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Health-care reform's biggest losers

stupakretire.JPG

Rep. Bart Stupak has not had an easy year. He made himself a villain to liberals when he threatened to kill the Affordable Care Act unless the already-restrictive abortion language was made more restrictive. He made himself a villain to conservatives when he accepted an executive order saying that the abortion language in the bill was intended to be extremely restrictive. And now, after weeks of negative ads and angry letters and shouting phone calls, he's retiring.

But Stupak isn't alone. If Sen. Ben Nelson was up for reelection this year, there's a good chance he'd be retiring too. The two of them took the most damage during health-care reform, and for the same reason: They took a hostage and then accepted the ransom. And while that strategy might have worked in the past, it's proven a disaster.

There were no end of legislators who didn't like the bill -- or didn't want to vote for it -- for one reason or another. But there were a very small group who used their ambivalence to elevate their public profile and strengthen their bargaining position. Nelson became a frequent guest on the Sunday shows, explaining how the bill wasn't good enough and he wasn't sure he could vote for it. He waited until the last minute, and then used all the anti-bill credibility he'd built to cut the best deal for his state: Free Medicaid expansion, in perpetuity.

The only problem was that his state didn't care about Medicaid. Nelson had helped convince them this wasn't a good bill, and now he was flip-flopping to support the monstrosity. Stupak followed a similar path: He spent months threatening to kill the thing and telling anyone who was listening that it would lead to taxpayer-funded abortions, and then flipped to support it. These flips were not necessarily unprincipled. Both Nelson and Stupak got real policy concessions. But they were unpopular. The left hated them for their preening ambivalence, the right for their eventual support.

Compare Nelson and Stupak to people such as Mark Warner or Brad Ellsworth, both of whom are moderate Democrats who had serious concerns about the bill, but who spent their time quietly getting those concerns addressed rather than using them to get TV bookings in advance of a high-profile deal. Nelson and Stupak made themselves into targets for both the left and the right, and ended the process with lots of notoriety but even more new enemies. Warner and Ellsworth haven't suffered from the same backlash. The old model in which moderate Democrats justify their vote for a bill by talking trash about it until they get bought off doesn't work in an environment where the media and the political opposition is waiting to pounce on the buy-off.

(Monica Potts makes some similar points here.)

Photo credit: By Melina Mara/The Washington Post

By Ezra Klein  |  April 9, 2010; 2:35 PM ET
Categories:  2010 Midterms , Health Reform  
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Comments

I'd say that the biggest losers from the PPACA are the 22,000 children in Arizona and the 100,000 Tennessee residents who are now without health care due to the cuts the states had to make in order to comply with the PPACA. I truly regret that so many Americans had to be cut from the Medicaid roles to pay for the increase in service to Cape Cod and Martha's Vineyard residents. At some point, we need a federal administration that won't drown out the voices of ordinary citizens in favor of large, powerful, and well-paid special interest groups like the Podesta brothers' Center for American Progress: how can Podesta advocate "clean coal" and ignore the tragedy in the mines? How can one justify paying for acne treatment in Massachusetts while denying oxygen in Tennessee?

Posted by: rmgregory | April 9, 2010 2:48 PM | Report abuse

It is a shame to lose pretty much any Democrat this year.

But, Stupak made his bed.

And I can't feel personally sorry for anyone who will most likely transition into a lucrative lobbying job.

Posted by: PorkBelly | April 9, 2010 2:51 PM | Report abuse

Don't forget about Blanche Lincoln -- her Arkansas colleague Mark Pryor took exactly the same positions on the health reform votes that she did and no one is even talking about him. He is much less reviled by both the right and left. Now granted, he's not up for re-election this year, but he also chose not to grandstand and publicly waffle so everyone had to come on bended knee to earn his vote. Somehow Lincoln pulled the inside straight of upsetting everybody, pleasing nobody, and convincing everyone that she opposed them. Not easy. In truth, this is where the median voter theorem meets political reality. If the moderate majority that David Broder and most of the mainstream media fantasizes about really existed (and paid attention enough to care) they'd be rallying to Lincoln's defense. But as we know, they don't exist (at least not in any significant and active number).

Posted by: vvf2 | April 9, 2010 3:00 PM | Report abuse

rmgregory - This is the stuff that happens when you have centralized government. Get use to it, it is going to happen more and more often if we continue to centralize our government.

Posted by: gjconely | April 9, 2010 3:08 PM | Report abuse

Health-care reform's biggest losers? That would be us.

Posted by: obrier2 | April 9, 2010 3:10 PM | Report abuse

"And I can't feel personally sorry for anyone who will most likely transition into a lucrative lobbying job." - So, does that mean you support this type of action?

Posted by: gjconely | April 9, 2010 3:10 PM | Report abuse

Ezra,
Good post, but it left me wondering: what were Warner's "serious concerns" about the bill, and how were they addressed? Thanks.

Posted by: screwjob1 | April 9, 2010 3:12 PM | Report abuse

One contributing factor that you're overlooking is partisanship, which meant that only Democrats were playing this game. That meant that they couldn't earn any points from liberals for bringing a few Republicans on board, they couldn't win any cover from conservatives by having a few Republicans in Congress share their position, and they couldn't win any plaudits from pundits for bipartisan coooperation.

In order for this strategy to work for your public image, you either need to get mostly ignored by the public (until they bill has passed and you can brag about your accomplishment) or you need to be seen as a reasonable centrist / moderate / bipartisan / dealmaker who worked to improve the bill and get things done. In a big public fight with unanimous Republican opposition, it's hard to get either of those to work.

Posted by: vince432 | April 9, 2010 3:20 PM | Report abuse

Stupak's bad year was not limited to his bungled play on the politics of abortion with the health care bill, and the reprehensible personal threats that followed. Stupak also is facing increasing scrutiny as a resident of the infamous "C Street House" which may lead to problems with both the IRS and the House Ethics Committee.

It is definitely a good time for Bart to be considering a different line of work.

Posted by: Patrick_M | April 9, 2010 3:21 PM | Report abuse

LOVE THAT SOCIALISM!!!

Don't cry for Bart. He's a double-dipper -- retired Michigan State Police. Now, the congressional pension. LOVE THAT SOCIALISM!!

Cry for the WORKING CLASS who have to pay for this BULL-CR*P that MESS-IAH SHOVED! So fr*ckin' important, thinking couldn't be used!

IMPEACH OBAMA!!!

Posted by: russpoter | April 9, 2010 3:33 PM | Report abuse

Stupak not only stabbed the country in the back, but his constituents, and even his party. Obama and Pelosi have manipulated yet another into political suicide. As a penalty Stupak will go on to make a few million a year as a lobbyist for big pharma. Am I wrong or is that backwards?

Posted by: smc635 | April 9, 2010 3:35 PM | Report abuse

LOVE THAT SOCIALISM!!!

Don't cry for Bart. He's a double-dipper -- retired Michigan State Police. Now, the congressional pension. LOVE THAT SOCIALISM!!

Cry for the WORKING CLASS who have to pay for this BULL-CR*P that MESS-IAH SHOVED! So fr*ckin' important, thinking couldn't be used!

IMPEACH OBAMA!!!

REPEAL!!!

DO NOT LET FREEDOM DIE!!!

Posted by: russpoter | April 9, 2010 3:38 PM | Report abuse

#*$#$

I would have sworn someone would have said the public option in the first 10 posts. Guess I didn't assume it'd be on the front page already and goofs like russpoter would've jumped in with his requests for impeachment.

Posted by: visionbrkr | April 9, 2010 3:44 PM | Report abuse

russpoter reminds me of a one-act "ironic" monologue play concocted as a senior project by a college student.

Posted by: MosBen | April 9, 2010 4:41 PM | Report abuse

"I'd say that the biggest losers from the PPACA are the 22,000 children in Arizona and the 100,000 Tennessee residents who are now without health care due to the cuts the states had to make in order to comply with the PPACA."

This is awesome. Healthcare reform has now caused the economic downturn that started over two years ago. Way to go Socialists! What's next? Retroactively causing the Haitian earthquake?

Someone's been reading far too much McMegan for his own good.

Posted by: slag | April 9, 2010 4:54 PM | Report abuse

Ezra,

MassCare is melting down like Kyrgyzstan. Private insurers have STOPPED accepting new policies from individuals and small businesses because their latest rate proposal was rejected by Governor Patrick as being too expensive.

Are you going to blog about it?

Posted by: millionea7 | April 9, 2010 4:59 PM | Report abuse

Nice revisionism Ezra. Stupak is an honest man. He says he's retiring for personal reasons, after 18 years in the House. I believe him. I do not believe Michael Bennet or Nancy Pelosi when they point fingers at each other over the public option.

Posted by: bmull | April 9, 2010 5:13 PM | Report abuse

MosBen,

i still haven't seen him and msoja in the same place at the same time.

hmmmm.

Posted by: visionbrkr | April 9, 2010 5:37 PM | Report abuse

Ok... but where's the fallout for Lieberman?

Posted by: kejia32 | April 9, 2010 6:05 PM | Report abuse

He missed two: anyone on medicare.

anyone who pays taxes in a state with medicaid (oh, that's all 57 of them, right?)

Posted by: docwhocuts | April 9, 2010 6:45 PM | Report abuse

Bye, bye, Bart....you traitor! You deserve retirement! The Congress is better without you! Enjoy your Obamacare!

2010...WITHOUT DOUBT, VOTE THEM OUT!

visit: http://eclecticramblings.wordpress.com

Posted by: my4653 | April 9, 2010 9:07 PM | Report abuse

What were Warner's serious concerns, and how were they addressed... asked a previous poster. Indeed. There were none, and none were addressed. Those with "concerns" either did what they were told, remained silent and were steamrollered, or they wound up like Stupak.

Posted by: truck1 | April 10, 2010 4:02 AM | Report abuse

"The old model in which moderate Democrats justify their vote for a bill by talking trash about it until they get bought off doesn't work in an environment where the media and the political opposition is waiting to pounce on the buy-off."

Good! If there's one thing John Kerry ever contributed to the Democratic Party, it's putting the nail in the coffin of the idea that you can take a political position based on pure expedience one minute and then flat-out run against it the next. You can't "vote against it before you vote for it" anymore, and that's a very positive development. Hopefully Stupak and Nelson's experience will underscore the point -- you need to pick your side early and stick with it.

Posted by: NS12345 | April 10, 2010 6:15 AM | Report abuse

I entirely agree. What gets overlooked too often is that Stupak wasn't just voting yes or no, he was threatening to filibuster with the opposing party, to stop a vote from being taken on the issue.

No Democrat should work with him as a Democrat after that.

Having Democrats elected in conservative areas is a good thing. Having them walk all over you blatantly, and get away with it, that's not good.

Posted by: BillEPilgrim | April 10, 2010 9:49 AM | Report abuse

NS12345

Kerry's vote was on two different versions of a bill, and it wasn't because of political expediency, it was because of differences in the bill.

You bought the Republican noise machine line, hook and sinker.

Kerry's weakness was in speaking, he made a muddle of many things he tried to say. Maybe because of that he should rightfully have been denied the Presidency, but to claim that it was because the right wingers were right that he was a "waffler" is nonsense.

Posted by: BillEPilgrim | April 10, 2010 9:54 AM | Report abuse

Ok... but where's the fallout for Lieberman?

Posted by: kejia32

======================================

trust me, lpezoe tortureman's comeuppance is in the mail

with a 2012 delivery date

senator joezoe (party of one) might as well have an expiration date on his congressional parking permit

Posted by: nada85484 | April 11, 2010 12:42 AM | Report abuse

Nice ghoulish article … very fitting for the season and impressively damn interesting.

http://www.bankruptcyattorneyincalifornia.com/

Posted by: brownhelen124 | April 12, 2010 2:33 AM | Report abuse

The difference between Nelson and Stupak is that Nelson used his position to get pork for Nebraska, but Stupak used his position to get a ban on federal funding on abortion, which is what he said he was seeking all along. Nelson didn't argue for the "Cornhusker kickback" in public, while Stupak very publicly argued for the pro-life cause. Nelson was not honorable here, Stupak was.

Posted by: LifeDemocrat | April 12, 2010 2:24 PM | Report abuse

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