HIGH DRAMA IN HEALTH CARE

March 25, 2010

Last Sunday's rush to passage of the health-care reform bill by the House of Representatives was an example of high drama you never thought happened in a place better known for droning diatribes made to an empty chamber. It was a parliamentary flurry of motions and amendments and scrupulously-timed speechlets and nail-biting votes. For those watching it on TV, the experience was positively exhilarating, a seldom-seen live civics lesson on how bills become laws, how your do-nothing Congress actually does something. It may have changed the minds of not a few young voters about the value of entering public service.
Another civics lesson, far beyond the scope of textbooks, was the way in which Speaker Nancy Pelosi and President Barack Obama marshaled their recalcitrant troops for the necessary 216 votes, an outcome quite uncertain just hours before.
To the surprise of almost everybody, they hauled in the two big fighting fish of totally different ideological species, single-payer proponent Dennis Kucinich and abortion opponent Bart Stupak, along with their respective schools.
Exactly how they did it may never be fully known. No smarmy sweeteners like those bestowed on certain Senators are yet evident; it appears to have been the result of fervent appeal to party loyalty, the promise that their respective objections would not go unheeded, and Obama's Voltairian mantra, "We cannot let the perfect be the enemy of the good." Whatever the tactics, it was a masterful display of the power of persuasion, Dale Carnegie on steroids.
Of all the high drama, swaying Stupak and his anti-abortion Democratic colleagues was certainly the highest. Long before Saturday's vote, this new little caucus, whose convictions had been excluded from the Democratic tent and platform for decades, became the makers or breakers of health-care legislation. They were no naïve fools, either, showing serpentine political acumen first in allying themselves with the Republican minority to block passage of last November's House bill unless highly restrictive language on abortion funding were included, and then in pulling the rug out from under them by going with their party at virtually the last minute on Sunday ("Baby killer!").
Stupak himself was the best of all. Last week, when the Network nuns defied their own bishops by coming out in favor of the bill, he enfuriated them by declaring that "on right-to-life issues, we don't call the nuns"; days later, he reversed positions and became their hero. Most interestingly, Stupak and Co. not only exhibited a flexibility seldom seen in the anti- abortion movement but forced flexibility from staunch abortion- rights advocates Pelosi and Obama. Both sides, for the time being at least, eschewed the perfect for the good.
Many more fascinating developments still lie ahead. The first is what enactment of this law will do to the fate of the Democrats in general and Democrat-in-Chief Obama in particular. Over the months, the public has expressed ambivalence at best and hostility at worst both to the legislation and to the legislative process itself. Republicans act convinced that they can still tap into fears of "socialized medicine" and fan a backlash to the majority party's parliamentary ploys; Democrats act convinced that once the law is on the books and people see its immediate effects, they'll come around to support it. We'll get a hard sell from both sides right through the November elections.
The second development is development; reforming the health-care system is a work in progress. Next week, Senate Republicans will try to thwart the House's "fixes" to the new law, then try to repeal it altogether; neither attempt is likely to succeed. Progressive Democrats will do the opposite, proposing gradual changes leading to what they've wanted all along, a sleek and seamless single-payer plan. Having a law in place may allow them to do what they couldn't do in committee; as with Medicare — initially indefensible but now indispensable — they believe that once people see government actually doing some good, they'll ask for even more of it.
As with much high drama, the denouement may be as exciting as the climax.