Why Democrats Deserve a Pat on the Back for The Health Care Bill


The Senate has voted to vote on health care reform. Reactions to the series of late-night, last-minute votes that should, if Senate Majority Leader Harry Reid has his way, result in that chamber’s passage of a health care reform bill by Christmas Day, has been mixed. On the one hand, progressives are mad (really mad) at Senator Joe Lieberman and the assorted centrists who have watered down what they consider to be key provisions of the bill. On the other hand, relieved lawmakers (including the White House) are just happy that Barack Obama hasn’t had to renege on his summer swagger, which promised the nation “we will get this done this year.” Of course, the bill, yet unpassed, is by no means final (it will have to be reconciled with the version that the House of Representatives passed in late October), but there is hope for both camps in what the Senate got done this weekend.

For black Americans, the bill should provide long-term peace of mind. Health disparities and barriers to access have long plagued the community (for more, read Kai Wright’s excellent précis on just what African Americans are fighting for). The years of failure to reform the system has cost countless lives. “Real people are going bankrupt, losing their homes and even dying for real health care reform in this country,” says Ben Jealous, President of the NAACP. Groups like La Raza, the Campaign for Community Change, the Leadership Council on Civil Rights and Health Care for America Now have all made similar statements about what health care reform means to communities of color. The legislation’s universal mandate, generous subsidies for low-income Americans, insurance industry reforms and—most importantly—cost control mechanisms, which physician Atul Gawande documents in fine detail in a recent issue of the New Yorker, should make a significant impact in that troublesome status quo:

At the current rate of increase, the cost of family insurance will reach twenty-seven thousand dollars or more in a decade, taking more than a fifth of every dollar that people earn. Businesses will see their health-coverage expenses rise from ten per cent of total labor costs to seventeen per cent. Health-care spending will essentially devour all our future wage increases and economic growth. State budget costs for health care will more than double, and Medicare will run out of money in just eight years. The cost problem, people have come to realize, threatens not just our prosperity but our solvency.


Those problems are not gone. But they will be smaller problems, thanks to the committed work of lawmakers who dragged the bill thisclose to the finish line. In short, these reforms will positively affect the health and wealth of all Americans, particularly the minority population that is significantly more likely than non-Hispanic whites to be uninsured.

As for the politics of the bill: Right-wing critiques of the legislation range from skepticism that costs can be contained to apoplectic reaction to what’s seen as the creation of massive new system of "socialist" entitlements. Compared with Bush 43 administration policy on Medicare, such critiques are, as Eric Alterman points out at the Center for American Progress, fairly hypocritical:

[Medicare Advantage, passed in 2003] handed over massive subsidies of literally billions of taxpayer dollars to global corporations while allowing overall medical costs to rise and at the same time shielding Medicare customers from real prices. What’s more, for all of the conservative complaints about the “process” through which the president and congressional leaders have sought to achieve passage of the bill, the Medicare legislation set new records for abusive [sic] of minority rights.

Democrats, elected in large numbers in 2006 and 2008 in order to change the way government interacts with American citizens, can proudly say they are in the majority here—not just in Washington, but in terms of public sentiment about the need for better health care delivery.

Why is it important that Democrats have stood firm on passing a health care bill, however flawed? At The New Republic, Jonathan Chait makes the good point that if Republicans had been more willing to engage with the health care debate in good faith, we might today see a significantly more conservative legislation with a dramatically smaller budget. So Democratic ownership of this bill has been key to pushing the legislation as far left as has been politically palatable. And, while even Obama might not go so far as to call the compromise bill “sexy” (that praise he reserved for home weatherization), it is no doubt a significant and worthwhile attempt to reform the health care delivery system in the U.S.

Personally, I’m skeptical that the political capital that Obama has enjoyed in the first year of his presidency was well-spent on health care reform. The vicissitudes of a partisan Washington and a recession-shocked public almost guarantee that what benefit Americans will eventually derive from this bill comes at a political cost to Democrats in next year’s midterm elections.

Ezra Klein, however, who has been doing yeoman’s work all year to simplify arguments and advocate for the best possible version of a health care bill, offered some comforting analysis about the likelihood that the legislation will only get better:

[Section 1332 of the Senate bill] allows states to wiggle out of the consequences of those imperfections. Rather than having to go back through the Congress and the Senate to change a part of the bill, a state that finds the bill’s language inefficient for achieving the bill’s goals can simply petition the secretary of Health and Human Services for a waiver. No new legislation needed. No filibusters or holds to evade. No national agenda to contend with.

The law for the law of unintended consequences is also an important reminder that this bill represents the beginning, rather than the end, of health-care reform. “I am not the first president to take up this cause,” Obama said back in September, “but I am determined to be the last.” He will not be the last, or even close to it.


So to those progressives, myself included, who have been disappointed with the demise of the “public option” and other compromises contained in the final version of the health care bill, it’s important to remember that this will be a victory for Democrats and, as Obama said this weekend, a “genuine reform that offers security to those who have health insurance and affordable options to those for do not.”

I can live with that.


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