Amazing what a little history-making legislation can do for your image. As others have already pointed out, the media narrative of the Obama presidency has undergone a wholesale revision in the wake of the House’s passage of health care reform legislation. Gone are the accounts of a flailing presidency and a Democratic Party headed for doom in November. In their place are breathless stories about an administration pulled back from the brink, and a presidency on its way to becoming one of the most consequential in the nation’s history.

It’s far too early to make a judgment of Obama’s legacy, of course. But the stories of triumphant Democrats are all too real and affirm what those who’ve been advocating for reform have been saying: winning does a party good. November may still look ugly for Democrats – historically, the out party has gained seats in a new president’s first midterm election – but passing their top domestic priority will rally the base and give them a fighting chance to keep losses to a minimum.

More than firing up a disillusioned base for the election, the passage of health reform also gives the American public an image of a triumphant Democratic Party. And if there’s one thing Americans like, it’s winners. Before the passage of health care reform, polls showed a majority viewing it unfavorably. In the wake of Sunday’s historic win – and, no less important, headline after headline about that historic win – the first Gallup poll to come out on health care now has the numbers flipped: 49 percent now call reform a “good thing,” versus 40 percent saying it was a “bad thing.” As the president is poised to go on the road to do some more barnstorming for the plan, expect those numbers to inch up some more.

One of the healthiest effects health care’s passage will have on Democrats politically is that it will likely give President Obama’s approval rating a boost. According to Nate Silver’s analysis, the correlation between a president’s approval rating prior to the midterms and his party’s performance at the polls is actually very strong. Today, President Obama’s approval-disapproval rating on Gallup’s daily tracking poll sits at 51 percent-43 percent; just a few days ago, it was at 46 percent-47 percent.

It’s early yet, of course, and capricious as the CW machine is, the narrative could change at any time. The bounce may prove to be evanescent. But compared to where the Democrats were before Sunday, it’s fair to say that health care reform was not just good policy but good politics as well.

Republicans have been gnashing their teeth and rending their garments, lamenting the landmark passage of health care reform late Sunday night. The Tea Party wing of the party has been vowing that this isn’t the end of the fight over healthcare — it’s just the beginning.

While House Minority Leader John Boehner’s response to the health care bill (not least its tax hike on tanning salons) has been a “hell no,” the more pragmatic thinkers on the other side of the aisle have been bemoaning the GOP’s Waterloo. David “Axis of Evil” Frum, who coined the “Waterloo” phrase, has laid out some constructive responses Republicans can take up on health care — and he’s making more sense than most in the party of Lincoln.

Frum outlines four ideas that Republicans should get behind:

1) One of the worst things about the Democrats’ plan is the method of financing: an increase in tax on high-income earners. At first that tax bites only a very small number, but the new taxes will surely be applied to larger and larger portions of the American population over time.

Republicans champion lower taxes and faster economic growth. We need to start thinking now about how to get rid of these new taxes on work, saving and investment — if necessary by finding other sources of revenue, including carbon taxes.

2) We should quit defending employment-based health care. The leading Republican spokesman in the House on these issues, Rep. Paul Ryan, repeatedly complained during floor debate that the Obama plan would “dump” people out of employer-provided care into the exchanges. He said that as if it were a bad thing.

Yet free-market economists from Milton Friedman onward have identified employer-provided care as the original sin of American health care. Employers choose different policies for employees than those employees would choose for themselves. The cost is concealed.

Wages are depressed without employees understanding why. The day when every employee in America gets his or her insurance through an exchange will be a good day for market economics. It’s true that the exchanges are subsidized. So is employer-provided care, to the tune of almost $200 billion a year.

3) We should call for reducing regulation of the policies sold inside the health care exchanges. The Democrats’ plans require every policy sold within the exchanges to meet certain strict conditions.

American workers will lose the option of buying more basic but cheaper plans. It will be as if the only cable packages available were those that include all the premium channels. No bargains in that case. Republicans should press for more scope for insurers to cut prices if they think they can offer an attractive product that way.

4) The Democratic plan requires businesses with payrolls more than $500,000 to buy health insurance for their workers or face fines of $2,000 per worker. Could there be a worse time to heap this new mandate on smaller employers? Health insurance comes out of employee wages, plain and simple. Employers who do not offer health insurance must compete for labor against those who do — and presumably pay equivalent wages for equivalent work.

The first point is red-meat, tax-cutting rhetoric for the Republican base – not much to see there.

The third point is very broad, but middle ground could be easily reached. Everyone is against “over-regulation” but everyone is for “consumer protection.” Finding the middle ground to give patients the best set of alternatives should be a key goal as the regulations of health-exchanges are spelled out.

The fourth and final point, while a good-faith effort to protect engines of job creation from additional burden, misrepresents the small business coverage of the health care reform bill. The small business provisions of the bill exempt companies with less than 50 employees. The only way Frum’s payroll figure would make sense is if each employee was being paid $10,000 a year. At that point they’re eligible for health care subsidies of almost $50,000 for a family of four.

But it’s Frum’s second point that progressives should consider. Employer-based health care has been a long-term roadblock to innovation and job creation. (The whole story can be heard here.) Moving from a system where insurers try to sell packages to employer HR departments to one where patients can make choices themselves on the exchanges envisioned in Sunday’s historic bill can save up to 40 percent of what we’re spending on health care. But many of us getting health care through our employers don’t have the option to look to the exchanges. (The Washington Post has a handy tool you can use to see what your health care options will be come 2014.)

We should take sensible Republicans like Frum at their word and look to give more people the opportunity to embrace the benefits of choice that will be brought around by health exchanges. Maybe by getting behind an idea like the Wyden proposal we can get Republicans like Frum to embrace the president’s vision of working in a bipartisan manner.

Photo credit: https://www.flickr.com/photos/urbanmixer/ / CC BY-NC 2.0

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 uninsured 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 percent of the vote in 2008 voted “no,” or that 61 of the 63 representing districts where Obama won over 60 percent voted “yea.” But 13 of the 30 from districts where Obama won more than 40 percent 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.

This item is cross-posted at The Democratic Strategist.

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 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 Reid 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.

This item is cross-posted at The Democratic Strategist.

They took the scenic route, but they got there. After a year of negotiations, town halls, summits and shouting, Democrats have passed comprehensive health care reform legislation. The reform measure passed by the House Sunday now goes to President Obama’s desk for his signature. The House’s fixes inscribed in a separate bill will now be taken up by the Senate, and is expected to pass via the budget reconciliation process.

The outcome certainly affirms President Obama’s reputation as a clutch player – someone who’ll come through when you need him the most. Of course, the game probably wouldn’t have been that close if he hadn’t sat out for so long. This is where I hope the Obama administration has learned its lesson. Throughout the process, the president decided to take a hands-off approach, letting Congress do much of the work. It was a strategy borne of the failure of President Clinton’s plan, which was seen as a case of a White House completely oblivious to how Congress works. But Obama overcompensated, and the result was a process that seemed rudderless.

Worse, the hands-off approach extended to the bill’s selling. Confident that it was the right policy, the administration was complacent that the media and the public would see that it was the right thing to do as well. What we got instead was tea parties and town halls and “death panels.” In the absence of a permanent campaign to enlighten the public, misinformation ruled the day — and continues to infect public understanding of what just passed.

Which is why this is a good sign:

President Obama is set to begin an immediate public relations blitz aimed at turning around Americans’ opinion of the health-care bill.

Planning inside the West Wing for the post-vote period has proceeded quietly, even as the president and his allies on Capitol Hill were fighting for the measure’s passage.

Reshaping the legislation’s image will take place in three phases, White House aides said: the immediate aftermath; the seven months until the November midterm elections; and the several years that follow, during which many provisions in the measure will gradually take effect.

The plans for a PR blitz to sell the bill post-passage suggest an administration that has learned its lesson. Polls show that support for health care reform, particularly among Dems, began inching up the more Obama threw himself into its passage. It was a powerful reminder: when Obama commits himself to firing up the base, the base tends to get fired up. The promise of an all-out publicity campaign by the White House probably also assuaged a lot of wavering Democratic congressmen. As Nate Silver points out, one of the best predictors of whether a congressman would vote for the bill was whether they thought Obama would be an asset to them.

He may be known as No Drama Obama, but the president supplied plenty of it these last few weeks, with a bipartisan summit, rousing public appearances and quiet one-on-ones with recalcitrant Dems, culminating in a tour-de-force address to House Democrats on Saturday. The result was a pitch-perfect campaign that rallied progressives, bucked up public opinion, and emboldened lawmakers.

This administration has the best salesman in the country at the helm. When he talks, people – at least the converted and the persuadable – tend to listen. It seems like they’re finally starting to figure it out.

Health care reform legislation, declared dead so many times by its enemies and sometimes its friends, became an accomplished fact last night via House enactment of the Senate-passed bill. The House also passed the closely associated reconciliation bill “fixing” the Senate bill, and final action on that measure in the Senate will take a while. But no matter: the most important health care legislation since the enactment of Medicare in 1965 is on its way to the president’s desk. It will ultimately provide coverage for 32 million people lacking health insurance; will finally outlaw the denial of insurance (or outrageous premiums for) those with pre-existing conditions, beginning with children; will undertake the most serious effort yet to move the health care system from payment for procedures to payment for good health results; and is estimated to reduce federal budget deficits by $120 billion in its first decade. For dessert, the bill closes the arbitrary “donut hole” for the Medicare prescription drug benefit.

The winding road leading to this accomplishment almost defies description, particularly after Republicans gained a 41st seat in the Senate in January and with it the ability to veto any legislation that didn’t proceed under budget reconciliation rules. After endless mockery for their handling of the issue last year, the administration and the Democratic congressional leadership all earn a great deal of credit for the ultimate victory: Harry Reid for getting all 60 Senate Democrats on board for a bill in December; Nancy Pelosi for the deft negotiations that produced 219 votes in the House; and the White House and the president for refusing to heed a thousand calls to totally revamp or abandon the legislation.

And despite the many conflicts among Democrats over the composition of the ultimate bill, it’s significant that joy over the vote last night extends all across the party, from single-payer fans to managed competition advocates to all sorts of people focused on narrow issues. It appears we owe a special thanks to the Catholic nuns whose strong support for the legislation seems to have shamed Rep. Bart Stupak and several other House colleagues into a face-saving deal on abortion language, mainly a symbolic gesture offered to secure real live votes.

Now Republicans, of course, are predicting a huge public backlash and then a quick repeal of the legislation if and when they retake control of Congress. There will be a lot of noise made in the days just ahead by Tea Party activists who have become invested in apocalyptic rhetoric about the dangers of health reform, and perhaps others who have bought some of the lies and distortions conservatives deployed to fight this legislation, from wild claims about “death panels” to pervasive predictions that premiums will skyrocket and Medicare benefits will be cut. When these disasters don’t occur, much of the negative excitement will die down, even as the merits of health reform become more apparent.

As for threats that the bill will soon be repealed: the very tools of obstruction that Republicans so eagerly utilized to try to thwart health reform will be available to those trying to stop its repeal. Will 60 senators vote to withdraw health coverage from tens of millions of Americans any time soon? Will 60 senators go to the mats to re-establish the “right” of insurance companies to deny coverage to children with pre-existing health conditions? Will Republicans vote to re-open the Medicare prescription drug “donut hole”? Where will they find the funds to offset elimination of health reform’s deficit savings? Maybe they ignored the president’s recent arguments about how the most popular reform measures won’t work without a comprehensive approach. But if Republicans try to repeal reforms piece-meal, they’ll finally figure out what he was talking about.

All in all, it’s clear that President Obama and most congressional Democrats did one thing that cynical voters don’t much expect of politicians these days: they kept a promise to meet one of America’s most urgent national challenges, and they kept it despite a collective Republican decision against any cooperation, despite vast institutional barriers in the Senate, and despite predictable public nervousness about — and, for many, hostility towards — comprehensive action on such a complex issue.

That’s an accomplishment worth celebrating, extending and, if necessary, defending. Let’s prove America’s not ungovernable after all.