Health-Care Reform's Winners and Losers

It doesn't take a rocket scientist—or even an alleged expert such as this reporter—to see that the big political winner in tonight's House vote is the president of the United States. After more than a year of fitful but increasingly focused effort, Barack Obama is able to claim victory in an effort that he had made the emblem and focus of his entire presidency. In some ways, the win was a negative one: the humiliation of a defeat would have made him look powerless and inept. And in Washington, appearances beget reality. But, hey, as teams in the NCAA basketball tournament can tell you, a win is a win.

The list of winners and losers only begins with the president. Here is my sense of who they are, in both political and real-life terms.

WINNERS

Obama: He staked everything on this and, like the long-distance runners from his father's homeland, he made it (barely) across the finish line.

Nancy Pelosi: They said she knows how to count votes, and she does. They can't stand her in Tea Party America, and some liberals are angry at her, but she knows how to deliver.

Rahm Emanuel: The White House chief of staff was tasked by Obama with the job of getting this done, and Emanuel, whose effectiveness and commitment have been questioned, has just taken a major step toward showing that he was the right guy for the job.
 
Near-poverty Americans not covered by Medicaid: Some 15 million more Americans than currently have it will get health care through Medicaid.

Middle-class families who can't afford to buy insurance: Some 15 million will eventually get subsidies.

Policyholders: For the first time, the federal government will impose rules designed to control some of the risk-avoiding (and profitmaking) strategies of the insurance companies.

Drug companies: They kicked in $80 billion to help make the bill work, but stand to make 10 times that amount in revenues from added government and government-subsidized business.

Tea partiers: They are crying havoc (outside the Capitol) and now have their cause, apocalypse and all.

LOSERS

Insurance industry: The health-care industry grew out of insurance, which has never been subject to direct and thorough national regulation by the federal government. It stayed aloof from a deal, and ended up losing the game of musical chairs, even though it will get new customers.

Blue Dog Democrats and Democrats from GOP districts: There is still time for them to recoup—Election Day is still eight months away. But this vote is a loser for many of them, and they know it.

Wealthy and semi-wealthy taxpayers: Those making $200,000 individually or $250,000 as families are going to get squeezed—and they should know it. The bill makes big assumptions about spending cuts. Most realistic and neutral observers believe that those "savings"—in Medicare, for example—will never happen, which means more deficits.

The Republican Party: It will gain seats in the midterms for sure, but not necessarily as many as it is assuming. For one, the world is not going to end if and when the bill becomes law. In fact, nothing much at all will happen. That will be a relief to many, and no grist for the GOP. The Dems will have something to run on, and the Democratic president will look like a winner.

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