A glimpse into the abyss of health reform's (unlikely) defeat.

Who's winning, who's losing, and why.
Dec. 15 2009 7:52 PM

What If It Fails?

A glimpse into the abyss of health reform's (unlikely) defeat.

Click here for a guide to following the health care reform story online.

Rahm Emanuel. Click image to expand.
White House Chief of Staff Rahm Emanuel

The White House is so determined to pass anything—and I mean anything—it can call health reform that I'm not yet prepared to believe that Senate Majority Leader Harry Reid's sweat-drenched labors will fail. But the bill as currently configured is in sufficient peril that President Obama called a meeting of the entire 60-person Democratic caucus (including two independents, Sen. Bernie Sanders of Vermont and the much-loathed Sen. Joe Lieberman of Connecticut). The public option is dead, and so is its understudy, the Medicare buy-in. The abortion issue remains unresolved. A self-imposed Christmas deadline almost certainly won't be met. Public support for health reform is dropping in the polls. Though still unlikely, failure is becoming easier to imagine.

What would it look like?

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Politically, it would be an obvious setback for Democrats and a triumph for Republicans, for whom stonewalling is now official policy. The antecedent weighing on everybody's mind is the death of Hillarycare, which in 1994 helped the GOP recapture the House of Representative for the first time in 42 years. Gary C. Jacobson, a political scientist at the University of California San Diego, argued in a 1996 paper that the GOP's 52-seat House gain (it also picked up eight votes in the Senate, winning a majority there, too) owed much to a sense of frustration on voters' part with "the kind of partisan posturing, haggling, delay, and confusion" characteristic of government when one party lacks sufficient votes to get legislation passed.

Sound familiar?

Democrats controlled 56 votes in the Senate, leaving them four votes shy of a filibuster-proof majority; then, as now, there was also some resistance to health reform among Democrats (most notably New York Sen. Pat Moynihan, who, inconveniently, happened to be chairman of the finance committee). Democratic control of the House, Senate, and White House created an "illusion of unified government" but not its reality. That illusion, Jacobson wrote, "put the onus of failure on the Democrats."

The irony is that in venting their rage against what they failed to recognize as de facto divided government, voters ended up with the real thing, diluting the Democrats' power to such an extent that at one press conference President Clinton felt obliged to bleat, "The president is still relevant here." Clinton went on to win re-election in 1996, but much of the rest of his presidency was spent furiously "triangulating" to find some patch of common ground with Republicans, with sometimes-ghastly results. (The homophobic Defense of Marriage Act is the most vivid example.) If health reform were to fail today, it's very easy to imagine a comparable shift rightward for Obama and the Democrats in 2010.

Granted, there are significant differences between 1994 and 2009. Clinton had raised taxes, something Obama hasn't yet done. (Restoration of the top marginal tax rate to the Clinton-era 36 percent from the Bush-era 33 percent is unlikely to occur before November.) Violent crime and teenage birth rates, two problems conservatives often blame on "permissive" liberal social policies favored by Democrats, were significantly higher in 1994 than they are today, and the Christian right was a much greater force in electoral politics. The president's party typically loses ground in midterm congressional elections, and House Democrats are reportedly a bit jumpythat already four Democrats representing swing districts have announced their intention not to run in 2010. That's well short of the 28 Democrats who created open seats in 1994.

But in some respects, the peril of potential failure is greater today for members of Congress than it was in 1994. The House has already voted on health reform, leaving legislators more vulnerable to identification with a stillborn policy than their counterparts were fifteen years ago, when Hillarycare never got out of committee. Today, as in 1994, the economy is experiencing a very weak recovery from recession. But unemployment is much higher now than it was then, and it easily could remain so through the 2010 midterms.

After the Democrats' electoral debacle in 1994, more than a decade passed before Washington was willing to take up any ambitious reform effort. Jacob Hacker, a Yale political scientist who was principal author of the public option, says that if health reform goes down now, "I don't think there's going to be any stomach for going back to fight this battle. …The administration is not going to want to come back to this."

What would a failure to pass health reform mean for ordinary people?

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