As of yesterday, the term “pre-existing condition” has been stripped of its capacity to frighten. The same is true of the word “rescission,” the insurance industry practice of canceling coverage for customers who had the audacity to become ill and need assistance. Both have been rendered all but meaningless.
In the wake of yesterday’s vote, emergency rooms should begin to evolve back toward providers of emergency care and away from serving as outrageously expensive primary care clinics for the millions of uninsured. The uninsured themselves should shrink to a fraction of current levels. And Americans who have clung to jobs with health-care benefits attached will now be more likely to strike out on their own, knowing that they will be able to get insurance at an affordable rate.
And believe it or not, all this and more will happen without an onslaught of government tyranny, without the wholesale abandonment of medicine by physicians, without the ruination of the United States of America. Really, trust me on that.
Politically speaking, the accomplishment of President Obama, House Speaker Pelosi and their fellow Democrats is impressive. A major endeavor considered all but dead in the wake of the election of Sen. Scott Brown in Massachusetts has been resurrected and made reality by leaders who remained stubbornly committed to a goal and saw it through. While the consequences of failure would have been enormous in terms of lost confidence and momentum, the consequences of this once-unlikely victory will be equally large as Democrats turn to other challenges.
Of course, as David Sanger of the New York Times and many others are noting, it has come at a price. Sanger writes:
“But there is no doubt that in the course of this debate, Mr. Obama has lost something — and lost it for good. Gone is the promise on which he rode to victory less than a year and a half ago — the promise of a “postpartisan” Washington in which rationality and calm discourse replaced partisan bickering.
Never in modern memory has a major piece of legislation passed without a single Republican vote. Even President Lyndon B. Johnson got just shy of half of Republicans in the House to vote for Medicare in 1965, a piece of legislation that was denounced with many of the same words used to oppose this one. That may be the true measure of how much has changed in Washington in the ensuing 45 years, and how Mr. Obama’s own strategy is changing with the discovery that the approach to governing he had in mind simply will not work.
“Let’s face it, he’s failed in the effort to be the nonpolarizing president, the one who can use rationality and calm debate to bridge our traditional divides,” said Peter Beinart, a liberal essayist who is publishing a history of hubris in politics. “It turns out he’s our third highly polarizing president in a row. But for his liberal base, it confirms that they were right to believe in the guy — and they had their doubts.”
I think that’s wrong, at least in this sense: You cannot lose what you never had, and Obama never had the slightest chance of achieving a “‘postpartisan’ Washington in which rationality and calm discourse replaced partisan bickering.” The evidence was there on the final tote board yesterday. The fact that this mainstream health-care reform bill — it doesn’t institute a single-payer system, nor does it contain a public option — could pass both the House and Senate without a single GOP vote says much more about the political climate and the strategy of the opposition than it does about the bill itself or Obama.
At the moment, the impact of this vote on an election held in faroff November is being overplayed. A lot more is going to happen between now and then as the nation’s attention turns to issues such as financial reform, immigration, the economy and the wars in Iraq and Afghanistan. The health-care vote won’t be ancient history by any means come the fall, but it also won’t be the single dominating issue of the 2010 campaign. We live in more complicated times than that.
In addition, to the degree that the Republicans and their allies present themselves as angry and radical, as defined by the Tea Party crowd, they will find themselves rejected by the American mainstream. The passions they have inflamed are already proving difficult to control, and the excesses of any movement, right or left, can quickly come to define it.
Many Americans have a lot of reasonable doubt and even fear about the impact of this legislation. That’s as it ought to be — the bill promises a major change in how we handle important issues. Even in their doubt, however, most Americans do not see it in the dire, Armageddon-type terms in which the Republican leadership has tried to frame it.
This reform effort is far from a finished product, just as this nation is far from a finished product. Parts of it will no doubt be problematic in ways we will not understand until it is actually implemented, and adjustments will have to be made. But it is an impressive accomplishment in terms of both policy and politics, and the country and its people will be better for it.