Public Options and Death Panels: How the Health Care Debate Evolved

Sarah Palin proved in the 2008 campaign that she can make a slogan stick — that pitbull and lipstick comment, and "palling around with terrorists" — and she returns in August 2009 to write on her Facebook page that Obama's health care plan includes a "death panel" (which she puts in quotes for some reason) that will determine who lives and who doesn't. There was no death panel but it didn't matter.

"It was hard to answer because it was hard to simply explain," Schlesinger says. "It was easy to raise people's fears about what might be lurking in this complicated and hard-to-define piece of legislation."

Palin reshaped the debate, mostly by raising the temperature and making health care a do-or-die issue. It was already a partisan debate, and now there was less hope for Democrats that they would be able to get Republicans on board.

A Long and Mostly Boring Meeting

In February 2010, Obama opened up the White House to members of Congress from both parties so they could sit around and talk about the health care plan. The idea was to share ideas, but really the idea was to show that Obama was a mediator, not a demagogue.

For seven hours, Obama and the Democrats debated health care reform with the Republicans. It produced a few fiery exchanges but nothing essential changed.

One thing that Obama learned from Bill Clinton's failure in the 1990s was to be wary of what the Democrats call "GOP scare tactics," be they death panels or government takeovers or raised debts. Afraid that the public would think that the new plan would change their health care coverage drastically, Obama repeated variations of the line, "If you've got a health care plan that you like, you can keep it."

"This was not a masterpiece of democratic debate," said Michael Tanner, a senior fellow at the conservative Cato Institute. "It was a pretty horrible political debate on all sides of this thing."

Smoke-Filled Rooms and Locked Doors

Republicans became upset that Democrats were making deals behind closed doors, after Obama had promised during the campaign that health care negotiations would be televised on C-Span. The Democrats were meeting secretly in the first place because they needed enough votes to pass the thing, but some — like Nebraska's conservative Sen. Ben Nelson and Louisiana's Mary Landrieu — needed some sweetening in the legislation.

The GOP started tossing around the term "Cornhusker Kickback" (there's corn in Nebraska) to characterize the deal-making. Obama told ABC News, "I didn't make a bunch of deals." Either way, it didn't look good.

This whole time, Democrats were unable to get a single Republican to vote for the bill — not even those liberally ladies from Maine. And things got complicated when ...

Republican Named Scott Brown Takes Ted Kennedy's Seat

Ted Kennedy had been a liberal hallmark of the Senate, crusading for health care reform and brandishing a righteous legislative history of brokering disputes between the parties. When he died, a special election was held for his seat, and instead of another Democrat winning, Scott Brown won the open Massachusetts seat.

The Democrats needed 60 votes in the Senate to avoid a Republican filibuster, and now they had only 59. They whined for a while about how the GOP was being obstructionist, that they had a clear majority, that the rules are a little weird anyway, aren't they?

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