Many commentators have denounced the process by which the health care reform has made its way through Congress. There was the "Cornhusker kickback" which exempted the state of Nebraska from paying its share of Medicaid, and other back room deals that are not uncommon in the legislative process but which look bad when the light of day shines on them. There is Speaker Pelosi’s ridiculous plan to have the House pass the Senate bill without actually voting on it. &c.
But, the health care reform process has also shown something else, and that is the strength of our democracy and the vitality of its mores. First and foremost, although it has been may decades since Franklin Roosevelt and Harry Truman first really focused on the need for universal health care, and every time the issue has been put off, it has returned to the forefront of the nation’s political agenda because enough Americans want it addressed. Those with much invested in the status quo have successfully staved off reform in the past, but this time they have been unable to stop it. The results of the 2008 election matter.
Secondly, the final bill is about as centrist as one can imagine, and it is so because the public has demanded it become so. Last summer, the Tea Party crowd raised two central objections to health care reform: They were concerned about its cost and they were worried about government taking over the delivery of health care. Sometimes the Tea Party crowd was woefully misinformed, for example, the public option was an option, not a government takeover. Other times, the Tea Partiers were comically misinformed, as when a man stood up at a rally with the sign "Keep your Gov’t Hands off my Medicare!" Perhaps in spite of themselves, the Tea Party crowd made it clear to Congress that the final bill could not add to the deficit and that many Americans can abide government regulation of health care, but not government administration of health care. I do not share the objection and would be perfectly happy if the Congress was about to pass a single-payer system, but my point of view remains in the minority and the effect of the Tea Party brigade was to shape the debate in a way that made the bill not better but more centrist. That is precisely how the Founders designed our system, to find the center, not the truth, through the competition of interests. This disappoints purists on both ideological sides, but it largely explains the success of the republic.
Thirdly, in recent days a flurry of polls have shown that the public is all over the place on the final bill. Some polls show that people are more likely to vote for a congressman if he supports the bill, others that they are more likely to vote against him. Some polls show people coming around to support the final bill, now that the White House has finally framed the debate as one between change and the status quo, but it remains highly controversial. In short, no fence-sitting congressman can decide how to vote by putting his or her finger to the wind. The wind is blowing in a lot of different directions and offers no guidance. This means that individual members of Congress must do what they think is right, what they think they can best defend. Per se, this weights the political process against reform: A member of Congress can always plead that he was in favor of better reform, but that this variety of reform was unacceptable for such and such reason, although that explanation works less well on an issue like health care that has gone on for more than a year. Still, this is another example of the system working as it was intended to: For good or ill, the Founders wanted to make government action difficult to accomplish.
Finally, the process has certainly informed the electorate. Yes, there have been red herrings like the charge that the bill included death panels. But, by and large, most people know more about the health care system and the options for fixing it than they did a year ago. I certainly know a hell of a lot more than I ever wanted to know about health care policy. The bill, if it passes, will not be a cure-all, and as it is implemented, more legislation will be required, just as Social Security and Medicare had to be amended over the years. It will help to have an informed electorate engaged in that on-going work – and, I should add, an electorate that is about to see that the sky will not fall when President Obama signs the health care bill.
It appears the final vote in the House will be on Sunday. The Senate will take up the reconciliation package next week. It has been a long road but it has been a profoundly small-d democratic road. The moment that has eluded previous generations is coming to pass at long last because democracy has demanded that government address the horrific inequities and rising costs of our health care system. That democratic impulse manifested itself by electing Barack Obama and his promise of real change to the White House, and a Congress with majorities in both houses that pledged themselves to reform health care. The public debate has shaped the movement the public need had demanded. This is democracy in action. Sometimes it is not pretty in detail, but let us not lose the forest for the trees. It is a sloppy, messy, occasionally maddening, but magnificent way to achieve self-governance. As Churchill famously said, "Many forms of Government have been tried, and will be tried in this world of sin and woe. No one pretends that democracy is perfect or all-wise. Indeed, it has been said that democracy is the worst form of government except all those other forms that have been tried from time to time." Indeed.
Michael Sean Winters