and Charlie Rangel -- came together to produce a plan that would give progressives reason to cheer if it passed. Although it was a substantial achievement that these three did so jointly (rather than fight among themselves to protect their own turf), the lower chamber is not where health care will live or die. Because it is a comparatively democratic institution (in which California's 37 million residents have more representation than North Dakota's 640,000 residents -- imagine that), health-care reform is all but certain to pass the House. The Senate, on the other hand, is where things get dicey, where multiple committees will produce multiple bills, and where a few individual senators could, by virtue of their location in the "center," hold the fate of the nation's health-care system in their hands.

Every few days, we get a new troubling comment from a key Democrat about what might or might not happen to key elements of the plan. Then we hear this or that Republican -- always pretending that in this universe he might actually vote for the Obama administration's health-care reform -- attempt to stay relevant by threatening to withdraw his nonexistent support over one provision or another (this I call the Grassley Maneuver).

It isn't only those on the Hill who are issuing dark warnings. Stan Greenberg, who was President Bill Clinton's pollster during the last health-care reform effort, recently penned a gloomy article in The New Republic, making the case that from the standpoint of public opinion, 2009 is starting to look like 1993 all over again.

Should we be nervous? Of course -- lives are at stake, after all. But should we panic? Absolutely not. Greenberg is right that the public clamor for change is no stronger today than it was 16 years ago. But the problem in 1993 was never that the public didn't support reform. The Clinton administration couldn't win over members of Congress -- particularly those in its own party -- to get on board with the plan it had proposed.

The second reason 2009 is not 1993 is that Congress is very different. Clinton enjoyed an almost identical numerical majority to the one Obama does -- he had 258 Democrats in the House and 57 in the Senate, whereas today there are 255 in the House and 60 in the Senate, once Al Franken gets seated. But Clinton's were very different Democrats. Southern white conservatives, many of whom were unenthusiastic about health-care reform, made up a significant portion of the party's representation in Congress. Even many not from the South felt no particular loyalty to Clinton and were perfectly willing to let his proposal die a slow death. Democrats in Congress today are not only more progressive as a group than their Clinton-era counterparts, they also know that if they can't pass health-care reform, they could suffer the same fate Democrats did in 1994, when they lost both houses to a Republican landslide.

And in 1993, no one in Congress ever really had to take a stand. The Clinton administration's bill never came to a vote. There was no filibuster. No senator had to stand up and say, "I am willing to kill health-care reform." But this time, they will. There will be a vote, and there will at the very least be an attempt at a filibuster. No one will have the luxury of watching health reform fail while claiming to have hoped it would succeed.

The coalition that proved so powerful in torpedoing Clinton's reform also seems to be acting almost tentatively this time around. That coalition -- conservatives, business groups, and the insurance industry -- has so far not waged the kind of scorched-earth campaign against reform one might have expected. And every day they hold their fire is one more day they lose. Republicans have complained about the accelerated calendar on which this effort is proceeding -- the administration hopes to have a vote on the bill some time in the fall -- because they know that defeating a reform effort of this kind requires a war of attrition, where more time means more doubts that can be raised and more pressure can then be exerted on wavering senators.

Finally, the Obama administration has learned a great deal from Bill Clinton's failure. So much of what it's doing this time around is different, from the way it's letting Congress write the bill (thereby not alienating the territorial members they'll need to pass it), to the way they're constantly repeating the mantra, "If you like your current health plan, you can keep it" (fear of change was a powerful weapon wielded by reform opponents in 1993).

All this isn't to say that reform is sure to pass -- far from it. But if you're someone who pays a great deal of attention to politics, it's sometimes difficult to step back and distinguish the real threats from the day-to-day silliness of political debate. You can watch one Republican after another go on TV and gravely invoke the threat of "a government bureaucrat getting between you and your doctor," and feel an urge to throttle them for their focus-grouped disingenuousness. But that doesn't mean the attack is shifting Americans' opinions.

Before this is all over, some putative ally of the administration will say something dumb, appearing to throw progressive principles overboard or making a comment that conservatives will seize on. A Democratic senator will make a dire prediction about the bill's passage, perhaps even declaring that reform is "on life support" or "in critical condition." Republicans will at some point gleefully proclaim (with no particular evidence) that the public has turned its back on health-care reform. These things will probably happen more than once. But the foolish comments and the play-acting of opponents aren't worth getting worked up over. This reform could still fail, and it would be a terrible tragedy if it did. For now, though, things are still moving in the right direction.

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