Assuming that the health-reform struggle culminates in a dramatic, down-to-the-wire House roll call that enacts the bill, history will record not only a landmark achievement but the names of those who did the most to pass it or block it. What follows is a first draft, a list of the heroes and the villains of this final battle.

It comes with two caveats.

First, I recognize that the opponents don't view themselves as villains, but neither did the die-hards who waged a last-ditch battle against Social Security and—surprise—traduced it as "socialism." The measure of their status is that today they wouldn’t want to be remembered for their obstruction.

Second, there are heroes already gone—that great Republican President Theodore Roosevelt, who first proposed the "Bolshevik" idea of national health coverage, and Harry Truman, who sought to realize it in the 1940s over the bitter scare tactics of the American Medical Association (which has switched sides this time). Whatever his motives, even Richard Nixon gets an honorable mention—to use a word rarely applied to him—for negotiating with Ted Kennedy on a national health deal before this talented and twisted president was blown out of the Oval Office by the winds of Watergate.

Kennedy carried the cause for four decades. His towering presence, and his loss, have loomed over this debate. He played a pivotal role in nominating the president who, probably alone among his rivals, was willing and able to see the struggle through to success.  

And that's why, among those who are alive to celebrate the victory, Barack Obama holds the highest place.


1. President Obama relied on the long game, disdaining counsel to go for something small and safe, and refusing to turn in the face of a political firestorm. His performance wasn't perfect, but he has been steadfast, and he's now headed for a defining moment—for the nation and his presidency. Like FDR with Social Security, Obama's name will be indelibly associated with one of the great steps forward for social justice in American history.

2. Nancy Pelosi, whom Republicans and tea-baggers love to hate, has earned their enmity. As speaker of the House, she has ably led, cajoled, and juggled the shifting coalitions of a fractious party, and appears on the verge of corralling enough votes to get the job done. She was told there was no way the House would ever pass the Senate bill while waiting for the Senate to pass reconciliation. But she found a way when she had to. Pelosi no doubt would prefer to avoid the arcane parliamentary maneuver by which the House can "deem and pass" the Senate legislation. Better a straight up or down vote, for which some House Democrats would have to swallow their pride. Pelosi may get there yet, but it's a manifestation of her legislative mastery that she has another route in reserve. She's been indispensable.

3. House progressives are proving to be bigger than the fine points of their ideology. Pro-choice members have decided to live with the Senate prohibition on public funding for abortion. Almost to a person, indeed to a Kucinich, the advocates of single-payer and a public option have agreed to settle—for now—for something less. For their effort, they're being criticized by the purist fringe of the Left blogosphere, which has become a Republican pawn fighting progress. Fortunately, most House progressives are voting for it.

4. Sen. Bob Casey, Democrat of Pennsylvania, has been an unsung hero. As a political consultant, I was honored to work for his election—and before that for his father, who was governor of the state. I’ve always disagreed with the adamant opposition of both father and son to abortion rights. But in the health-care fight, Sen. Casey has been both true to his convictions and effective. He helped fashion the Senate amendment that denies public money for abortion without angling to use health reform to achieve a backdoor ban on the procedure. Now, the Catholic Hospital Association and a group representing more than 60,000 Catholic nuns have publicly endorsed reform—despite the machinations of the Catholic bishops. Casey helped make that possible with his imprimatur.

5. Mitt Romney. The former governor of Massachusetts is an unwilling hero who would surely turn this Shrummie Award down. Before he took up kowtowing to the far Right—an unconvincing exercise that may nonetheless earn him a GOP presidential nomination, albeit one even more thankless and morally bankrupt than the last—Romney worked closely with Ted Kennedy and other Democrats to enact a statewide health plan that's a model for Obama's reform. Due to the deep and disfiguring perversity of contemporary conservatism, this admirable achievement is now excruciatingly embarrassing to Romney. Yet for demonstrating Obamacare’s feasibility and effectiveness, I say, thanks, Mitt.


1. A tie between the Senate and House Republican Leaders, Mitch McConnell and John Boehner. McConnell has confessed that he plotted total opposition to reform before he even knew what was in the bill. (Given the GOP’s indifference to policy, he may still not know.) Along with the bronze Boehner, a coconut-butter poltergeist of Newt Gingrich, McConnell keeps a teapot of lies at the ready. The latest is the claim that Pelosi’s "deem and pass" parliamentary maneuver is unconstitutional. (I guess Boehner violated his oath of office when he repeatedly voted for it in the past.) McConnell’s effort to paralyze the Senate will get ugly before it ultimately fails. It’s remarkable, however, to think that his position was once held by Illinois Sen. Everett Dirksen, who in pursuit of the national interest helped JFK ratify the Nuclear Test Ban Treaty and helped LBJ pass the Civil Rights and Voting Rights Acts. Dirksen had a congressional office building named in his honor. McConnell and Boehner won’t.

2. Chuck Grassley. The dour, duplicitous senator from Iowa pretended to be bargaining with his earnest Democratic colleague Max Baucus, then suddenly turned and denounced the "death panels" that were never in the bill. It was a lie, and Grassley knew it was a lie. After three decades as a U.S. senator, he cowered before the wing nuts, assuring them that he, too, could see the world is truly flat.

3. The MINOWs—Moderates in Name Only Whiners. Republican Sen. Olympia Snowe and her sidekick from Maine, Susan Collins, along with a few House members, run to the middle in elections, but complain their way to the Right on most votes. They flirt with bipartisanship and one or two may even support a stimulus package to rescue the economy. But on health care, they descended into the party-line ditch. You can throw in the “maverick” John McCain here, too. Pandering his way to renomination in Arizona, he’s marched in hard-line lockstep, nursing his childish animosity toward the president who defeated him every step of the way.

Some of the Blue Dog Democrats have riled liberals, but they are ready to vote for reform despite the political peril of the midterms. They deserve at least footnotes in a new edition of Profiles in Courage. Snowe, McCain, et al. belong in a different book.

4. Bart Stupak is the somewhat Democratic congressman from Michigan who contrived the original House legislation’s backdoor attempt to outlaw abortion. He's refused all rational compromise, even insisting, falsely, that the Senate alternative pays for abortion. The Democratic Party should have room for pro-life senators and representatives—and to its credit, it does. But Stupak’s “pro-life” moniker is a mockery; he nearly destroyed a bill that will save lives and improve the health of millions of Americans.

5. I am reserving one last dishonorable spot in the event enough Democrats desert to defeat reform. I don't believe it will happen. If I'm wrong, progressives ought to single out the vulnerable turncoats and recruit and fund primary challengers. Democrats who can't stand up for health care as a fundamental right don't stand for much other than their own slippery hold on political office.

Barack Obama, who just canceled his Asia trip for a second time, is all in. We haven't witnessed presidential leadership this bold, persistent, and far-reaching since Ronald Reagan. But long after Obama signs this hard-won legislation, with the spirits of TR, FDR, Truman, and Ted Kennedy in the room, history will recount its heroes and villains.

NOTE: I understand comments, which were down due to’s redesign, are due back as soon as today. If comments are functional, I’d love to know who your nominees for Heroes and Skunks are. Who should be remembered?