The House of Representatives passed a major healthcare reform bill on Saturday by a close margin of 220 votes to 215. It is the first of its kind since Medicare was passed in 1965 and the first-ever aimed at implementing universal coverage. Only one Republican voted for the bill, while 39 Democrats broke party ranks. Speaker Nancy Pelosi deserves much credit for achieving this important milestone, but the narrow victory sets the stage for a drawn-out fight in the Senate.
Blue Dog Democrats will most likely pursue their attempts to either eliminate or weaken the public option when they begin to deliberate, while independent Senator Joe Lieberman is hinting he might join a Republican filibuster. In other words, the 60 senators needed for cloture are no longer onboard. Saturday night’s vote may prove historic should Barack Obama end up with a comprehensive reform package. But unless he opts for reconciliation, a process that allows for a straight up and down vote requiring a simple majority, there may not be anything for him to sign before the holiday season.
At 1,900 pages, the bill still appears confusing and scary to many. It is indeed far-reaching, including reforms to health insurance practices that have been contentious for many years and a mandate to achieve universal coverage. But it has already cleared several important hurdles. The CBO estimates that, over a 10-year period, the bill will in fact reduce the deficit. Furthermore, it is supported by AARP and the AMA, both of whom had opposed the Clinton reforms of 1994. Despite the closeness of the vote, this weekend’s developments add momentum to the president’s thrust. Yet, the political process in the Senate remains a significant obstacle.
The temptation by the Republican right will be to encourage a filibuster at all costs in the hope that polls will doom reform efforts, or at least make it difficult for both Houses to agree on a compromise bill. After all, 2010 is an election year and the prospect of having to face the wrath of disgruntled voters no doubt led many Democrats in Republican areas to vote with the GOP. The Democratic leadership has reason to be worried. As last week’s votes in New Jersey and Virginia showed, the Obama coalition, so successful last year, is just as capable of staying home when it is unhappy. However, Republicans and conservative Democrats may find that progressives are not in a conciliatory mood, especially after the amendment limiting access to abortion was passed. These factors may explain why Obama was far from exuberant when he congratulated the House for its vote. He knows the battle will be fierce in the Senate .
Even though a vast majority of Americans want health care reform, but there remains an elephant in the room. That elephant, to quote Democratic strategist James Carville, “is the economy, stupid.” A vibrant economy would have made a public option a no-brainer. With 10.2 per cent of Americans unemployed as of last Friday, the feeble recovery is what has provided Blue Dogs with a rationale for standing firm against the expansion of government programs. Considering the talk of new stimulus spending, the spectre of rising taxes, and the growing cost of the wars in Iraq and Afghanistan, it is understandable that Blue Dogs can gain some traction on fiscal issues.
This being said, Americans have never been closer to achieving Roosevelt’s dream of affordable and universal health care. With or without the Blue Dogs, Democrats ultimately have the votes to pass legislation in both Houses. And while the fragile economy will likely preclude Obama from fulfilling his hope of being the last president to tackle health care reform, if he signs a bill, he will have gone further any of his predecessors.