It’s easy to get caught up in the daily machinations behind health care reform – how many votes the vile Stupak amendment limiting reproductive rights was able to secure, what kind of payoffs will be necessary to buy the assent of conservative Democrats in the Senate, the latest threat from the festering ball of bitterness and resentment that is Joe Lieberman. But what Democrats need to do more than anything else is take a deep breath, step back, and look at the long term. The only thing that will matter in the long run is whether this reform works. Look at Medicare – Republicans called it socialism and the AMA campaigned against it, but what mattered is that it worked. And today, we no longer argue about whether Medicare is a good thing (even Republicans pretend to believe it is). The political effect is that it makes every election and debate a little bit harder for the right, since their philosophy is refuted by the success of a program that improves the lives of millions of Americans. A lot of what will determine how well the reform works is buried in the less-discussed provisions – the mechanics of the insurance exchange, for instance. But as Democrats wonder what they have to keep and what they can bargain away, they ought to keep asking themselves these questions: How is this going to affect how people think about the health-care system in 10 or 20 years? Will people worry less about their access to care than they do now? Will people still be bankrupted by medical bills? Will insurance companies still find ways to screw their customers? Will premiums still be rising? Will they look back on what happened in 2009 and say, “I sure am glad that health-care reform passed back then – remember how much worse things used to be?” Lastly, we ought to acknowledge that though the final outcome is still in doubt, Nancy Pelosi just accomplished something pretty incredible. Unlike every Speaker of the House dating back to the Truman administration, she managed to herd the unruly collection of members she leads, with their incredible mass of egos, interests, fears, and delusions, to a successful passage of comprehensive health-care reform. Not too long ago, most people thought it was impossible. -- Paul Waldman
