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Who passed health-care reform?

healthsigning.JPG

Sam Stein's long look at the way the Obama campaign informed the Obama administration's approach to health-care reform is a very sharp piece of reporting, and worth a read. It suffers, I think, from the tendency to explain major legislative initiatives from the perspective of the president, which is an important perspective, but can diminish the roles played by congressional leadership and individual legislators.

In particular, the individual legislators tend to get left out of this story. But what was remarkable about health-care reform was how many Democrats wanted to vote for it. That basic desire to see the bill passed persisted through conservative pressure, grim polls, Scott Brown's election, painful compromises, and much more. And at the end of the day, even the holdouts seemed to want the bill passed: Conservatives like Ben Nelson and Bart Stupak and Mary Landrieu and many others were willing to cut the deal so they could vote for the bill. The bill wasn't exactly a political winner for any of them, but when it came down to it, they said "aye." Liberals like Anthony Weiner and Bernie Sanders were willing to accept a "compromise of a compromise of a compromise of a compromise."

The White House gets some credit for brokering those deals. Congressional leadership gets even more. But none of it would have been possible if elected Democrats didn't actually want to get health-care reform done. In that sense, the past 20 years of organizing and arguing worked. Health-care reform was so core to the identity of most Democrats that they stuck with the bill long after they would've let another priority die. If you want to see how it looks on the other side, check out climate change, where a lot of Democrats who are nominally in support of action on the issue seem totally disinterested in sticking their necks out on it, at least right now.

Photo credit: Marvin Joseph /The Washington Post.

By Ezra Klein  |  May 13, 2010; 2:11 PM ET
 
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Comments

Their necks go out in direct proportion to the amount of political capital and presidential muscle Obama is willing to use. Obama was totally committed to passing HCR, so in the end the troops fell in behind him, despite the bills many flaws.

Will we see the same level of commitment from Obama on Fin reg, immigration or energy/climate? Inquiring minds want to know....

Posted by: srw3 | May 13, 2010 2:28 PM | Report abuse

Another thought not mentioned is how every option (over the last 3 passes at HCR) that Republicans could "stomach" ended up being where Dems would start their process.

At that rate if it didn't pass this time I'm thinking the next go round in 2025 would have started with Dems begging for vouchers. I wonder how much that aspect of it affected liberal dems willingness not to let the perfect be the enemy of the good.

Posted by: visionbrkr | May 13, 2010 2:32 PM | Report abuse

@vb: HCR = good for you? I mostly remember you taking potshots from the cheap seats in that debate.

Posted by: srw3 | May 13, 2010 2:37 PM | Report abuse

srw3,

good for me? SURE. If the government was going to subsidize your industry wouldn't it be good for you?

Is it the "best thing for the country" (ie me the taxpayer) NO.

Again. COST CONTROLS. Not nearly enough.


And the only potshots I took was trying to make sure the truth was understood about the current healthcare system because most don't get the true cost drivers (DOCTORS!!!) and the complaints I had were about the weakness of the individual mandate (which is OK for me once i understood it to be the GREATER of 2.5% of AGI). I'm also not a fan of the employer portion because I worry a bit about employee dumping on the exchange and hope it won't be too common and if it starts to happen I hope they take steps to ensure it won't continue.

But overall as I've ALWAYS said its light years better than the status quo WAS. They should have done this in 1994 or earlier.

Posted by: visionbrkr | May 13, 2010 2:46 PM | Report abuse

In hindsight, regarding Obama's strategy - did he adapt well at the end of the process, have a good master plan all along, or did he get lucky?

Posted by: jduptonma | May 13, 2010 3:09 PM | Report abuse

@vb: I think we agree that there are insufficient cost controls.

true cost drivers (DOCTORS!!!)

I think you need to include drug and medical device manufacturers and for profit hospitals and doctor owned "surgery centers." Insurers that skim of 20% for "administrative costs", which I assume includes advertising, bribing oh, I mean lobbying officials, and obscene executive salaries don't improve the cost structure of health care.

Still, I am happy that you mostly approve of HCR.

Posted by: srw3 | May 13, 2010 3:45 PM | Report abuse

@vb: I think we agree that there are insufficient cost controls.

true cost drivers (DOCTORS!!!)

I think you need to include drug and medical device manufacturers and for profit hospitals and doctor owned "surgery centers." Insurers that skim of 20% for "administrative costs", which I assume includes advertising, bribing oh, I mean lobbying officials, and obscene executive salaries don't improve the cost structure of health care.

Still, I am happy that you mostly approve of HCR.

Posted by: srw3 | May 13, 2010 4:02 PM | Report abuse

Obama did nothing while Baucus (remember him?) allowed himself to be slow-rolled for months and months. Then Obama let the public option die by doing nothing to save it. Then the adminstration was completely blind-sided by the teabaggers and had no plan to counter them. Then they blew the Massachusetts special election, taking the voters completely for granted. Then, after Scott Brown got elected, Obama and Emmanuel tried to tip-toe away from health care as if it were a dying man in the gutter that they had nothing to do with.

Reform got passed because too many Democrats had already voted for it and knew that they couldn't walk away. If it failed they would be hammered in the 2010 election. If anyone deserves credit, Pelosi does. Obama and his running dog Emmanuel desrve none.

Posted by: Bloix | May 13, 2010 4:26 PM | Report abuse

"what was remarkable about health-care reform was how many Democrats wanted to vote for it."

The key word in this sentence is "it", because "it" means many things to different Democrats. Some wanted a stronger bill. Some wanted a weaker bill. Very few actually "wanted" to vote for the mishmaash that eventually got passed.

Posted by: tomtildrum | May 13, 2010 4:35 PM | Report abuse

srw3,

yes I'm mostly for it but yes everyone you mention should have had their feet to the fire after they're given 30 million new patients (for docs, pharma, med device) and 15 million (insurers). I gave insurers only 15 million because half or so were going onto Medicaid something they don't see anything from.

And as I've said before I'd be much happier with Wyden/Bennett today but your friend Senator Kerry nixed that in the SFC hearing.

Posted by: visionbrkr | May 13, 2010 4:45 PM | Report abuse

"It suffers, I think, from the tendency to explain major legislative initiatives from the perspective of the president"

Well, duh, Sam Stein is the Huffington Post's White House reporter. He's not looking at the story from the WaPo's viewpoint, which many of us could say suffers by not looking at the story from the eyes of people who don't have insurance, as all of their employees are insured.

Perspective is in the eye of the beholder.

Posted by: jc263field | May 13, 2010 5:14 PM | Report abuse

I think it is pretty disingenuous to equate Weiner and Sanders to Nelson, Stupak and Landrieu. The last 3 pretty much got what they wanted added to the bill and then voted for it, I guess Sanders did get some of what he wanted but not all, but really Weiner is the only one who could really be said to have wanted to see the bill pass regardless, as he was the only one that didn;t get any condiments to cover the taste of the crap

Posted by: williamcross1 | May 13, 2010 5:27 PM | Report abuse

Who passed healthcare reform?

Why, Angela Braly, CEO of WellPoint of course. With all due respect to Pelosi, Reid and Obama, if Braly's bumblers hadn't chosen to seek 39-percent rate increases based on faulty math for some select few members of their California individual plans, HCR would have died.

I can't help but note that WellPoint, with all its individual and small-group business, and the weight of the "Blue" brand, stands to benefit the most from the reform package. I'm not a big believer in conspiracies, but I'm not a big believer in coincidences either.

Posted by: Rick00 | May 13, 2010 9:40 PM | Report abuse

I'll give an important share of the credit to Scott Brown.

Once Brown was elected, the Senate leadership was finally liberated from caring about getting 60 votes, and the reconciliation sidecar was drafted and passed with ease, giving us the huge bonus of college financial aid reform at the same time.

Thank YOU, Scott Brown!

Posted by: Patrick_M | May 13, 2010 10:54 PM | Report abuse

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