Health Care Reform: The Political Surprise of the Year?


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.

Health care's passage shows exactly how small the target is for any future Obama initiative, from cap-and-trade to financial reform. With no room for bipartisan compromise, and also no room to tell Joe Lieberman what everyone surely wants to tell Lieberman, the path forward is hard to see. As long as Republican opposition holds, even with the occasional press-release exception such as Sen. Lindsay Graham on cap-and-trade, there will be no room to the right and even less room to the left.


Schmitt's right: It's a fallen state of affairs. It's also worth noting that Senator Roland Burris of Illinois got a congratulatory call from the White House after the bill prevailed. Beyond the awkwardness of Obama phoning the man who took his Senate seat in a shroud of controversy, Burris represents both a hopeful exception and a sad confirmation of the rules of politics in Washington—where incumbency corrupts, and clubby kickbacks (of the sort Nebraska Senator Ben Nelson arranged for his state in exchange for his vote) are de rigeur.

Burris is no Barack Obama. He's also no Harry Reid, Max Baucus, Ron Wyden, Chuck Schumer, Chris Dodd, or any of the other powerful Senators and committee chairmen Obama also called on Christmas Eve. The Root has kept tabs on Burris' leadership, however, during the thorny months of debate. And the accidental senator has been most effective because he is least respected—96th in seniority and seen (as Jeff Toobin documented in his profile for The New Yorker) as a bit of a Democratic embarrassment. With little to lose, Burris came out swinging this fall, for accountability and a strong "public option"—with others, pushing the bill leftward as a result. In this respect Burris is similar to, for example, retiring Senator John Warner of Virginia, who chose his conscience over poll numbers—cosponsoring key environmental legislation last summer—only when he had decided not to run for reelection in 2008.


Burris work improved the legislation—a fact about which even president Obama, making calls this morning, had no doubt. One hopes similar political surprises will be forthcoming in 2010.


Covers the White House and Washington for The Root. Follow her on Twitter.