How to Pass a Health Care Bill

How hard was it to pass Medicare? Harry Truman failed to pass universal health coverage multiple times into the 1950s. John F. Kennedy failed to push Medicare through as a senator, and again as president. Even Lyndon B. Johnson couldn't pass the bill without "unseemly deal-making" and "a big pay-day to hospitals and doctors," writes David Leonhardt in the New York Times. And that was only after his 23-point landslide victory in 1964 coincided with the Democrats picking up their 68th seat in the Senate. In other words, it took a super-duper-majority in Congress and a hugely popular president. Matt Yglesias takes this history as evidence that Democrats needn't cling to the "get it right the first time" mantra.

He's right that passing one health care bill should be considered a beginning, rather than beginning, middle and end, to healthcare reform efforts. But the story above suggests that September represents a truly unique opportunity for the Democrats to pass significant health care reform. This story shouldn't placate liberal Democrats. It should give them nightmares.

If the Democrats' only successful effort to pass health care legislation after 20 years of failure followed landslide presidential and Senate elections, wouldn't that suggest that the Democrats' best chance to pass health care reform this round would be, well, following landslide presidential and Senate elections? You might say, "Hey, the Democrats always have 2010 to pad their majority." That's obviously true, they do have 2010. But recent history suggests that big majorities like this are difficult to maintain (look at '94 for Democrats or 2000, '06 for Republicans), and if health care reform flames out, it doesn't bode well for an even tougher fight on climate change and financial regulation. I'm not saying November 2010 is riding on September 2009. I'm saying I don't see any reason for much patience. How could the road to health reform get any easier for Democrats? How much closer to 1964 can you get?