As the healthcare reform fight unfolds in Washington, one can imagine that this summer will be remembered in one of three ways. In one account, healthcare reform marks the moment when Democrats learned to work with advocacy groups to enforce party unity and push for the most progressive legislation possible. Another version is a familiar caution to progressives who are told they are too idealistic: liberals are demanding more than the Senate can swallow, and that could prevent anything passing at all. The third is perhaps the most familiar–much is compromised in the name of pragmatism, and the bill that passes isn’t strong enough to get the job done.
That seemed to be the track that the Senate Finance Committee was on in early July. Chairman Max Baucus signaled that he was prepared to give up much in order to hang on to a few GOP votes. Moderate Democrats were also skittish, making it easier for Baucus to trade away a public health insurance option. In addition, he was covering a third of the bill’s $1 trillion cost by taxing employer-sponsored insurance, a change vigorously opposed by unions, whose members are 50 percent more likely than workers in nonunionized shops to get health benefits.
With the Senate leadership wavering, advocacy groups played bad cop to enforce party unity. The netroots organization Change Congress went after Nebraska Senator Ben Nelson online and in direct mail, alleging that he was swayed against the public option by the $2 million he received in campaign contributions from insurers. He recanted. North Carolina’s Senator Kay Hagan signed on to the public option–albeit the fairly weak version endorsed by the health committee on July 15–when threatened with a similar campaign. Unions had begun broadcasting ads back in May opposing a tax on benefits. By mid-July, Senate majority leader Harry Reid reportedly told Baucus to back off these concessions because he would lose as many as fifteen Democratic votes; the Finance Committee went back to the drawing board.
But if this activism has won some victories in the Senate, some party leaders–including President Obama–have suggested they may regard it as counterproductive. “We shouldn’t be focusing resources on each other,” Obama said during a conference call with Congressional leaders, according to the Washington Post. “We ought to be focused on winning this debate.”
But what does “win this debate” mean? I asked University of North Carolina political scientist Jonathan Oberlander, author of The Political Life of Medicare, to grade those involved in healthcare reform on how well they are doing to get a progressive bill, one that covers everyone and includes a public health insurance option.
Oberlander gave the White House high marks simply for creating a framework for negotiations that kept interest groups at the table and carried the process well beyond what any other administration had accomplished. While Baucus got low marks for overflexibility, he earned an A for effort–he’d kept healthcare reform at the top of the Finance Committee’s agenda for months and continued to push through difficult negotiations.