U.S. Poised to Pass Health Care, but at What Cost?

The Senate's 1 A.M. vote may have finally cleared the way, but the year-long battle demanded many sacrifices

In itself, the Senate's 1 A.M. vote on health care reform accomplished little legislatively, but symbolized a great deal. Sixty Senators joined to defeat a Republican filibuster aimed to block a procedural matter on health care legislation. The vote was seen as a test to demonstrate that Senate Democrats have the votes needed to pass reform. Sen. Chuck Schumer, a health care proponent, said, "The die is cast. It's done." Barring the defection of any "yes" votes, the Senate is now on the path to passing the bill, perhaps as early as Christmas. After this, the bill will have to be merged the House's more expansive version, and it can be given to President Obama for signing.

All of this makes this morning's vote a tremendous victory for Democrats and supporters of reform. But the year-long road to the vote has been filled with battles and compromises, and Democrats have given up much along the way. From abortion rights to bipartisanship, what have we sacrificed to make it here?

• End Of Senate's Historical Bipartisanship  The New York Times's Carl Hulse and David Herszenhorn lament, "A year that began with hopes of new post-partisanship has indeed produced change: Things have gotten worse." They recount, "Nasty charges of bribery. Senators cut off midspeech. Accusations of politics put over patriotism. Talk of double-crosses. A nonagenarian forced to the floor after midnight for multiple procedural votes. [...] Enmity and acrimony are coursing through a debate with tremendous consequences for both sides as well as for the legislative agenda in the months ahead." This has "shattered some of the institution’s traditional collegiality."

• Democrats Lost Much Political Capital  The Atlantic's Marc Ambinder evaluates. "The bruising year-long battle has left the Democratic party divided, has expended virtually all of the president's political capital, and the legislation's fidelity to the goals sketched by candidate Obama are questionable." Senate Majority Leader Harry Reid "will have sacrificed his power for the sake of a bill -- for the sake of President Obama's presidency." He writes of Obama, "When his chief of staff, Rahm Emanuel, insisted on bringing the hospital, insurance and pharma lobbies, the administration effectively incorporated ideas that were anathema to his party."

• Jeopardized Democratic Agenda  The New York Times's Paul Krugman worries about how "ominously dysfunctional" the Senate has become. "Now consider what lies ahead. We need fundamental financial reform. We need to deal with climate change. We need to deal with our long-run budget deficit. What are the chances that we can do all that — or, I’m tempted to say, any of it — if doing anything requires 60 votes in a deeply polarized Senate?" He adds, "Doing nothing is not an option — not unless you want the nation to sit motionless, with an effectively paralyzed government, waiting for financial, environmental and fiscal crises to strike."

• Eroding Abortion Rights  Female blogger "Riverdaughter" is among the many to blast the bill's provision allowing states to choose to ban all government funding on health care plans that would help pay for abortion services. "With anti-abortion measures, women are not just subject to the state, they are forced to recognize a religious presence in their lives whether they have faith or not," she writes. "In fact, if we’re going to continue to fight about Roe v. Wade for the duration of the Republic, let’s just get rid of it now and re-decide the case based on equality instead of privacy.  Are women equal persons under the law? Do they have the unalienable right to decide for themselves if and when they will be parents?"

• Republicans Became 'Nihilists'  The New Republic's Jonathan Chait argues that Republicans, instead of flat-out opposing everything, could have recognized the inevitability of reform's passage and, by getting involved, made the final bill far more friendly to conservatives. They knew this, but chose to do nothing, making themselves less relevant and legislative nihilists. "The Republicans eschewed a halfway compromise and put all their chips on an all or nothing campaign to defeat health care and Obama's presidency. It was an audacious gamble. They lost. In the end, they'll walk away with nothing."

• $100M 'Cornhusker Kickback' To Nelson  Democratic Senator Ben Nelson's wavering support could have killed reform, so when Democrats included $100 million in provisions specific to Nelson's home state of Nebraska, it didn't look good. Conservative blogger Michelle Malkin fumes at the "Cornhusker Kickback." Nelson's push for strict abortion restrictions makes it worse. Liberal blogger Digby snaps that Nelson has "finally given the liberals in the House a serious, principled reason to walk away." Politics Daily's David Gibson quips, "If the traditional definition of a compromise is a deal that pleases no one, then the newly minted provision on abortion funding in the health care deal that won over Ben Nelson is already a classic."