How Close Were We, Really?



If you go back two weeks to before the Massachusetts unpleasantness, one thing that I was doing at that time was on-and-off disagreeing with some of my reporter friends about the odds that health care would fall apart at the last minute. I didn’t have anything like the Coakley Collapse in mind, I just thought that the odds of the House and Senate working out a deal weren’t as good as some were saying.

And I do think that part of what we’re seeing in the post-Coakley failure of nerve is precisely that the deal wasn’t really sealed even if Coakley had lost. We’d wound up with a Senate bill that reflected, overwhelmingly, the preferences of moderate Senators many of whom were fundamentally uncomfortable with the whole idea of ambitious party-line legislating. And the kind of liberal members, especially in the House, who were most favorably disposed to phrases like “$900 billion overhaul of the nation’s health care system” weren’t getting any of their pet priorities in terms of public option or pharma price controls but were being asked to swallow tax and IMAC ideas that they didn’t like. On top of all that, the White House wasn’t engaging in any kind of high-profile public defense on the perceived points of opposition attack—tax hike, Medicare cut, and IMAC-as-rationing. Last there was the abortion issue.

Now that’s not to deny that they were, in fact, close. In fact we’re still close and the door is still very open, logistically, to moving forward with essentially the deal that folks were working toward pre-Coakley. But I think the speed with which Coakley’s loss was seized upon as a reason not to walk through that door underscores how fundamentally uncomfortable with the framework so many people were. Say Coakley had turned back the tide and beaten Brown 51-49. Couldn’t some members have looked at that and said that Coakley’s very weak showing in the true-blue Bay State showed the unpopularity and infeasibility of Provision X and thrown a wrench in the works? It feels to me that a lot of members were looking for an excuse not to do it, and now they’ve seized upon one. But the underlying impulse to seek excuses and shift blame was long there.

This in turn illustrates the inherent difficulty of qualitative legislative compromise. You can do quantitative compromise—I want $800 billion, but I settle for $600 billion. And you can do horse trading compromise—You want A, I want B, so we do A and B. But qualitative compromise—I want Universal Medicare, you want to “bend the curve” while protecting profits for insurers and drug companies—is really difficult. It’s an inherently messy business. And in this case it resulted in the kind of plan that really ought to have been bipartisan, the way it was in Massachusetts, but looks very awkward when it becomes something liberals don’t love but moderates find nerve-wracking.