The Politics of Passing Health Care

The meaning of the approaching final vote on health care has changed since the halcyon early days of the Obama presidency when progressives experienced a hope and optimism unheard of in recent decades. The final vote on health care was supposed to be a cause for celebration as a progressive goal going back at least half a century was finally to be realized. It was supposed to be the most significant piece of progressive domestic legislation in many of our lifetimes. All of that changed late last year when Obama compromised away the public option and the expanded Medicare proposal. The last minute efforts to reinsert the public option felt more like death spasms for that possibility, rather than a serious chance of reinvigorating the bill.

Now passing the health reform bill will be a moment to breathe a sigh of relief, not so much due to the highly questionable content of the bill itself, but because the nasty and seemingly never-ending debate will have finally ended and because the Obama administration will have survived the process, albeit barely.

It is too early to tell how this bill will affect the more than 45 million uninsured Americans. It is certainly possible that at least some of these people will move from being uninsured to being uninsured and in violation of the law because they cannot buy insurance. The bill may, in fact, make slight improvements for many people but it is unlikely that it will radically reform health care, solve the pressing problem of tens of millions of uninsured Americans or weaken the grip of the insurance companies on much of the health care sector.

Nonetheless, passing the bill remains important and will be a significant moment in the Obama presidency, but because of politics, not health care. The bill is deeply flawed; and those arguing that it can be reformed after it passes are letting hope triumph over evidence, but passing the bill is still necessary. If the bill fails, the Obama presidency will be that much closer to being unsalvageable. Unfortunately, passage of the bill will not be a major victory for the Obama presidency, but it will allow Obama to live to fight another day. That is reason enough, and perhaps the only real reason, why passage of this bill is important.

Should the bill pass in the next week or two, it will not be a time for progressives to celebrate, but it will also not be a victory for Glenn Beck, the Tea Partiers, Rush Limbaugh and other right-wing opponents of President Obama. Passing the bill will demonstrate that the Democrats can get something done in Washington, that given a majority in both houses of congress and control of the White House, the Democrats can push through some legislation. Simply demonstrating this is important because the evidence from the late 1970s, early 1990s and, yes, first fourteen months of the Obama administration suggests the Democratic Party is not able to pass legislation when they are in control in Washington, or to put it more succinctly, govern.

In the unlikely event the health care bill fails, the consequences for the administration, and for what is left of progressive hopes in Obama, will be grave. The President has now twice -- once at the end of last year, and once in the last ten days or so -- more or less guaranteed the passage of this bill and made it his top domestic priority. By raising the stakes in this way, Obama has put unique pressure on progressive Democrats who have expressed hesitancy about supporting the bill because it does not include a public option or anything like it. These people are well positioned to understand that failing to pass the bill again will confirm the views of Obama's detractors who see Obama's presidency as becoming akin to Jimmy Carter's without the cardigans or Bill Clinton's without the peace and prosperity, and would almost certainly lead to greater Republican victories in November. It would also provide more fodder for those who question the raison d'etre of the Democratic Party altogether.

Sadly, the potential damage done to the administration, the Democratic Party and progressive politics more broadly by the failure of this bill are not matched by a significant upside for passing the bill. Passing this bill will not lead to major progressive victories in November; nor will it spur this administration on to more victories. However, it will keep the door open for that possibility. At this time, keeping that door open may be the best for which we can hope.

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