The real hero of health care reform: Nancy Pelosi

The House’s passage Sunday night of a reform package will inevitably be seen as President Obama’s biggest achievement, whether he goes on to serve two distinguished terms or is voted out in 2012. Given the magnitude of the legislation and how long it has eluded the grasp of all of Mr. Obama’s modern predecessors, this distinction is certainly merited.

That said, the ratification of healthcare is an even more impressive victory for House Speaker Nancy Pelosi. Faced with an endless litany of institutional roadblocks, false starts, egocentric members, and plain political pressures, Ms. Pelosi was able to wrangle together just enough votes to push reform to the finish line. It is Pelosi who deserves the most credit for seeing healthcare through.

The stakes implicit in the endgame of healthcare were politically momentous for House Democrats: After publicly grousing and debating it for over a year, failure to pass anything would have potentially cost their party control of Congress. To be sure, healthcare reform has become less and less popular as the process has lurched along, but if there is one thing more unattractive to voters than unpopular initiatives, it is looking weak.

Had the House not been able to tackle healthcare once and for all, majority Democrats would have looked utterly impotent and not deserving of full control of the government.

In other words, Pelosi faced enormous consequences for failure. Everyday politics is like professional sports: both are zero-sum games where winning is the only thing that matters and losing is unacceptable. But healthcare politics is more like March Madness: Win or go home. Pelosi had to deliver a majority not just for her party and her president, but for herself, as defeat could have hastened the end of her speakership.

Pelosi faced other immense obstacles, including:

•Sharply competing viewpoints in her own caucus between dominant progressives and recalcitrant pro-life Democrats who composed a crucial bloc of votes.

•A deeply heterogeneous Democratic caucus: regionally, ethnically, politically, ideologically.

•Little help from a rudderless White House operation that struggled to plot a course toward passage and stick to it.

•A Senate seemingly incapable of substantive movement, seeding anger and distrust in the House.

•A united Republican opposition and antireform outside lobbying effort.

•The typical electoral considerations on the mind of every member in an election year, exacerbated by national resistance to Democratic reform and the shocking victory of Sen. Scott Brown in Massachusetts.

1 | 2

Next