- Joined
- Aug 10, 2013
- Messages
- 19,112
- Reaction score
- 19,539
- Location
- Cambridge, MA
- Gender
- Male
- Political Leaning
- Slightly Liberal
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.
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.