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B.F.D.

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On Christmas eve 2009, the Senate voted to pass the Patient Protection and Affordable Care Act in what would be its final form, although nobody expected that at the time. Let me highlight some names on the yea side for you:

Max Baucus D Mont.
Evan Bayh D Ind.
Robert C. Byrd D W.Va
Kent Conrad D N.D.
Byron L. Dorgan D N.D.
Kay Hagan D N.C.
Tim Johnson D S.D.
Mary L. Landrieu D La.
Joseph I. Lieberman ID Conn.
Blanche Lincoln D Ark.
Claire McCaskill D Mo.
Ben Nelson D Neb.
Mark Pryor D Ark.
John D. Rockefeller IV D W.Va.
Jon Tester D Mont.
Jim Webb D Va.

It is ever more remarkable, in retrospect, that much of the discussion on the left following the passage of the ACA consisted of complaints about how Obama/Pelosi/Reid could “only” pass the ACA. This is, on one level, understandable, given that the ACA is unmistakably inferior to the baseline established by other liberal democracies. But this collection names should make clear than when evaluating the work of the Democratic leadership this baseline is irrelevant. The question is not why Obama/Pelosi/Reid couldn’t nationalize the American health insurance industry. The question is how they were able to get this rogue’s gallery — each and every one of whom had a veto — to agree to the most important progressive social welfare legislation passed since the Johnson administration. And note too that the only senator who is clearly more conservative than necessary to win election in the state is Holy Joe, who wasn’t the Democratic candidate but won because while the Democratic candidate would have been a better senator as a campaigner he made Martha Coakley look like FDR. (Webb is more conservative than you need to be elected statewide in Virginia now, but this was much less true in 2008.) The coalition that passed the ACA included three senators from the Dakotas, one each from Indiana and Arkansas, and two each from Montana and West Virginia. Glib “BE MORE LIBERAL!” exhortations don’t really help you to get liberal governing majorities in an institution that heavily favors conservative rural interests.

Comprehensive health care reform is brutally hard, as Truman and Johnson and Clinton can tell you. In addition getting the list of legislators above, the Democrats also needed to keep in the fold every liberal who was well aware that the ACA was substantially suboptimal. Senators like Bernie Sanders and Sherrod Brown deserve enormous credit for working to make the bill as it could be and then supporting it. The Republicans just completely failed with a more homogeneous coalition in the more top-down chamber. What the Democratic leadership pulled off in 2009 is remarkable, and we now know that it is an enduring accomplishment.

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