As if liberals need more motivation to push health- care reform, Rush Limbaugh, in a profoundly patriotic move, said last week he'll be "leaving the country" if health care passes. VOTE YES ON REFORM. SEND RUSH PACKING! It's a bumper sticker with the virtue of no reference to "cost curves" or pre-existing conditions.
Progressives are so dispirited—and, like the rest of the country, so sick of talking about sick people—that they can't wrap their heads around the reality that this is the Big One, the Super Bowl, for all the marbles. Mitch McConnell and John Boehner can scowl, but Republicans are now nearly irrelevant to the process. The only real question is if Democrats are in the mood to slit their own throats. The bill is complex, but the politics are simple: if health care doesn't pass this spring, Obama's domestic presidency is finished. The Democratic Party will be, to borrow a phrase from Nixon, a "helpless, pitiful giant." By contrast, if the bill gets signed, Republicans are setting themselves up for a "repeal the bill" campaign that will likely backfire in November's midterm elections. That's eight months away, but if the bill passes I'd bet on the GOP winning only a few new seats.
This is Politics 101, a class that many Democrats apparently flunked. The House Democrats who voted for the bill at the end of 2009 have no choice but to vote for it again if they have any clue as to what's in their political self-interest; the he-was-for-it-before-he-was-against-it ads write themselves. And the more conservative Blue Dog Democrats who voted against it need to understand that no matter how toxic health care is in their districts right now, things will be a lot worse if they have to run under the banner of a failed president. Voters won't reward them for being fake Republicans—they'll vote for the real ones instead.
The fate of the bill now rests mostly with the House. (The 51 votes in the Senate needed for reconciliation won't be a problem, but procedural hassles lie ahead; Senate parliamentarian Alan Frumin is about to become one of the most powerful people in Washington.) So I'd like to single out the "Suicide Six": Democrats—besides abortion foes like Bart Stupak—from districts Obama carried who are threatening to withhold their votes and blow up everything.
Eliot Engel—a Ben Nelson wannabe, it appears—is holding out for New York to be "treated fairly." He may be right on some of the merits, but when he told me, "I can't vote for something that makes my state worse off," I prayed he was bluffing. Worse off for whom? Not the uninsured. Note to Eliot: your district went 72 percent for Obama. Do you really want to break the president? Brian Baird of Washington state, John Barrow of Georgia, and Melissa Bean of Illinois want more cost containment. I'm with 'em. I'd like to see a Medicare commission with teeth. But if they don't get what they want, their vote still shouldn't be a close call. Don't blow it, guys; the status quo on costs is worse. Larry Kissell of North Carolina says health care is "badly needed," but his "line in the sand" is Medicare, which he promised not to cut. But experts say that, eventually, Medicare will be chopped much more severely for the elderly in need without the cost-control pilot programs in the current bill (especially phasing out fee-for-service medicine). Then there's Dennis Kucinich of Ohio, whose district went 59 percent for Obama. One question, Dennis: if it's good enough for the socialist senator, Bernie Sanders, what's your problem?
These members all know that, according to a Harvard study, 40,000 people a year die for lack of health insurance. Do they want that on their consciences? It's hard to imagine they do. This is their moment of truth as Democrats. Let's face it: if they vote to cripple a Democratic president now, they ain't real Democrats. It's like a Republican voting against Bush's tax cuts. In 2001 no House Republican did.
Ironically, this is not as hard a vote for Democrats as it looks. Sen. John Cornyn, the Texan who heads the National Republican Senatorial Committee, says the midterms should be a "referendum" on repealing the health-care bill (if the bill fails, the Republicans will run against it anyway). Because the insurance-industry reforms kick in immediately, this means Republicans would be running against protections that even those queasy about health-care reform are not going to want stripped away. Whose side will candidates want to be on? The insurers—or average people happy that they have the security of not worrying about their health if they lose their job? Even the lame message mavens of the Democratic Party can handle that one. Can't they?
Jonathan Alter is also the author of The Defining Moment: FDR's Hundred Days and the Triumph of Hope.