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Convicts and Convictions: Some Lessons From Transportation for Health Reform

wasn’t supposed to go this way. The Democrats had taken both
houses of Congress in 2006 and the presidency in 2008. With a

filibuster-proof majority in the Senate and a sizeable majority in the
House, the decades-long road to Democratic delivery of comprehensive
health reform had finally come to an end (along with conservatism and
the Republican party). President Obama had promised to deliver
health reform—although he allowed that if you liked your existing
arrangements, you could keep them. Polls indicated that Democrats
had maintained their traditional edge over Republicans in public trust
to handle health care. Pharmaceutical companies and insurers had
been bought off or intimidated into silence, ensuring there would not
be a repeat of the “Harry and Louise” commercials that helped sink
the Clinton health reform effort. The path to success
was clear, as long as the Administration let Congress write the bill.
Once Congress enacted the Patient Protection and Affordable Care Act
(PPACA), Democrats would receive the thanks of a grateful
nation, and their electoral dominance would be assured.

The only real question was whether to include a public option to placate
the left; everything else appeared to be a done deal.

intruded, as it always does. The enactment of PPACA was an excruciating
and extended process, with twists and turns that a novelist would have
been embarrassed to include in a work of fiction. Former Senate
Majority Leader Tom Daschle, the President’s first choice to lead
the Department of Health and Human Services and run the health reform
effort, was forced to withdraw his nomination after it emerged that
he had underpaid his taxes by more than $100,000.
Opposition to PPACA led to loud and rancorous public meetings between
legislators and their constituents during the summer of 2009.
Opponents accused proponents of lying about whether people could keep
their health care coverage and whether PPACA would cut Medicare; proponents
accused opponents of lying about “death panels” and the “government
takeover” of health care. The “public option”
was in, then out, then (maybe) back in again. Medicare
for the near-elderly was in, then out.