If health care reform fails, then Obama is toast, and the Democratic brand along with it. Having voted against the bill will provide little cover for moderate Democrats, as the 1994 elections show.
Now, it’s true that you can’t pass an effective health care reform without stepping on some toes. That’s why the best possible scenario for Democrats is to have the bill pass with them voting against it, so they can’t be held responsible for the toes that get stepped on. That’s also why they’re trying to get bipartisan support, which could give them cover, or possibly even the spare votes to allow them to vote against it.
But, at the end of the day, they’re going to have to decide whether to pass the bill or not. Specifically, Democrats will have to decide whether or not to support a filibuster of health care reform that would destroy their president and dig their own grave. And that’s the main difference between now and 1994 — health care can’t be filibustered without Democratic cooperation. I can’t see them doing it. Members of Congress may not be geniuses, but they’re usually pretty good at discerning their own political self-interest. And that’s why I think we’ll end up with a health care bill. A perfect bill? No. But the distance between the status quo anda perfect bill is so vast that we could have something that’s both a massive, historical improvement and a crushing disappointment. That’s what I think we’ll get.