Looking Back: How health reform passed

The cooler days of September have brought no change in the heated political weather. The stakes in the battle of health reform are too high to permit a cooling off, whatever the president may wish for. The outcome will be politically and historically decisive—for the Obama presidency and for both political parties. So let’s look past the arguments of the moment to a vantage point a few months ahead, when the commentators, many of whom today doubt it will happen, offer their explanations for Obama’s victory.

Here’s mine.

For Obama, there was no substitute for victory. He stayed the course—did whatever he had to and was ready to settle for a narrow partisan margin—because the alternative was a descent into a Clintonesque, post-1994 presidency, in which defeat on health care led to shattered authority, a lost Congress, and major initiatives that were impossible, impassable, or generated by political opponents.

Subscribe to The Week

Escape your echo chamber. Get the facts behind the news, plus analysis from multiple perspectives.

SUBSCRIBE & SAVE

Sign up for The Week's Free Newsletters

From our morning news briefing to a weekly Good News Newsletter, get the best of The Week delivered directly to your inbox.

From our morning news briefing to a weekly Good News Newsletter, get the best of The Week delivered directly to your inbox.

Sign up

Obama understood that as economic recovery takes hold, he will almost certainly be re-elected regardless of the outcome on health reform. Like Clinton, he could even have chosen to put the issue behind him. But Obama didn’t become president to do small things; he was thinking not just of a term in office but of a time of transformation. He brushed off the concerns that he wasn’t emotionally connecting with people, along with the polls showing he was taking on political water. He kept his eyes on the prize, confident that, no matter how hard-won, success on health reform would mean momentum for the rest of his far-reaching program. Without a health bill, for example, there would have been no prospect of big steps on energy and climate change. Obama would have been consigned to a shadow presidency. He knew he had to prevail—and he did.

Democrats, too, could read history and were determined not to repeat it. They hadn’t acted as an effective governing party since the mid-1960s; unlike Republicans, they’ve regularly abandoned presidents of their own party on signature proposals—Carter on energy, Clinton on health care. The breaks represented a political calculation to assure their own electoral survival. Both times this was a miscalculation; in 1994, when Republicans swept to control of Congress, the most prominent victims included the most self-consciously "moderate" Democrats who had conspicuously separated themselves from Clinton on health care. They were punished at the polls for his failure.

Knowing this, Obama gave the Democratic "Blue Dogs" room to object to reform proposals, and the chance to claim subsequently that their qualms had been addressed. This was the real aim—and genius—of his ostensibly bipartisan negotiations. The Blue Dogs might not have been enthused about walking the plank on health reform with him, but they preferred that to the threat of another Gingrich Revolution decimating their ranks and dooming their committee chairmanships.

Progressive Democrats, the other half of Obama’s winning equation, had to face the same reality. They could have insisted on a purist approach, which they threatened even as September dawned. But they ultimately realized they didn’t have the votes and, in the end, they couldn’t bring themselves to kill reform. They couldn’t secure a full-blown public option—which, as important as it may be, is properly understood by too few Americans and is misunderstood by too many as "socialized medicine." The progressives considered lesser options to ensure competition and hold down costs, including creation of effective co-ops and a mechanism for triggering a public option in the event costs continue to soar. Following Ted Kennedy’s final lead, they opted for legislation that was less than perfect, with the understanding, in Kennedy’s phrase, that they "can adjust and improve the program next year or in the years to come."

While progressives were unwilling to kill reform, the Republicans embraced that role, partly out of instinct, partly out of ideology, partly because they were simply too far down the tea-bag path of paranoid negativism to turn back. Only the moderate remnant, the two Republican senators from Maine, threatened to breach the GOP's wall of implacable opposition. The GOP "negotiators" on the Senate Finance Committee talked sensibly behind closed doors with Democratic counterparts and then went public parroting Rush Limbaugh and Glenn Beck. The party whose members had repeatedly resorted to the filibuster-proof process of reconciliation to push Reagan and Bush legislation through the Senate, hypocritically denounced the process as undemocratic. (Perhaps they meant it was only supposed to be used by Republicans.)

Where do things stand afterwards? First, Republicans are now hoping against hope for a non-recovery, a slow recovery, or a jobless recovery. But it's a long, long way from this September to next November; by then, the odds are that both economic performance and the public perception of Americans going back to work will be working for Obama and the Democrats. The Congressional Republicans, by contrast, will be viewed as both the anti-prosperity and the anti-health-care party. After clinging to their default position of "no" on climate and energy policy, they will lose again in 2010. It will probably take several more elections before they modulate and moderate—and face the prospect that they must accommodate somehow to the Obama era.

Politics isn’t everything. As the Obama plan phases in, nearly 50 million Americans will gain health insurance—and all Americans will find that their insurance is more affordable, more portable, and that it can’t be cancelled when you get sick and need it most.

That achievement ranks with the creation of Social Security and guarantees Obama’s standing as a redefining political force in America. The consequences of the passage of health reform include a Democratic Party that has come through the fire tempered and ready for 2010 and 2012, and a Republican Party that could become more isolated than it has been since the mid-1930s.

That’s not the way the story’s written in the first week of September. But that’s how it will be. To paraphrase Theodore H. White, that’s my retrospect on tomorrow’s future.