For a party that seemed moribund just a few years ago, the Democrats have shown they have a big, and fractious, coalition. All the really important arguments over the last year occurred within the Democratic Party, but who were the winners and losers?
One of the most striking realizations for me was that the pro-life wing of the Democratic Party has a lot of pull. Until recently, I never realized there were pro-life Democrats. The caricature of liberals during the Bush era was that of a tiny, coastal, cosmopolitan elite for whom Roe v. Wade was the Magna Carta of sexual freedom. Little did I know that Bart Stupak was lurking in the shadows waiting to make our lives miserable and wage jihad against women's reproductive rights. Nor did I realize that Democratic leaders would roll over to the demands of a few Midwestern social conservatives in order to get a bill done, while negotiating serious concessions to the pharmaceutical industry, unions, and so forth.
Clearly the labor movement has done its best to influence the process, despite not getting everything it wants. Indeed, the AFL-CIO seems to have put its broad commitment to social welfare over the interests of its dues-paying members. It's hard to see the upside for union workers who will see a new tax levied on the costly insurance plans they have fought so hard to win from employers. This is the so-called "Cadillac tax," which is meant to curb the inflation of healthcare costs by discouraging generous insurance plans that lead patients to use medical services inefficiently. This tax has been pushed off into the future, such that it may never even go into effect, and perhaps it will not make a big difference in any case. But it is interesting to see Richard Trumka threatening Democratic legislators who waffled on supporting the healthcare bill, when part of the bill is a slap to the benefits that are the hallmark of union membership for many workers. In order to provide subsidies and assistance for millions of Americans who don't have good union jobs, the movement was willing to make sacrifices and deal.
Much has been made of the odious and illogical concessions that the Senate had to make to get Blanche Lincoln, Ben Nelson, and a bunch of other prima donnas on board for the crucial Christmas Eve Senate vote that made this all possible. As bad as the "Cornhusker Kickback" and the "Louisiana Purchase" were, they were the ultimate fig leaves -- providing just enough cover for Lincoln to vote for the bill, and quickly discarded by the House and Senate (one hopes) through the reconciliation process.
But much bigger compromises are much more telling. The fact that President Obama worked out a truce with the pharmaceutical industry from the beginning, and promised not to do much of anything with reform that would hurt their bottom line, gives you an idea of who really has power. Cheaper drugs will not be imported from Canada, due to some bogus concerns about "safety," and the sanctity of the industry's monopolistic property rights will be insured for the foreseeable future. The deal gave Obama the political room to pursue reform without waging war with the Tea Party, the insurance companies, and Big Pharma, but it is interesting to see which interest groups were placated and which were not.
Progressives, in contrast, were not to be compromised with. The likes of Joe Lieberman, to say nothing of the actual GOP, never showed the slightest recognition that they should actually negotiate with the party's left flank -- Lincoln and Lieberman and company simply did not consider meeting progressives halfway on the public option, despite Harry Reid's heroic efforts to work out some sort of half-measure, like an opt-in, opt-out, state-by-state coop-based kind-of sort-of public option (some restrictions may apply). In retrospect, I think progressives held the line against further watering down of the bill by conservative Democrats, but they could do little more than this.
The American Medical Association, the hospitals, even the Catholic nuns got on board for this reform. Thanks to the media's facile obsession with "bipartisanship," little attention has been paid to the substantial compromises that Obama and the Democrats worked out with this legislation -- the fact that a lot of interested parties and stakeholders in the existing system were persuaded to support reform. In the long term, the nitpicky nitty gritty about doughnut holes and gatorade will fade from memory, and we'll be able to see this from the enlarged perspective that one would have liked to have seen from Democratic lawmakers over the last year.
How will this legislative victory be understood fifteen years from now? As a sign of Obama and Pelosi's ability to build consensus, despite wrestling with the most emotional and explosive issues around? Will the dynamic duo finally get some props for LBJ-like negotiating skills? Or will it be seen as a fateful overreach, which consigns dozens of Democrats to the unemployment lines this Fall? Liberals are hopeful their reform will become a bulwark of American social policy like Medicare or Social Security, while conservatives will frame it as costly social experiment that taxes the middle class for the benefit of the poor, like the War on Poverty. No one knows whether this big, complicated bill will do anything to slow the rise of red ink in the federal budget or shorten the unemployment lines, no matter how many soothing scores the Congressional Budget Office can produce.
Perhaps George W. Bush will ultimately get the most credit for this landmark legislation. If Dubya had not so thoroughly screwed up the country in every conceivable way, we probably would not have elected enough Democrats to push healthcare reform over the line by just a few votes.