What Gregg and the Stimulus Debate Foretell for Health Care Reform

“Bipartisanship” in politics is like “chemistry” in baseball.  No one precisely knows how to define it, no one knows what’s going to generate it in any given circumstance, everyone thinks you have it when things are going well, and no one thinks you have it when things are going ill.  We’ve been through a weird two weeks where Sen. Judd Gregg agreed to be Commerce Secretary in a stunning display of bipartisanship, only to request a “do-over” a week later in a stunning display of… well, you tell me.  Then we saw what everyone calls the greatest economic threat since the Great Depression get met with the smallest amount of “let’s all work on this” patriotic spirit since, well, the last Congress.  Given what we’ve seen, what can we learn about out chances for health care reform now?

Here are my five lessons of the politics of health care in 2009.

1.)    The process needs to happen in the Senate

In many ways, the stimulus bill was the antithesis of the process for how health care needs to be.  The stimulus was a reaction to an emergency – the process was always going to be somewhat rushed.  But health care can’t be that way.  The legislative process has to be given room to breathe.  The real choke point is the Senate – not just because it’s less liberal than the House but because Democrats don’t have enough of a majority to shove legislation through.  Given how stratified the vote ultimately became, with three lone Republican senators needed to even get to the magic cloture number of 60 votes, you need the slow, methodical process of building legislation to have a chance of building any kind of consensus.  (Luckily, from the selection of Daschle to the posturing of Baucus and Kennedy, this is the road we were headed for anyway.)  As the stimulus taught, once you have that consensus, it's also difficult to shake it off -- so it cuts both ways.

2.)    You need to get the outside-the-beltway politics right first

The President’s “hit the road” style of selling the stimulus helped shore up support in the polls and solidified the message – and made a few folks less scared about the health care provisions to boot.  But it should have been done long ago.  It had no practical effect on the final vote because it came too late in the game.  Health care is going to require a lot of pressure from the outside and from the grassroots – a bona fide campaign.  That’s the only way to create enough pressure on potential swing votes (especially Republicans) to give them incentive to break what looks right now like a strong party discipline.  But it’s also the only way to get an even more liberal or progressive marker out there.  The stimulus bill, already pretty centrist, got dragged even more to the right of center in part because there was insufficient pressure from the left.  We can’t let that be the case with health care.

3.)    If it’s an existential threat, prepare for the kitchen sink

No one quite knew how the Republican party would react to being completely out of the driver’s seat – would they consider major legislation with a chance of solving big problems an existential threat to their future electoral chances or a chance to show their patriotism and statesmanship?  Now we know – it’s going to be the existential threat.  There may be common ground on many issues, but the possibility that Obama and the Democrats could achieve meaningful health care reform signals clearly is being taken as a threat to the viability of the G.O.P.  We can expect to be fought tooth and nail.

4.)    Truth won’t really have much to do with the opposition

Towards the end of the stimulus debate, Sen. Coburn was on the Senate floor, lambasting comparative effectiveness research.  I’m paraphrasing, but he said we may as well accept British health care, rationing and the wait lines of Canada if we accepted a program designed to test whether the treatments we provide are actually effective.  I expect distortions, lies and spin from know-nothings like Rush, Fox News and Betsy McCaughey (who, by the way, we learned received over $55,000 from medical device maker Cantel Medical, whose board she also sits on.  Coincidence?  I think not.)  But it’s disappointing coming from Coburn, himself a doctor.  Could he actually prefer not to know if what he’s prescribing his patients is useful or not?

You heard a lot about government run health care for a $1 billion provision in the stimulus that, previous to this debate, both parties had championed.  This was just the warm up.  Expect to hear the phrase “socialized medicine” applied to any idea that will increase access, lower costs or improve quality, regardless of the content of that idea.  And expect to want to vomit early and often.

5.)    A scorpion is still a scorpion.

Bipartisanship makes everybody feel good – at least it makes reporters in The Washington Post feel good – but the tale of Sen. Gregg is a cautionary one.  He had a chance to serve his country or his party.  He decided it was going to be much more fun to do the latter, and went from someone who vaguely spoke positively about the stimulus to someone who would vote against it.  It was reminiscent of Aesop's fable of the frog and the scorpion where, after promising not to sting the frong for safe passage across the river, the scorpion stings him anyway, declaring, "I'm a scorpion.  It's my nature."

We have real differences in this country, and that’s a good thing.  Often we debate them honestly.  But sometimes we debate them deceptively.  By their actions, Republican lawmakers have demonstrated that health care reform will be debated as deceptively as it comes.  In such cases, bipartisanship is nice, but winning is better.  And when winning means health care as a right for every single American, winning isn’t everything – it’s the only thing.