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Greenbeard

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We don't always think about counterfactuals. In the grand sweep of history, certain past events just start to (retrospectively) seem inevitable, even when they certainly weren't.

Odd as it may seem now, there was a time, back before 20 million people gained health insurance coverage, before medical bankruptcies were cut in half, before health cost growth slowed to come in line with economic growth and employers' health care cost growth plateaued and per capita Medicare costs started falling, before medical care and health for our most vulnerable began improving, before infant mortality started falling and cardiac arrests started decreasing and early cancer diagnoses rose, before hospitals started getting safer, before all that -- it wasn't at all a sure bet that comprehensive health care reform would ever be passed.

None of that was inevitable.

Back in January 2010 the question we all faced was: Does Brown's Senate Win Mean the End of Health Reform?

Obama, swayed by Rahm, and even the tenacious Harry Reid were considering tucking tail and curtailing their ambition: Obama, Dems Consider Pared-Back Health Care Bill.

Pelosi, on the other hand, in her weekly Speaker presser on 1/28/10 dismissed the small-ball strategy, famously vowing:

You go through the gate. If the gate's closed you go over the fence. If the fence is too high, we'll pole-vault in. If that doesn't work, we'll parachute in. But we are going to get healthcare reform passed for the American people.

And she did it. Despite Bart Stupak's quote in an article above that there weren't 100 votes in the caucus for reform in January 2010, in March 2010 she got 219 votes for it (including Stupak's), and then 220 for the reconciliation bill she engineered to improve the law and ensure House support. She did what 70 years of Democratic leadership couldn't.

The real hero of health care reform: Nancy Pelosi
That said, the ratification of healthcare is an even more impressive victory for House Speaker Nancy Pelosi. Faced with an endless litany of institutional roadblocks, false starts, egocentric members, and plain political pressures, Ms. Pelosi was able to wrangle together just enough votes to push reform to the finish line. It is Pelosi who deserves the most credit for seeing healthcare through.
And indeed, a comprehensive article in yesterday’s New York Times notes that after Scott Brown won, it was Pelosi who convinced Obama and her former deputy, White House Chief of Staff Rahm Emanuel, that pushing the full bill was the best course of action, scoffing at their desire to scale back the healthcare effort.

Pelosi was convinced she could get the votes, pragmatically telling the president: “We’ll never have a better majority in your presidency in numbers than we’ve got right now.” And Pelosi eagerly took on the duty of lobbying all of the tough Democratic votes herself.

And now all the outcomes above, on costs, on coverage, on care quality, on health system redesign, on improving outcomes, they've all come to pass. And the politics have shifted. Republicans just ran an entire campaign promising they'd never get rid of the part of the ACA that protects those with pre-existing conditions (lying through their teeth, of course, but still they now have to say it). The Dems, using a strategy devised by Nancy Pelosi, just had their best midterm election since Watergate, running a campaign laser-focused on health care.

Give her the gavel.
 

bearpoker

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We don't always think about counterfactuals. In the grand sweep of history, certain past events just start to (retrospectively) seem inevitable, even when they certainly weren't.

Odd as it may seem now, there was a time, back before 20 million people gained health insurance coverage, before medical bankruptcies were cut in half, before health cost growth slowed to come in line with economic growth and employers' health care cost growth plateaued and per capita Medicare costs started falling, before medical care and health for our most vulnerable began improving, before infant mortality started falling and cardiac arrests started decreasing and early cancer diagnoses rose, before hospitals started getting safer, before all that -- it wasn't at all a sure bet that comprehensive health care reform would ever be passed.

None of that was inevitable.

Back in January 2010 the question we all faced was: Does Brown's Senate Win Mean the End of Health Reform?

Obama, swayed by Rahm, and even the tenacious Harry Reid were considering tucking tail and curtailing their ambition: Obama, Dems Consider Pared-Back Health Care Bill.

Pelosi, on the other hand, in her weekly Speaker presser on 1/28/10 dismissed the small-ball strategy, famously vowing:



And she did it. Despite Bart Stupak's quote in an article above that there weren't 100 votes in the caucus for reform in January 2010, in March 2010 she got 219 votes for it (including Stupak's), and then 220 for the reconciliation bill she engineered to improve the law and ensure House support. She did what 70 years of Democratic leadership couldn't.

The real hero of health care reform: Nancy Pelosi



And now all the outcomes above, on costs, on coverage, on care quality, on health system redesign, on improving outcomes, they've all come to pass. And the politics have shifted. Republicans just ran an entire campaign promising they'd never get rid of the part of the ACA that protects those with pre-existing conditions (lying through their teeth, of course, but still they now have to say it). The Dems, using a strategy devised by Nancy Pelosi, just had their best midterm election since Watergate, running a campaign laser-focused on health care.

Give her the gavel.

AMEN Brother! I'm with you! Republicans hate her because they know she'll clean their clocks on a regular basis.
 
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Grokmaster

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ALL bankruptcies are down, primarily due to changes in bankruptcy law, and more people LOST THEIR INSURANCE and were forced to buy MRE EXPENSIVE insurance, than people who gained insurance.

We saw who's "clock got cleaned" the last time Ms."We Have To Pass It to See What's In It" was speaker...didn't we?

63 seats flipped.....blue to red.

Pelosi is the greatest vote getter for the GOP out there.
 

bearpoker

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ALL bankruptcies are down, primarily due to changes in bankruptcy law, and more people LOST THEIR INSURANCE and were forced to buy MRE EXPENSIVE insurance, than people who gained insurance.

We saw who's "clock got cleaned" the last time Ms."We Have To Pass It to See What's In It" was speaker...didn't we?

63 seats flipped.....blue to red.

Pelosi is the greatest vote getter for the GOP out there.

Don't worry. We'll flip them back. The only reason we didn't get them all this time was because of the aggressive gerrymandering. Which is totally ok by me. It'll take time to undo and go with nonpartisan commissions. After that, you guys will actually have to appeal to most of the voters again. Game on!
 

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Obama in January of 2010 said that Brown's election was a message from a troubled nation and that Democrats should listen to the discontent and rebuild the bridges they had let fall into disrepair.

Then he climbed on board with Pelosi's "the will of the people be damned" express, and he and Democrats have been paying for that ever since.



I understand the OP's point. Because Democrats bulled through their "we know better than you what is good for you" policies, and with the help of lies and a complicit media they got to delay full accountability until after the 2012 elections, Pelosi did indeed help change the expectations of the nation. Now more people consider parts of Obamacare a right and don't want it taken away.

But IF Obama had followed the path he knew he needed to take, and if he had brought Pelosi along with him, this nation would have been a much better, less bitter place. There might not have been a shellacking in 2010 or the GOP takeover of the Senate in 2014. Obama and Pelosi were as big of factors in giving us President Trump as Hillary and Trump himself were.
 
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Greenbeard

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Then he climbed on board with Pelosi's "the will of the people be damned" express, and he and Democrats have been paying for that ever since.

Obama was re-elected and the Dems just won the House on a health care message.

Meanwhile, tens of millions of people gained health insurance coverage, health cost growth stalled, quality improved, people's health got better, and the care delivery system continues to improve. Worth the pettiness of the repeal crowd? Clearly.

But IF Obama had followed the path he knew he needed to take, and if he had brought Pelosi along with him, this nation would have been a much better, less bitter place. There might not have been a shellacking in 2010 or the GOP takeover of the Senate in 2014. Obama and Pelosi were as big of factors in giving us President Trump as Hillary and Trump himself were.

That's an incredibly naïve view. Putting aside the absurdity of the claim that the nation would be better off with 20 million fewer people insured and the pre-ACA cost trends and quality performance, the ACA was not the first piece of legislation the Dem majority tackled. With the economy collapsing, only three Republicans voted for an economic rescue package (and one of them later had to switch parties). There was no secret comity just waiting to be discovered. Fostering bitterness was the GOP legislative strategy for years.

Giving up on doing the nation's business and making progress in the name of meeting nihilists in the middle is the sort of thing Obama would've done (and often tried to do). Thank god Nancy Pelosi was there.
 
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bearpoker

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Obama in January of 2010 said that Brown's election was a message from a troubled nation and that Democrats should listen to the discontent and rebuild the bridges they had let fall into disrepair.

Then he climbed on board with Pelosi's "the will of the people be damned" express, and he and Democrats have been paying for that ever since.



I understand the OP's point. Because Democrats bulled through their "we know better than you what is good for you" policies, and with the help of lies and a complicit media they got to delay full accountability until after the 2012 elections, Pelosi did indeed help change the expectations of the nation. Now more people consider parts of Obamacare a right and don't want it taken away.

But IF Obama had followed the path he knew he needed to take, and if he had brought Pelosi along with him, this nation would have been a much better, less bitter place. There might not have been a shellacking in 2010 or the GOP takeover of the Senate in 2014. Obama and Pelosi were as big of factors in giving us President Trump as Hillary and Trump himself were.


Don't kid yourself. The shellacking was an inevitable part of the cost of change. Once the dust settled and people started to see the real results of the ACA as opposed to the Republican lies, they understood that it is a good idea. Democrats got shellacked after Social Security too.
 

Greenbeard

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Don't kid yourself. The shellacking was an inevitable part of the cost of change. Once the dust settled and people started to see the real results of the ACA as opposed to the Republican lies, they understood that it is a good idea. Democrats got shellacked after Social Security too.

They lost 47 seats immediately after passing Medicare and the rest of the Great Society.
 

Amelia

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Obama was re-elected and the Dems just won the House on a health care message.

Meanwhile, tens of millions of people gained health insurance coverage, health cost growth stalled, quality improved, people's health got better, and the care delivery system continues to improve. Worth the pettiness of the repeal crowd? Clearly.



That's an incredibly naïve view. Putting aside the absurdity of the claim that the nation would be better off with 20 million fewer people insured and the pre-ACA cost trends and quality performance, the ACA was not the first piece of legislation the Dem majority tackled. With the economy collapsing, only three Republicans voted for an economic rescue package (and one of them later had to switch parties). There was no secret comity just waiting to be discovered. Fostering bitterness was the GOP legislative strategy for years.

Giving up on doing the nation's business and making progress in the name of meeting nihilists in the middle is the sort of thing Obama would've done (and often tried to do). Thank god Nancy Pelosi was there.


The nation would be better with a Democratic party which (a) stayed in touch with the people and (b) did the work needed to create a good healthcare law.

But especially (a). If Democrats had stayed in touch with the people, we wouldn't have President Trump. Not "meeting nihilists in the middle". Rather, staying true to the ones who brought Democrats to the dance. Not giving up on doing the nation's business. Rather, doing it right. Putting in the work to get the people on board with good law -- not creating bad laws in the backroom with Big Insurance and then when the people rise up in frustration, pushing through even worse law because the people so resoundingly objected to what you were already working on.


Having Trump as president is a helluva price to pay to get the ACA -- that is, what is left of the ACA now that the individual mandate is gone and preexisting conditions coverage is under threat.

If Democrats had had greater respect for the people they could have kept the House longer and could have created a lot of good legislation and saved us the grief which led to Trump. Wouldn't have needed Obama's pen and phone so much for those last several years. Wouldn't have handed Trump so much that he could erase with a signature. (Wouldn't have handed Trump anything, because he wouldn't have gotten the traction he did, but especially wouldn't have handed Trump Obama's raft of executive orders to erase.)


Obama and Pelosi decided the ends justified the means and now we're paying for their hubris.
 

Amelia

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Don't kid yourself. The shellacking was an inevitable part of the cost of change. Once the dust settled and people started to see the real results of the ACA as opposed to the Republican lies, they understood that it is a good idea. Democrats got shellacked after Social Security too.


The ACA was bad law. They understand that it's a good idea? No, approval of the ACA is only at 49%.

https://www.kff.org/interactive/kai...esponse=Favorable--Unfavorable&aRange=twoYear


With Obama's high approval ratings when he was elected, this was not necessary. He could have used the people to help force Democrats to pass good law, instead of going with the "you'll thank me later when you finally understand what we're doing" attitude which resulted in a law which he had to lie about in an effort to push off the day of reckoning until after the 2012 election. Well, he succeeded in pushing off that reckoning past 2012. But he got it in 2014 and 2016. And Democrats are not yet out of the woods. Thanks to Democrats' failures, Republicans have a solid hold on the Senate and are reshaping the judiciary without Democrats being able to do anything about it. (P.s., thanks, Harry Reid, for violating your word and invoking the nuclear option. That's working out great. /sarcasm)
 

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Don't kid yourself. The shellacking was an inevitable part of the cost of change. Once the dust settled and people started to see the real results of the ACA as opposed to the Republican lies, they understood that it is a good idea. Democrats got shellacked after Social Security too.
Actually, ACA popularity never skyrocketed. It's
hung in there a few point above or below 50% since it was implemented
. Not too impressive given that those get free or almost free insurance probably voted favorably.
 

MovingPictures

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The ACA was bad law. They understand that it's a good idea? No, approval of the ACA is only at 49%.

https://www.kff.org/interactive/kai...esponse=Favorable--Unfavorable&aRange=twoYear


With Obama's high approval ratings when he was elected, this was not necessary. He could have used the people to help force Democrats to pass good law, instead of going with the "you'll thank me later when you finally understand what we're doing" attitude which resulted in a law which he had to lie about in an effort to push off the day of reckoning until after the 2012 election. Well, he succeeded in pushing off that reckoning past 2012. But he got it in 2014 and 2016. And Democrats are not yet out of the woods. Thanks to Democrats' failures, Republicans have a solid hold on the Senate and are reshaping the judiciary without Democrats being able to do anything about it. (P.s., thanks, Harry Reid, for violating your word and invoking the nuclear option. That's working out great. /sarcasm)
The ACA being protected from repeal is 50% of the reason Democrats regained the House. It's become pretty popular even in areas where Republicans politics are king. That's because after the dust settled, people saw it wasn't the horrible law they were told it was.

Republicans threatened during the Bush years to go nuclear with the Senate, when they were unable to get their most radical judges through. It was clearly something they were planning on doing down the road. McConnell was filibustering to keep the judicial vacancies open, so he could later go nuclear himself, and stab the Democrats in the back. Reid knew this and did what he could to minimize the damage.

That's how Republicans work today.
 

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But especially (a). If Democrats had stayed in touch with the people, we wouldn't have President Trump. Not "meeting nihilists in the middle". Rather, staying true to the ones who brought Democrats to the dance. Not giving up on doing the nation's business. Rather, doing it right. Putting in the work to get the people on board with good law -- not creating bad laws in the backroom with Big Insurance and then when the people rise up in frustration, pushing through even worse law because the people so resoundingly objected to what you were already working on.

The ACA is a good law. It's done a tremendous amount of good in ways big and small, and in ways people see and in ways they don't. It took eight years, but the Dems were rewarded for it.

Passing good law doesn't guarantee immediate electoral success. As already noted, even passing Medicare and Medicaid didn't save the Dems from an almost 50-seat drubbing. You do it because it's good policy and the chips fall where they fall.

There hasn't been a Dem leader more capable of passing good policy than Pelosi in a very long time.
 

bearpoker

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Obama in January of 2010 said that Brown's election was a message from a troubled nation and that Democrats should listen to the discontent and rebuild the bridges they had let fall into disrepair.

Then he climbed on board with Pelosi's "the will of the people be damned" express, and he and Democrats have been paying for that ever since.



I understand the OP's point. Because Democrats bulled through their "we know better than you what is good for you" policies, and with the help of lies and a complicit media they got to delay full accountability until after the 2012 elections, Pelosi did indeed help change the expectations of the nation. Now more people consider parts of Obamacare a right and don't want it taken away.

But IF Obama had followed the path he knew he needed to take, and if he had brought Pelosi along with him, this nation would have been a much better, less bitter place. There might not have been a shellacking in 2010 or the GOP takeover of the Senate in 2014. Obama and Pelosi were as big of factors in giving us President Trump as Hillary and Trump himself were.

I don't think that would have been possible. This was a do or die moment and a lot of democrats died politically. As when social security passed, and as when medicare passed, democrats took a shellacking. It was worth it. It took a while. Now people understand that access to healthcare that the ACA gives them is a good thing and they like it. The tables are turning.
 

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The ACA is a good law. It's done a tremendous amount of good in ways big and small, and in ways people see and in ways they don't. It took eight years, but the Dems were rewarded for it.

Passing good law doesn't guarantee immediate electoral success. As already noted, even passing Medicare and Medicaid didn't save the Dems from an almost 50-seat drubbing. You do it because it's good policy and the chips fall where they fall.

There hasn't been a Dem leader more capable of passing good policy than Pelosi in a very long time.



The ACA is bad law.

If it had the public option, it might have been good law. But without the public option, it broke Obama's promises.

And in the version that it had to stay in for Pelosi to be able to sneak it through the reconciliation backdoor, it was fragile and extraordinarily vulnerable to lawsuit. If Roberts hadn't basically rewritten it for the Democrats to call the mandate a tax in spite of Democrats explicitly denying it was a tax, it wouldn't have passed the first Supreme Court hurdle. Now, with the individual mandate gone, and another rightwing justice on the court, it's more fragile than ever. Roberts' wording when he announced his verdict the first time left open the door for reversal if the people voted in a Congress which would take the necessary steps for reversal. And with the individual mandate gone, that could be all it takes for Roberts to use the out he saved for himself.


Lots of people lost their insurance because of the ACA. And, no, it wasn't just bad policies which were lost. Democrats were arrogant and dishonest and they didn't do the job they were sent to do. They broke their promises in a big way. They broke faith with the American people. And they handed the White House over to the Orange Sludge currently in residence there.

That did not have to happen. If Democrats hadn't turned a deaf ear to the people things would not have gotten this bad.
 

Amelia

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I don't think that would have been possible. This was a do or die moment and a lot of democrats died politically. As when social security passed, and as when medicare passed, democrats took a shellacking. It was worth it. It took a while. Now people understand that access to healthcare that the ACA gives them is a good thing and they like it. The tables are turning.


Well, obviously we disagree.

I don't think Democrats needed to lose Wisconsin. I think their bad choices lost Wisconsin.


And if the Democrats want to give the speakership back to Pelosi, okay. Their choice. I'll still vote for them for the foreseeable future, because Trump. But what I'm hearing from them is that they haven't yet turned away from the path which brought us Trump to begin with. And even though I have turned solidly from the GOP, and hope others will join me, Democrats still haven't made the sale with enough people here. And to me they don't look like they're on track to doing so. It didn't need to turn into the coin toss that it currently is. But it looks like it's going to stay a coin toss ... with whoever wins the toss parading around and trying to convince us that it was something they did which won the toss and not luck.
 

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The ACA is bad law.

If it had the public option, it might have been good law. But without the public option, it broke Obama's promises.

Obama's promise was to extend health coverage to millions (and the associated health benefits of being covered), while modernizing the health care system and revamping the incentives that inhibit quality improvement and drive up costs. The ACA has been doing all of that. That's good. And the single biggest reason for that success, arguably the biggest achievement of the Dems in a half century, was Pelosi.
 

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Well, obviously we disagree.

I don't think Democrats needed to lose Wisconsin. I think their bad choices lost Wisconsin.


And if the Democrats want to give the speakership back to Pelosi, okay. Their choice. I'll still vote for them for the foreseeable future, because Trump. But what I'm hearing from them is that they haven't yet turned away from the path which brought us Trump to begin with. And even though I have turned solidly from the GOP, and hope others will join me, Democrats still haven't made the sale with enough people here. And to me they don't look like they're on track to doing so. It didn't need to turn into the coin toss that it currently is. But it looks like it's going to stay a coin toss ... with whoever wins the toss parading around and trying to convince us that it was something they did which won the toss and not luck.

I'm not ready to thank God for Trump. I sorry that you're voting Democrat faute de mieux.
 

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The ACA being protected from repeal is 50% of the reason Democrats regained the House. It's become pretty popular even in areas where Republicans politics are king. That's because after the dust settled, people saw it wasn't the horrible law they were told it was.

The most important reasons to give Pelosi back the gavel are that she's the most experienced and effective, not to mention the living Dem with the biggest accomplishments under her belt. She does big things and she gets them done.

But to your point, she also engineered this month's victory. She warned the GOP last year that if they voted for their awful repeal bills they would glow in the dark.

And indeed that was the strategy she laid out:
It was a meeting of House Democrats early in 2017, during Republicans’ drive that March to strike down the Affordable Care Act. Ms. Pelosi and her political lieutenants laid out their counterattack: Democrats would talk about pre-existing conditions and millions of people losing coverage. And they would talk about an “age tax” — a provision in the Obamacare replacement passed by the House, which would have allowed health insurers to widen the premium gap between younger and older customers. . .

That narrow focus on health care and a few economic issues came to define the Democrats’ midterm campaign. It represented a wholesale rejection of Hillary Clinton’s failed strategy in the 2016 campaign, which focused on Mr. Trump’s fitness for office.

And it's the one the party executed to win decisively:
The main reason for Democrats’ electoral success this year with older Americans is that in 2018, Democratic candidates stopped seeing health care as a liability and began seeing it as a political weapon.

An analysis of House and Senate campaign ads by the Wesleyan Media Project found that from Sept. 18 to Oct. 15, 2018, a full 54.5 percent of all ads for Democratic House and Senate candidates discussed health care, while only 31.5 percent of pro-Republican ads did the same. It’s a striking reversal from the four election cycles since the 2010 passage of the Affordable Care Act—four elections in which no more than 10 percent of Democratic ads mentioned health care and during which Republicans were several times more likely to discuss the issue.

Health care was the single-most-discussed issue in political ads in 2018. Of the more than 3 million election ads that ran on TV this cycle, at least 1.2 million mentioned health care, according to an analysis by Bloomberg News based on data from Kantar Media/CMAG. Nearly three-fourths of those ads were paid for by Democrats and Democratic-aligned groups. And many of those were aimed squarely at voters over 50—and weren’t particularly subtle about that fact.
It was one of the most reliable arrows in the Democratic quiver this year, a reference to a provision of House Republicans’ health care legislation that would’ve allowed insurers to charge Americans over age 50 up to five times more for health insurance than younger people. In races from upstate New York to the Arizona-Mexico border to Cedar Rapids, Iowa to the suburbs of Richmond, Va., Democratic challengers flipped GOP-held House seats while running ads accusing Republicans of supporting this so-called Age Tax, using a term popularized by the political arm of the AARP.
 

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The ACA is obviously the most important achievement of the Dems in this century, but some on the left might also enjoy Pelosi's successful effort to scuttle Dubya's post-election effort to privatize Social Security in 2005. When pressed by wavering Dems on when she'd start negotiating with Dubya on Social Security, Pelosi responded: "Never. Does never work for you?"

In the face of unified opposition under Pelosi's leadership, the privatization push failed and Social Security survived.

Quite unusual among Dems, Pelosi wins.
 
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