Sometimes it takes a century

Health care reform is finally a reality. I never thought I would see it in my lifetime. Here is my view of it all.

When I started graduate school back in 1980, I was asked what I wanted to be when I grew up. With all the boldness of the young and naive, I stated that I wanted to be the first woman to run the national health insurance system. I actually believed that there would be one. Silly me.

Come 2003, I was one of those nameless, faceless 500 who worked on Hillary's Health Care Reform Task Force. It was an honor to be part of the effort. Then, after all that work, we watched it crash and burn as a result of LIES. More lies than I could imagine. And those lies went uanswered. Harry and Louise were the chief purveyors of the lies, you may recall. Harry and Louise were the well-financed creation of the private health insurance industry.

When Obama was elected, I was pleased to know that health care reform was going to be his #1 priority. But I didn't really expect much to come of it. There had already been so many tries -- Theodore Roosevelt, Franklin Roosevelt, Harry Truman, Lyndon Johnson, Richard Nixon (didn't expect to see that name, did you?), Bill Clinton -- and they all ended in failure. The wounds of the Clinton failure were still a bit raw.  Lyndon Johnson came closest. He managed to get Medicare and Medicaid enacted. Did you know that Medicaid (public health insurance for the poor) was added to the Medicare (public health insurance for the elderly) legislation in an attempt to kill it? Today, millions of people reject "government health care" but think Medicare is sacrosanct, just like Social Security. 1965 … the good old days, when the President and Congress could get big things done.

Then, Obama turned responsibility for reform over to the Congress. Big mistake, right? Well, no, it wasn't. Rather, it demonstrated that President-O had learned an important lesson from Bill Clinton, i.e., it is Congress that eventually has to pass the bloody bill. He learned another important lesson too:  expose the lies, of which there were plenty.

And what did Congress do? They dithered ... and negotiated ... and politicked ... and did what Congress does. But eventually, the House of Representatives passed a bill. It took Speaker Pelosi a good long while, and she had to cut some deals, and eventually she had to cave to the anti-choice crowd, but she got the bill passed. (I won't criticize her for caving. Obviously, she knew that she would have another bite at the apple during reconciliation of the House and Senate bills.) And then all eyes and hopes turned to the Senate. And what did the Senate do? They dithered ... and negotiated ... and politicked ... and, well, you know, they did what they do. Senate Majority Leader Harry Ried's constituents in Nevada applied pressure (lots of it). Ted Kennedy died. What a mammoth loss! But eventually, on Christmas Eve, the Senate also passed their bill, depending on their razor thin margin of 60, without which a filibuster from the Republicans would have been the bill's death knell. What a Christmas present!

All that remained (or so it seemed) was for the House and Senate to get together in January, reconcile the two bills (that is, work out all the differences between them and make them identical), and then pass the reconciled bill. Simple, right? WRONG. The differences between the bills were major in several areas, not the least of which was how to pay for it and whether there would be a "public option." A public option (in the House bill, but not the Senate one) would have provided a public insurance option to compete with private insurers. An amazing number of people (many Republicans, for instance) who say they love competition in the marketplace reject this kind of competition, so the public option was a really big difference to reconcile. And, of course, everyone wants benefits but no one wants to pay for them, so how to finance health care reform was equally big and divisive. These weren't the only big differences, but they are illustrative of just how far apart the House and the Senate began their reconciliation negotiations.

And then Massachusetts threw a new monkey wrench into the machinery by electing a Republican to fill the Senate seat vacated by Ted Kennedy. And with that one fell swoop, the Senate Democrats no longer had that filibuster-proof 60-vote majority. Death to health reform? Near death, certainly. And after it became clear that no Republican would compromise even a little, only one option remained. The House had to pass the Senate bill AS IS. That was the only way. The Senate couldn't pass a bill, any bill, anymore. It was all up to the House, and Speaker Pelosi. Of course, they did maneuver a way to make some reconciliations. If the House would pass the Senate bill, then both the House and the Senate agreed to pass some amendments, and the Senate decided (with Senator Byrd's blessing) that they could pass the amendments under rules for budget reconciliation, which cannot be filibustered. In other words, the Senate could pass the amendments with 51 votes, not 60.

And they did it. The House passed the Senate bill, and the House passed the agreed-upon amendments. The anti-choice Democrats were placated with an executive order that probably means nothing. The Senate has now passed the amendments; they had plenty of votes to do it. President Obama signed the health care reform bill into law. In short, they made history.

Is it a good law? Absolutely. Is it a perfect law? Absolutely not. Policy like this gets made through compromise, hard-fought give and take. Making policy is like making sausage. It is not pretty. It was not designed to be. But they got it done.

But did they do the right thing? Winston Churchill said, "You can always count on Americans to do the right thing - after they've tried everything else." I’m not sure we’ve tried everything else, but we’ve tried health care reform failure (again and again), and we’ve tried a stupid, immoral system of letting people die for lack of insurance, and we’ve tried health insurance for the well but not the sick. We’ve tried being the only industrialized nation in the world not to have health coverage mandated for its citizens. Yes, they did the right thing. And it is well past time.

That is my view.