THE TREATMENT NOVEMBER 8, 2009
Saturday's debate on the House floor was at various turns entertaining, depressing, amusing, and even enraging. But, strictly speaking, it was not particularly dramatic.
Yes, the final vote was close. A bill needs 218 votes to pass. This one got 220, including one not entirely expected Republican. And at least according to one Capitol Hill source, the leadership didn't have a bunch of extra votes in its pocket. (If they had, the source noted, they would not have made the deal on abortion funding.) But whatever the margin, Speaker Nancy Pelosi was saying all day long the bill would pass--a verdict operatives on the Hill were echoing. While nobody was guaranteeing victory, everybody was expecting it.
Of course, that's often the way these votes go: The outcome is all but certain beforehand. If you want appreciate the significance of what happened on Saturday, you really have to take a step back. Or maybe a few steps back.
The last time the House of Representatives tried to pass health care reform was at the beginning of the Clinton administration. That effort failed miserably, as committees squabbled over jurisdiction. This time, three committees produced nearly identical versions of legislation, putting those turf battles (mostly) aside. They got their work done quickly--well in advance of a self-imposed August deadline. And, most important, the legislation they produced was good.
Do not be fooled by the Beltway conventional wisdom, which has repeatedly treated House legislation as inferior to its counterpart in the Senate. If anything, the opposite is true. Should the House bill or something like it become law, the vast majority of Americans would have health insurance--protecting them from financial calamity and giving them access to medical care when they need it.
Republicans have repeatedly mocked the House bill because of its length. But there is a reason the bill needs so many pages: It's the product of thinking carefully about how best to design a health care system. The legislation has its problems; all legislation does. But at the level of detail--like, for example, the all-important question of how to design insurance exchanges--the House bill holds up extremely well.
And the bill pays for itself--not just in the first ten years, as the original version did, but in the future, as well. It may not do as much to reduce the overall cost of health care as the Senate bill would; in the view of most experts, that's the House bill's chief weakness. But it at least makes moves in the direction of cost-control.
Speaking of the Senate, that is where attention now turns--and where the process is unlikely to go forward as smoothly. It's the nature of the institution and the people who presently inhabit it. It'd be nice to think health legislation would blend the best of both approaches, rather than the worst. Alas, that's not a given.
But that's a matter for another day. Or at least later in the day. Now is a moment to appreciate what has taken place. The House has passed what is arguably the most significant piece of domestic policy legislation in a generation. Dramatic or not, it qualifies as history.