Healthcare's Future

| Tue Jan. 19, 2010 2:40 PM EST

In an attempt to retain my sanity, I'm trying not to blog too much about the Massachusetts Senate race. There are just too many people to be angry at for contributing to a possible Scott Brown win, and I'm not looking forward to the feeding frenzy of recriminations that's likely to start tearing apart the liberal coalition if it happens. But on a related subject, what Josh Marshall says here is too important to ignore:

If Brown wins, I don't think it makes sense to continue the negotiations or trying to pass a bill through the senate prior to seating Brown. The House simply needs to pass the senate bill without revisions....For the House liberals, it was clear that only very limited revisions were going to be gained in the House-Senate negotiations. It's one thing if someone wasn't going to vote for the final bill at all. But if they were, the differences between the senate bill and whatever the negotiation was going to produce simply were not going to be big enough — not remotely — to justify voting against it.

For the conservative Dems, if they already voted for the more liberal House bill, it won't help them a wink to refuse to vote for the senate bill now — whether that means casting a no vote or just preventing it from coming up for a vote at all. This should be obvious to anyone who knows how 30 second TV ads work (or frankly, even how very reasonable political argument works). And the lesson of 1994 is clear: the folks who killed health care in 1994 didn't gain any benefit from it. They were the ones who got slaughtered in November.

Let me hazard a prediction. If the Dems push through this bill now, bank the accomplish and move on to selling it and working the jobs agenda, it'll be a bad but not terrible November. If they all run to ground after a Brown victory, it's really all bets are off. Why? Because this is about meta-politics. There are all sorts of reasons for the troubles the Dems are now having. They're overwhelmingly linked to the catastrophically bad economy — whether that's because of 10% unemployment, the spending that has been required to keep the economy from slipping into a Depression, the bailouts of the banks etc. But the key reason, the ones the Dems have some control over, is their ability to act and deliver on an agenda.

Obviously I have a dog in this fight: unlike a lot of progressives who have rebelled against the current state of healthcare reform, I think it's gone about as well as could be realistically expected. It brings down insurance rates, expands Medicaid, offers the prospect of moderately priced insurance to tens of millions of the uninsured, forces insurers to take you on even if you have a chronic pre-existing condition, mandates minimum levels of coverage, and takes several small but important steps toward reducing the future growth of healthcare costs. Passing it would be a historic progressive victory, something that conservatives are keenly aware of even if liberals aren't. That's why they've pulled out all the stops to defeat it. They know perfectly well that it will inevitably lead to further progressive victories on healthcare, and they're determined to stop that first step from ever happening.

What's more, on a purely tactical level, Josh is right. The differences between the Senate bill and the likely compromise bill are minuscule. Those differences may have been worth fighting for, but they're nowhere near important enough to sink the entire bill over. Not by light years. If Brown wins and House Dems vote down the Senate bill in a fit of pique anyway, Republicans will have a huge victory, the media will be writing "center right nation" narratives all the way through November, Obama will be badly weakened, and Dems will go into the midterms in total disarray.

If the only option open to the House is to pass the Senate bill, they need to buck up and do it. It's good policy and good politics. Any other path would throw out decades of effort and court a midterm blowout of epic proportions. I still hope Coakley wins in Massachusetts, but if she doesn't it's time for everyone to stand up and be counted. One way or another, pass the damn bill.

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