Health Care Reform: The Political Surprise of the Year?

This was never supposed to happen in the first place--Democratic presidents have tried and failed before to get health care done. So it is a bit of a Christmas miracle. Nevertheless, it has also showcased the hair-pulling politics of progressive reform.

In the wee hours of Christmas Eve, the United States Senate passed a health care reform bill—an achievement that, despite the months of controversy that preceded its passage, hasn’t been done, ever before. President Obama, rarely one to miss the historic nature of any political act, cheered the bill’s passage in remarks made just before he took off for his Hawaiian vacation:

Ever since Teddy Roosevelt first called for reform in 1912, seven Presidents—Democrats and Republicans alike—have taken up the cause of reform. Time and time again, such efforts have been blocked by special interest lobbyists who’ve perpetuated a status quo that works better for the insurance industry than it does for the American people. But with passage of reform bills in both the House and the Senate, we are now finally poised to deliver on the promise of real, meaningful health insurance reform that will bring additional security and stability to the American people….

As I’ve said before, these are not small reforms; these are big reforms. If passed, this will be the most important piece of social policy since the Social Security Act in the 1930s, and the most important reform of our health care system since Medicare passed in the 1960s.

Of course, the Patient Protection and Affordability Act of 2009 is not yet law. When Congress returns from its holiday recess, the Senate and House versions must be merged in conference committee before hitting the president’s desk. Democratic Party leadership and the White House have set a timeline for getting a final bill, scored by the Congressional Budget Office, signed by the president by February 2, the day of Obama’s State of the Union address, or shortly thereafter. For a great rundown of the keep points at issue—namely what to do about the House’s “public option”, Medicare buy-in, various restrictions on reproductive choice and the vicissitudes of an employer mandate—see TIME’s comprehensive assessment.

Additional reactions from Democrats and Republicans alike are pouring in. House Speaker Nancy Pelosi stood up for the more progressive bill she and the House Democratic caucus had passed in October:

We are proud of the House bill, which provides more affordable coverage for the middle class, covers 36 million currently uninsured Americans, begins health insurance reform in 2013, fully closes the prescription drug donut hole for seniors, mandates strong reforms of the insurance industry, and is fiscally responsible, cutting the deficit by $138 billion over 10 years.

Republican National Committee Chairman Michael Steele was harsher:

The Democrats have put a $2.5 trillion lump of coal in the stocking of every American knowing that their risky health care experiment still increases premiums, still cuts Medicare, and still enacts hundreds of billions of new taxes to pay for it. Scrooge would be proud.

We should remember that this bill was never supposed to happen in the first place–as Obama has noted, he is not the first to take up the challenge of health care reform. So even a centrist final product is a bit of a Christmas miracle. Nevertheless, it has also showcased the hair-pulling politics of progressive reform: Mark Schmitt, editor of the American Prospect, in an excellent essay on how progressives move forward from here, seems to nail the unfortunate political dynamics that handcuff both the conference negotiations and what follows for Obama.