The reaction from the kill-billers to the Senate's health care compromise seems to be somewhat muted this afternoon.
One reason may simply be that this is occurring on a Saturday when a lot of people are traveling and a lot of people who aren't traveling are snowed in. But, also, the compromises that Nelson extracted are not especially significant -- the more substantive changes were really wrought by Lieberman. And in fact, there are several changes to the bill that work in the opposite direction.
For instance: the CLASS Act has survived; the ban on lifetime coverage limits was restored; there was no tinkering with the Medicaid provisions; there's some Ron Wyden like amendment to permit workers to opt out of their employer-provided coverage and purchase insurance on the exchanges instead; the abortion language in the Senate's bill is milder than that which is already in the House's (to an extent that may actually be a problem); a provision to allow people to purchase insurance through non-profit programs organized by the OPM was inserted, and some decent medical loss ratios were established.
While the very nature of last-minute negotiations makes it hard to draw straight lines from point A to point B, it seems likely that if the kill-billers had not pushed back so hard against Lieberman, the bill would have been worse -- maybe much worse. It's sometimes said that a good compromise serves to make everyone equally unhappy. I'm not quite sure if that's the case here, but it does seem that Lieberman pushed things very close to the brink, to the extent that Nelson didn't have much leverage. Allow states to opt-out of their Medicaid obligations, for instance, as Nelson was said to have desired, and the unions might have gone from neutral to outright hostile to the bill, the opposition in the progressive blogosphere would have become nearly universal, and even the "wonk bloc" -- people like Ezra Klein and Jonathan Cohn and Paul Krguman and myself -- might have said this was a bridge too far. Nelson certainly could have voted to kill the bill outright, but he wasn't going to succeed in making it substantially more conservative.
From a policy standpoint, indeed, I think the kill-bill / public-option-or-bust strategy has helped to push the bill toward an optimal outcome. Certainly not optimal in the sense of "the best bill that the Senate could possibly have passed", or "the best bill that progressives could have hoped for". But in terms of the best bill that the Senate was actually going to pass, given the 60-vote requirement, an unpopular Congress, and an inexplicably lackluster performance from the White House, this is probably fairly close -- especially if some further concessions can be realized in conference with respect to the magnitude of the subsidies.
With that said, the downside to the kill-bill / public-option-or-bust strategy was not necessarily in terms of producing a suboptimal policy outcome. Rather, it was arguably political, both in terms of having drawn out the process, and in terms of framing the bill in negative terms both during and after its passage. You certainly haven't had a lot of people, outside of the White House and the Congress itself, going on MSNBC or CNN or Fox News and talking about the good that this bill would do. It's been trashed from both the left and the right. Is it surprising that only 30-something percent of the country still supports it?
Politically speaking, indeed, this was a very costly negotiation for the Democrats. Approval ratings for President Obama, for the Democratic Congress, and for the health care bill itself have declined slowly but quite steadily over the course of the past six months, and the Democrats will exit this debate being much more vulnerable in 2010 than they were going in. Some of that was inevitable -- ultimately, you win elections and accumulate political capital for a reason, which is to achieve your policy goals. And health care -- a big, cumbersome piece of policy that does not lend itself well to 30-second soundbyes -- tends to be especially costly from a political capital standpoint. Still, even relative to those diminished expectations, this seems to have gone quite poorly for the Democrats.
Do I blame the kill-billers for that? No, not mostly. Mostly I blame the White House, and most of what blame I don't assign to the White House I assign to Joe Lieberman, and most of what blame I don't assign to Joe Lieberman I assign to Max Baucus. But, it does seem that one of the most significant potential upsides to passing the bill -- motivating the base -- may now be significantly muted.
I mostly don't blame the kill billers for that either, nor do I expect them to cheerlead for a policy that leaves them feeling dissatisfied. But to the extent that some of the opposition on the left has been based on (i) an unrealistic read of the political environment, or (ii) an ill-considered (IMO) desire to use health care as a pawn in a somewhat amorphous long-run power struggle, or (iii) a principally emotional reaction to the intrinsically and inevitably ugly mechanics of compromise -- I do assign them some of the blame for this portion of the political fallout.
But the kill-billers also helped, perhaps a lot, to make this a better, more progressive bill. And that upside will in all likelihood prove to outweigh and outlive the downside.
UPDATE: To clarify a couple of things. Yes, I still think opposing the bill from the "left" on the policy merits is extremely hard to defend and is close to being categorically wrong, and if the kill-billers actually did kill the bill, it would be a catastrophic mistake.
On the other hand, merely threatening to implode the bill so as to strengthen it could obviously be a canny negotiating tactic.
What has actually happened is probably somewhere in between. It seems to me that most of the opposition is, in fact, sincere -- the kill-billers really do think (or perhaps have convinced themselves) that the bill is worse than nothing. They may be wrong -- I think they're very wrong! But ironically, the self-evident sincerity of their position may help to make it more credible -- as a negotiating tactic.