Amidst the understandable relief among Democrats at the passage of health care reform by the House, there’s been relatively little talk about the Democrats who still voted “no.” But 34 of them did, and fortunately, Nate Silver of 538.com took a close look at factors that might have explained the residual defections.
Nate concludes that Obama’s 2008 share of the vote in each Members’ district, their general ideology, and their views on abortion, were the variables most highly correlated with a “no” vote. Variables that didn’t make as much difference include the competitiveness of the Members’ own races, the number of unisured in their districts, and campaign contributions by insurance industry lobbyists.
It’s not that surprising that all 12 House Democrats representing districts where Obama won less than 40% of the vote in 2008 voted “no,” or that 61 of the 63 representing districts where Obama won over 60% voted “yea.” But 13 of the 30 from districts where Obama won more than 40% but less than a majority voted “no.”
Despite Bart Stupak’s decision to support the bill at the last minute, it’s significant that 24 of the 34 “no” votes in the House were Members who voted for the original Stupak Amendment. Putting it another way, supporters of the Stupak Amendment split 37-24 in favor of the bill, while opponents split 182-10.
Ideologically, Nate uses the Poole-Rosenthal system to break down Democrats, and shows that “roughly the 110 most liberal Democrats voted for the health care bill.” That’s pretty amazing when you consider the unhappiness over the bill expressed by so many self-conscious progressives once the public option dropped out. Those categorized as “mainline Democrats” in the Poole-Rosenthal typology went for the bill 48-2, and “mainline-moderates” voted for it 44-7. In the most rightward category–“moderate-conservative”–Members split right down the middle, 25-25.
All the other variables don’t quite have the salience of Obama vote share, ideology, or abortion position. That should be at least mildly comforting to those Democrats who feared that pure political self-protection or insurance industry money were the major motivating factors for those voting “no.” And it’s very clear that the Democratic Left’s decision to support the bill despite concerns over its composition was absolutely crucial.

Today we learn that a coalition of State Attorneys General–12 so far–plan to launch a constitutional challenge to the just-passed-but-not-yet-signed Senate health reform bill on grounds that imposing an individual mandate to buy health insurance is not justified by the powers Congress enjoys under the Commerce Clause of the U.S. Constitution.
Interestingly enough, the media reports I’ve seen on this story do not mention that eleven of the twelve AGs in question are Republicans. The one Democrat, Drew Edmondson of OK, is running for governor in this very conservative state.
FWIW, few constitutional experts find any merit for a Commerce Clause challenge to health reform. But the proposed suit is probably part of a longstanding conservative legal effort to slowly chip away at the expansive view of the Commerce Clause, which has been the basis for a variety of important congressional actions, including the Civil Rights Act.
While the challenge is unlikely to get anywhere, it is worth remembering that there wasn’t much if any precedent for the decision in Bush v. Gore, either.

Just over a month ago, Jon Chait of TNR predicted that conservatives would “freak out” if and when health reform legislation was indeed enacted. Aside from the fact that many of them have been drinking their own kool-aid about the allegedly totalitarian implications of a health care system that would maintain America’s uniquely capitalist orientation towards health services, conservatives spent far too much time and energy celebrating the death of reform to accept its resurrection.
I don’t believe in spending too much time on schadenfreude, but it has been interesting to see the absolute shock with which some conservatives and tea party activists have reacted to last night’s vote. My favorite reaction is this from Newt Gingrich, posted on the Human Events site:

This will not stand.
No one should be confused about the outcome of Sunday’s vote
This is not the end of the fight it is the beginning of the fight.
The American people spoke decisively against a big government, high tax, Washington knows best, pro trial lawyer centralized bureaucratic health system
In every recent poll the vast majority of Americans opposed this monstrosity
Speaker Pelosi knew the country was against the bill. That is why she kept her members trapped in Washington and forced a vote on Sunday.
She knew if she let the members go home their constituents would convince them to vote no.
The Obama-Pelosi-Reid machine combined the radicalism of Alinsky, the corruption of Springfield and the machine power politics of Chicago.
Sunday was a pressured, bought, intimidated vote worthy of Hugo Chavez but unworthy of the United States of America.
It is hard to imagine how much pressure they brought to bear on congressman Stupak to get him to accept a cynical, phony clearly illegal and unconstitutional executive order on abortion. The ruthlessness and inhumanity of the Obama-Pelosi-Reid machine was most clearly on display in their public humiliation of Stupak.

Hugo Chavez! Saul Alinsky! A six-adjective sentence (“big government, high tax, Washington knows best, pro trial lawyer centralized bureaucratic health system”)! The end of civilization as we know it!
This is the same Newt Gingrich, mind you, who led a Republican-controlled Congress over the brink in 1995 and 1996 in the pursuit of extremely unpopular policies, arguing he had a mandate from the electorate to carry out a conservative revolution. And this is the same Newt Gingrich who increased the power of the Speaker’s Office to levels not seen since the days of “Czar” Reed, all but abolishing the seniority system and making loyalty to the Speaker and the Caucus’ agenda the only criterion for advancement. As for “intimidation”: wonder what Gingrich thought of those Republicans who placed photos of defeated 1994 Democrats on the seats of wavering Democratic Members yesterday?
Gingrich’s crocodile tears for Bart Stupak are even more ludicrous. Stupak made himself a national celebrity by creating a symbolic fight over essentially inconsequential language differences in the House and Senate provisions on abortion. Yesterday he accepted a symbolic victory that was equally inconsequential, and folded his tent. I can’t imagine how Obama, Pelosi and Reed were guilty of “ruthlessness and inhumanity” by accepting his face-saving deal.
Newt was almost certainly playing for the galleries where his heart really lives these days: among potential 2012 caucus-goers in Iowa, a right-tilting crowd if ever there was one. And speaking of Iowa Republicans, Rep. Steve King outdid Gingrich in his remarks to a crowd of Tea Party protestors outside the Capitol last night:

“You are the awesome American people,” said King. “If I could start a country with a bunch of people, they’d be the folks who were standing with us the last few days. Let’s hope we don’t have to do that! Let’s beat that other side to a pulp! Let’s chase them down. There’s going to be a reckoning!”

It’s interesting how King alternates between a threat of violence and a threat to leave this godless socialist country behind and take the “real Americans” with him.
Let’s hope Republicans get a grip over the next few days.

So at 10:43 EDT, the 216th vote was cast for the Senate’s health care bill, which means, no matter what happens on the reconciliation bill later tonight in the House or later in the year in the Senate, the largest health reform legislation since the enactment of Medicare in 1965. The final vote was 219-212, or three votes more than the minimum necessary.
As Jerry Garcia might have said: “What a long strange trip it’s been!”

We’re now minutes away from the first vote on the Rule for consideration of health care reform in the House, with all the signs pointing towards victory, particularly now that the White House has cut a deal with Rep. Bart Stupak involving an executive order that the abortion provisions of the Senate bill mean what they say and do not involve some back-door unravelling of the long-standing Hyde Amendment prohibiting use of federal funds for abortions.
If you get restless during the debate that will unwind for the next several hours, you could check out an episode of Bloggingheads TV wherein my friend Sarah Posner and I discussion the relationship between the Tea Party Movement and the Christian Right. We agree that the two movements are more compatible than they sometimes appear; that they are feeding on each other’s extremism; and that perpetual predictions of the Christian Right’s demise remain premature.

As we count down towards the health reform vote(s) in the House, it’s clearer than ever that there are two distinct but mutually reinforcing conservative takes on the bill. The most obvious, of course, is the bizarre construction of “ObamaCare” that the Right has been building for nearly a year now, based on distortions, fear-mongering, a few outright lies, and sweeping smears, all in order to make legislation pretty close to what moderate Republicans have promoted for years seem like a socialist revolution if not a coup d’etat. This is the hard sell, and it will continue up to and well beyond this weekend’s votes.
But then there’s the soft sell, beloved of today’s model of “moderate” Republicans, such as they are, which involves lots of tut-tutting at the unedifying spectacle of the health reform debate, constant if unsupported claims that there are plentiful opportunities for a bipartisan “incremental” approach, and above all, phony concern for what Barack Obama is doing to his party and his country. This approach typically ignores or rationalizes the hard sell that most conservatives have undertaken, and the lockstep obstructionism of the congressional GOP, and blames Obama and Democrats for all the problems they are encountering in getting this legislation done.
A pitch-perfect example of the soft sell is Peggy Noonan’s latest Wall Street Journal column, presumably her final pre-vote expression of contempt for the president in the guise of respect for the presidency, which alas, isn’t what it used to be when her mentor, Ronald Reagan, stood astride Washington and the globe like a colossus.
The column begins with an extended expression of horror that Obama would postpone a trip to Indonesia and Australia in order to lobby for this little domestic bill that would deal with the trifle of health coverage for 40 million or so Americans:

And to do this to Australia of all countries, a nation that has always had America’s back and been America’s friend.
How bush league, how undisciplined, how kid’s stuff.

It’s characteristic that Noonan does not mention that Obama is trying to give Americans the universal health coverage that Australians have and take for granted, or that final passage wouldn’t have been delayed until now if Scott Brown hadn’t come to Washington pledging to kill “ObamaCare.”
Noonan then engages, with the air of someone examining an especially loathsome insect, in a lengthy attack on the procedural issues involved in House passage of health reform, asserting that Obama’s trying to hide something in the legislation via the “deem and pass” (which she suggests sounds tellingly like “demon pass”) mechanism that House Democrats are apparently going to deploy this weekend. She endorses as self-evidently correct the complaint of Fox News’ Bret Bair, in his obnoxious interview of the president last week, that “deem and pass” means nobody will know what’s in the bill that’s “deemed” and “passed.” Like Bair, Noonan doesn’t seem to understand the simple fact that the underlying bill we are talking about here is exactly the same bill passed by the Senate in December–long enough even for Peggy Noonan to have gotten wind of it. The changes in the bill–namely, the reconciliation measure–were made available, along with a CBO scoring of their impact, before the votes were scheduled, and will be voted on explicitly by the House (and later the Senate). Yes, this is complicated, but you’d think someone with Noonan’s experience and pay grade would be able to figure it out, and again, Democrats would have never resorted to this approach if Republicans weren’t using their 41st Senate vote to thwart the normal process after a majority in the House and a supermajority in the Senate had already passed similar legislation.
But whatever; Republican obstruction is never much mentioned in Noonan’s stuff on health reform. And so it is entirely in character that Noonan concludes her column by blaming Obama for the rudeness exhibited by Bair in last week’s interview, and hence for diminishing the presidency! Ah, if only we had a real president like you-know-who:

[W]e seem to have come a long way since Ronald Reagan was regularly barked at by Sam Donaldson, almost literally, and the president shrugged it off. The president—every president—works for us. We don’t work for him. We sometimes lose track of this, or rather get the balance wrong. Respect is due and must be palpable, but now and then you have to press, to either force them to be forthcoming or force them to reveal that they won’t be. Either way it’s revealing.

I’d say it’s hardly as revealing as Peggy Noonan’s inveterate habit of not only ignoring conservative hubris, but attributing it to its victims.

Over at TNR, congressional expert Sarah Binder provides a very useful and detailed explanation of the procedures the House will go through this weekend in dealing with health reform. There will be (assuming things go as planned and Democrats have their votes) four separate votes: one on a Republican motion to recommit the rule for consideration of the reconciliation bill, one on the rule itself, one on a Republican motion to recommit the reconciliation bill, and one on the reconciliation bill. If the first or third motions pass, or the second or fourth votes fail to pass, health reform will have been defeated, at least for the moment if not forever.
But it’s the vote on the rule that will (assuming the Rules Committee goes in the direction Speaker Pelosi has indicated is likely) “deem” the Senate health care bill as having been enacted. This “self-executing rule” is what all the yelling and screaming on the Right is about. But since everybody understands what’s going on, it is fundamentaly erroneous to say that the House is trying to avoid a vote on the Senate bill. The vote on the rule is a vote on the Senate bill, and will have exactly the same effect as an explicit vote on the Senate bill, no more and no less.
That fact obviously does raise the question of why the House leadership is utilizing the “deem and pass strategy,” since anyone voting for the rule is actually voting for the Senate bill. I can’t answer that question, but presumably this basically meaningless distinction matters to at least one House Democrat. But in any event, the conservative charge that the House is going to enact the Senate bill without voting on it just isn’t true, and is simply part of the fog Republicans are trying to spread over the fact that by the end of this process (again, if all goes as planned), majorities in both Houses will have twice approved health reform.

There’s been some interesting talk going on this week involving assessment (in the wake of the collapse of progressive resistance to the final health reform bill) of “the Left’s” strategy on health reform, particularly in terms of the ultimate emptiness of threats from progressive House Democrats that they would vote against any bill that didn’t include a “robust” public option.
Glenn Greenwald argues that progressives have once again exposed–and possibly even increased–their “powerlessness” within the Democratic Party. Chris Bowers challenges the premise by arguing that progressives did secure significant changes in the Senate bill, most notably the agreement to “fix” it, which certainly wasn’t the path of least resistance.
Meanwhile, Armando of Talk Left has compared the lack of leverage of progressives over items like the public option to the success of the labor movement in forcing concessions on the “Cadillac tax.” And Nate Silver has responded by arguing that progressive threats didn’t work because they weren’t credible in the first place.
I think everyone in this debate would agree that it’s generally a bad idea in politics to make threats you are entirely unwilling to carry out, but the real division of opinion on on whether such threats should be tempered or in fact intensified. But Nate makes one point that bears repeating: the political value of aggressiveness and posturing can and often does get exaggerated.

It feels good to assert that progressives just need to be tougher — perhaps even to the point of feigning irrationality. These arguments are not necessarily wrong — a reputation for being tougher bargainers would help at the margins — but it misdiagnoses the problem on health care. The progressive bloc failed not because of any reputational deficiency on the part of the progressives but because their bluff was too transparent — they claimed to be willing to wager enormous stakes (health care reform) to win a relatively small pot (the public option). That would have been beyond the capacity of any poker player — or activist — to pull off.

I’ve never much liked the strain of progressive analysis that endlessly promotes “fighting” and “spine” and “cojones” as the answers to every Democratic political problem. Sometimes “brains” or “heart” are more important, and moreover, if politics is reduced to a willingness to project brute force, the bad guys are going to win every time; it’s like getting into a selfishness competition with the Right–we’ll never win. But in any event, however you feel about the Will to Power theory of politics, Nate’s right, people aren’t all stupid, and macho posturing by progressives when it doesn’t make sense isn’t going to convince anybody. Poker playing is a relatively small and overrated part of politics. Real conviction and strategies based on conveying those convictions to friends and potential friends are the best building blocks for successful strategy.

After the exhausing and endlessly complicated process of developing and reacting health reform legislation, it’s natural to think of the final bill as an unholy mess, full of deals and compromises all but forgotten. But in a fundamental way, the bill is actually something of a thing of–well, not beauty, but certainly impressive craftmanship. Here’s Ezra Klein’s excellent summary of the accomplishment:

This was a hard bill to write. Pairing the largest coverage increase since the Great Society with the most aggressive cost-control effort isn’t easy. And since the cost controls are complicated, while the coverage increase is straightforward, many people don’t believe that the Democrats have done it. But to a degree unmatched in recent legislative history, they have.

Add in the fact that the bill reduces the federal budget deficit (which Republicans didn’t even attempt to do with their own major health care legislation of the last generation, the Medicare prescription drug benefit), and it really does offer something to both liberals and conservatives. And that’s why its opponents are so often resorting to lies (death panels), slurs (claims that the nonpartisan CBO is somehow cooking the books), threats (intimidation of vulnerable members of Congress) and meaningless agitprop (“socialism,” “government takeover of one-sixth of the economy”). We’re now well beyond the point of persuading much of anyone on the merits, but those Members of Congress who vote for this bill have reason to feel proud, for all the agony and sometimes disappointment that has accompanied the process. When you get down to brass tacks, it’s a major accomplishment.

Given the importance of Rep. Bart Stupak (D-MI) and his allies in the struggle for health care reform in the House, it’s worth thinking a bit about what actually makes him tick. A very revealing moment came yesterday, when Stupak blew off a communication from Catholic religious orders representing 59,000 Catholic nuns urging approval of the health reform bill. According to Fox News’ report of Stupak’s reaction:

The conservative Democrat dismissed the action by the White House saying, “When I’m drafting right to life language, I don’t call up the nuns.” He says he instead confers with other groups including “leading bishops, Focus on the Family, and The National Right to Life Committee.”

Stupak’s meaning couldn’t be clearer: in figuring out his position on health reform, he’s not identifying with fellow Catholics who are struggling to balance various ethical considerations; he’s acting as an agent for the Right-To-Life Movement and its often-machiavellian political game plans. It’s particularly interesting that he mentioned Focus on the Family, the right-wing evangelical Protestant “ministry,” as a greater influence on him than 59,000 nuns.
Why does this matter? Well, aside from the fact that any serious ethical review of the bill has to include the positive impact of reform on maternal and childhood health, it’s also pretty clear that the net effect of the bill will be to reduce federal subsidies for abortion. As Matt Yglesias reminds us today, current law massively subsidizes abortions via the tax exclusion for employer-sponsored private health insurance, which frequently includes abortion coverage. By encouraging (especially over time) people to move from employer-sponsored coverage to the new health exchanges for individual coverage, which under the Senate language will make insurance for abortion exceptionally inconvenient, it’s a sure bet that the overall use of federal money to pay for policies that include abortion services will decline. Indeed, a group of twenty-five prominent pro-life Catholic and Protestant leaders recently penned a letter describing claims that the pending bill would expand abortion subsidies as “misinformation.”
So official right-to-lifer opposition to the health reform bill isn’t really “about” abortion. It’s “about” the desire of the Right-To-Life political movement to score a big symbolic triumph, and it’s “about” the non-abortion political agenda of some of the movement’s constituent members. For a group like Focus on the Family, to which Stupak listens so closely, that agenda includes the Republican takeover of Congress and a wide variety of right-wing policy measures that have zero to do with abortion.