Pelosi's Victory On Health Care May Not Win Over WomenS

Last night, after a year of wrangling, Nancy Pelosi accomplished what Hillary Clinton and countless others could not: passing comprehensive health care reform. Almost everyone seems to be singing her praises. But should they?

It's hardly an open question whether this was more a political victory than a policy victory: a year ago, Pelosi swore there would be a public option. There is none. There is no cap on what insurance companies can charge people with so-called pre-existing conditions, including being a victim of domestic violence or sexual assault — insurance companies just can't refuse to cover you, but they can charge what they like and, worse yet, you'll be required to buy it or pay a fine. Obama's mandates that employers provide their workers with insurance turned into a mandate that individuals buy their own insurance if employers don't. Conservative Ben Nelson's abortion-related provisions - which require companies participating in the health insurance exchange to send patients two bills (one for regular insurance and one for "abortion" insurance) in order to highlight for Americans that women sometimes have abortions, and they hope, reduce Americans' support for it — remain part of the legislation despite the outcry from the pro-choice community.

Pelosi's leadership on this legislation was of a political nature — she didn't lead the charge on policy provisions. When she didn't have the votes politically to pass it, she sold out pro-choice advocates and, despite losing 4 committee votes, Congressman Bart Stupak got a floor vote everyone knew he would win on his anti-abortion amendment. Her job, as she executed it, was to get the health care reform — which changes, incrementally, insurance company regulations, not health care in America to any great degree — bill passed to put a win in the Democrats' column.

The Wall Street Journal, among others, describes the tactics Pelosi used to pass the Senate's version of the health care bill:

But House Speaker Nancy Pelosi of California, the Democratic lightning rod, has pushed through controversial legislation before and has done more than most to keep her party's health-care hopes alive. Her mastery of the quirks of her own caucus and her blend of arm-twisting and flattery could prove decisive in whether the mammoth bill becomes a reality this weekend.

Victory would likely cement her position as one of the more dominant House speakers in modern times.

They're right: health care will likely play a large part of her legacy as Speaker, but people will credit her with the passage of the bill and blame others for the intended consequences of the many compromises she, Majority Speaker Harry Reid and President Obama countenanced in order to pass a bill branded as health care reform.

Somewhat ironically, former Congresswoman Ellen Tauscher, in praising Pelosi's skills, brought up her command of the policy issuesto Time:

"She's always better informed about the public policy of the issue," says former Rep. Ellen Tauscher, another California Democrat who recently left the House for a State Department job.

So, it's not like she is unaware of the holes, policy-wise in the legislation.

Pelosi is also ironically credited with holding off the damned incrementalists in the Administration and the Senate. From Politico:

During a mid-February conference call with top House Democrats, Pelosi made it clear she would accept nothing short of a big-bang health care push - dismissing the White House chief of staff as an "incrementalist."

Pelosi even coined a term to describe Emanuel's scaled-down approach: "Kiddie Care," according to a person privvy to the call.

Of course, before Pelosi could get her bill passed, she needed the Senate to guarantee it would pass a reconciliation bill to "fix" her non-incremental health care bill.

Pelosi is already pushing bavk on those who might call this bill an incremental reform rather than a liberal, comprehensive package reports Politico:

"I think [Pelosi] is the one who has kept the steel in the president's back - and I think she represents that to Harry Reid, too," Rep. Anna Eshoo (D-Calif.), Pelosi's closest friend in Congress, told POLITICO.

"White Houses end up with - how do I say this? - they take an incrementalism pill," added Eshoo. "But Nancy Pelosi is not an incrementalist."

Democrats have been framing the current health care bill as the "beginning" of health care reform for weeks, both to mollify liberals unhappy with how far it doesn't go and because they all know it doesn't go nearly far enough.

But even Pelosi knows the situation isn't going to get any better for a more liberal or comprehensive reform. The New York Times reports she told Obama as much this year.

"We're in the majority," Ms. Pelosi told the president. "We'll never have a better majority in your presidency in numbers than we've got right now. We can make this work."

She's right: given the looks of the polls, Democrats are going to lose seats in November no matter how they did on health care reform. But, then, why not push for something more in line with her policy aims, rather than her policy goals? Why not put that steely resolve and arm-twisting ability to good use?

The question that remains is whether Pelosi's leadership on the bill — now viewed more as a legislative victory for her than any other player in the health care reform drama — will be viewed as a smart victory or be a morass of unintended consequences. In the end, it doesn't reform health care in America as much as it incrementally reforms health insurance regulation in America — and then it forces all Americans to buy said insurance from private companies. There's no private option, there are plenty of loopholes and the entire thing remains contingent on Harry Reid pushing through a number of changes as part of the reconciliation process. The fact that the bill still contains the Nelson provisions on abortion access might be the worst legacy of Pelosi's compromises. Pro-choice activists are already registering their disappointment that the first female Speaker of the House, and a supposed ally of the pro-choice movement, traded in abortion access for health insurance reform.

Nonetheless, health care reform is Pelosi's crowning legislative and leadership achievement, and she's already being called a heroine and a possible pick for Time's "Person of the Year." This is Pelosi's lasting legacy, and the bill's not yet become a law. Let's hope for everyone's sake that the positives outweigh the negatives.

Vote Puts Pelosi's Political Skills to the Test [Wall Street Journal]
Getting Her Way: Pelosi's Powers of Persuasion [Time]
Pelosi Steeled W.H. For Health Push [Politico]
Health Vote Caps a Journey Back From the Brink [New York Times]
Health Care Passage Hinged On Abortion Language [NPR]
Payback for Prochoicers [Nation]
Heroine of the Hour [The Daily Beast]
Health Care Finale Liveblog [Five Thirty Eight]