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Nancy Pelosi’s Theory of Change

House Speaker Nancy Pelosi is a longtime advocate for universal health care. She’s also demonstrated that she has a good feel for the politics of her chamber and her party, simply by passing so many major pieces of legislation this year. So when Pelosi says that the votes to pass a public option in health care reform just aren’t there, I assume she’s right—or, at the very least, that she’s more likely to be right about it than, say, I am.

Apparently not everybody thinks that way.  Last week, after Pelosi made clear the public option would not be part of the final House-Senate compromise on health reform, some public option advocates turned on her. And, on Monday, a coalition of three liberal groups, led by the Progressive Change Campaign Committee, launched television ads attacking her. 

It’s something of an extreme reaction; most liberal groups are focusing on the bill at hand—and doing everything they can to pass it. But the reaction of the public option groups (and those who agree with them) is, I think, indicative of a lingering ambivalence over reform on the left. And it’s something Pelosi addressed directly on Monday, in a roundtable with bloggers.

She did so, mostly, by focusing on how much the bill would expand health insurance coverage and help the American economy—argument certainly familiar to anybody who’s followed this debate but still, strangely, underappreciated by many on the left. “31 million Americans” she said, over and over again, referring to the number of previously uninsured people who would get coverage if reform passes.

But she made a more subtle point, too. “Think of what it does to the other side, who do not believe in government,” Pelosi said. “This will now be the legitimate political debate in our country. What is the balanced role the government should have in controlling the cost, of expanding the coverage, holding the insurance companies accountable.” In other words, the full measure of this bill isn’t simply the impact it will have on lives in the short- to medium-term. It’s also the impact it will have on politics.

Republicans say they welcome this debate--because, they say, government’s inevitable failure will reinforce their worldview. But the historical record on this is pretty clear: One government makes a promise of something like health benefits, that promise never gets revoked. (This is why Bill Kristol famously advised Republicans to oppose Clintoncare in 1993 and 1994.) And if enacting reform manages to make more ambitious changes possible later on, Pelosi made clear she intends to seize that opportunity: “Now we go from here. We kick open that door and there will be other legislation to follow.”

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