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On The Disrupted Sequence of Health-Care Reform

Elvin Lim is Assistant Professor of Government at Wesleyan University and author of The Anti-intellectual Presidency, which draws on interviews with more than 40 presidential speechwriters to investigate this relentless qualitative decline, over the course of 200 years, in our presidents’ ability to communicate with the public. He also blogs at www.elvinlim.com. In the article below he looks at the health-care reform bill that the House passed. See his previous OUPblogs here.

Democrats must be thinking: what happened to the halcyon days of 2008? It is almost difficult to believe that after the string of Democratic electoral victories in 2006 and 2008, the vast momentum for progressive “change” has fizzled out to a mere five vote margin over one of the most major campaign issues of 2008, a health-care bill passed in the House this weekend. If you raise hopes, you get votes; but if you dash hopes you lose votes. That’s the karma of elections, and we saw it move last Tuesday.

Democratic Party leaders scrambled, in response, to keep the momentum of “Yes, we can” going, by passing a health-care reform bill in the House this weekend. But despite claims of victory, Democratic party leaders probably wished that their first victory on the health-care reform road came from the Senate and not from the House. President Obama and Speaker Nancy Pelosi have always hoped to let the Senate pass its health-care reform bill first, initiating a bandwagon effect so that passage in the House would follow quickly and more easily, and a final bill could be delivered to the president’s desk.

Instead, the order of bill passage has been reversed, making a final bill less likely than if things had gone according to plan. If even the House, which is not subject to supermajority decision-making rules, barely squeaked by with a 220-215 vote, then it has now set the upper limit of what health-care reform will ultimately look like. Potentially dissenting Democratic Senators see this, and there might now be a reverse band-wagoning effect. Already, we are hearing talk from the Senate about the timeline for a final bill possibly being pushed past Christmas into 2010. This is just what Nancy Pelosi and Barack Obama were hoping against, by pushing the Senate to pass a bill first. Unfortunately for them, the Senate took so long that to keep the momentum going (and amidst the electoral losses in NJ and VA last week), they felt compelled to pass something in the House to signal a token show of progress.

But the danger is that the move to regain control may initiate a further loss of control. The less than plenary “victory” in the House bill has only made it clearer than ever that if a final bill is to find its way to the President’s desk, it will have to be relieved of its more ambitiously liberal bells and whistles. Even though the House Bill, estimated at a trillion dollars, is more expensive than the Senate version being considered, and it has added controversial tax provisions for wealthier Americans earning more than $500,000, what the House passed was already a compromise to Blue Dogs. On Friday night, a block of Democratic members of Congress threatened to withhold their support unless House leaders agreed to take up an amendment preventing anyone who gets a government tax credit to buy insurance from enrolling in a plan that covers abortion. If even the House had to cave in some, there will have to be many more compromises to be made in the Senate, especially on the “public option.”

Sequencing matters in drama as it does in politics. It is at the heart of the Obama narrative, the soul and animating force behind the (now unraveling) Democratic majority in 2009. “Yes, we can” generates and benefits from a self-reinforcing bandwagon effect that begins with a whisper of audacious hope. From the State House of Illinois to the US Senate, from Iowa to Virginia – the story of Barack Obama is a narrative of crescendo. “They said this day would never come” is a story of improbable beginnings and spectacular conclusions. The structural underpinnings of the Obama narrative are now straining under the pressure of events. To regain control of events, the President must first regain control of his story.

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