Even after a weekend of hyperbole from Democrats and Republicans on what the passage of health care legislation will mean for America, it is hard to overstate the bill’s political and policy implications.
President Obama largely got the bill he wanted — a tempered compromise between the wings of his party that alters the existing system without razing it. He sees this legislation as a significant step toward his ultimate goal: reestablishing government as a responsible partner — and, at times, steward — of the private sector, as well as providing for Americans who are unable to provide for themselves. It is the largest piece of social welfare legislation passed since the Great Society, and this president, speaker and congress will be enshrined as champions in the history books of the Democratic party for getting it through.
The unprecedented partisanship of Sunday’s vote — not a single Republican voted for the landmark legislation — will likely spark a long debate on the role of the minority in our government. On this particular issue, the Democratic vision proved incompatible with the Republican one. Monolithic, emotional opposition from the right was more about what the bill represented to them — a fundamental shift away from Reagan’s exhortation that “government is not a solution to our problem, government is the problem”– than an inability to accept what in reality are fairly moderate and uncontroversial policies. Obama, despite campaigning under the banner of post-partisanship, has a traditionally liberal view of governance; he just prefers to seek common ground and strike a conciliatory tone in his pursuit.
Health reform is contentious not only because of its human element, but because both sides see it as a symbolic foot in the door, a crucial first step toward polarized ideals of government’s role. The decades-long debate to come over the merits of this policy will be framed in these terms. Republicans will blame the bill for ballooning the health care inflation and entitlement spending it is designed to soften, but can do little to overcome alone. Democrats will fiercely defend the entire package, even if some elements prove ineffective.
And then there are the real world changes: 31 million Americans will be added to the health insurance rolls, expanding the risk pool and altering the business model of the industry; billions of federal dollars will be deployed to purchase portions of that coverage and expand Medicaid eligibility; and an unprecedented level of new taxes and regulations will be levied on companies of all sorts in the medical field. What all this means to each party, each individual, is hard to say, but we know this much: It’s big.
All that being said, I think health care’s political implications for this November have been overstated. Democrats will lose seats; such is the nature of this cycle. Repeal is not a realistic platform for Republicans — Obama’s veto pen isn’t going anywhere and the political wisdom of such a push is questionable at best. Passage will rally the bases, provide ample red meat for the trail and may narrow the enthusiasm gap for Democrats, but I don’t see it sparking a lopsided groundswell or changing many undecided minds. Those on the left like it, those on the right don’t. Democrats will have some concrete deliverables (no preexisting condition discrimination for children, etc.) but I suspect that they will fit into a larger theme of accomplishment and reform, not serve as a platform centerpiece.
The narrow section of true independents feel neither euphoria nor horror over health reform. People’s anger that “government is broken” isn’t about health care, it stems from economic insecurity. If the midterms are to be a referendum on any one issue, it will be stewardship of the economy. And if the Democrats must choose one cause to highlight, financial reform, if passed, has the potential to be a far more potent weapon against obstinate Republicans than health care ever could.
The gravity of this moment is undeniable, but health reform won’t be the pivotal issue this fall.