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That said, it would still be better if there were the half-dozen or more Republicans ready to deal. The tragedy of the GOP strategy of voting no and hoping to derail any plan supported by President Barack Obama is that the bill could be much better if there were more Republican potential support better malpractice reform, better ways to reduce defensive medicine, better ways to bend the cost curve, better ways to get real competition in the system. Those deals were there to be had; the White House and Congressional Democrats would have done a lot to get to 65 or more on this issue.
But we are left with Snowe (and perhaps her fellow Maine Republican, Sen. Susan Collins, and maybe a few more if and when we have a final vote on a conference report). Important as Snowe is, however, the big challenge for the president, Senate Majority Leader Harry Reid (D-Nev.) and Speaker Nancy Pelosi (D-Calif.) remains their fellow Democrats.
Bill Clinton in 1994 had nearly the same number of Democrats in the House as Obama does now. He had fewer in the Senate (he started with 57, but the number dropped to 56 after the special election victory in Texas of Kay Bailey Hutchison) but the filibuster was not the obstacle it is now. If he had held his Democrats together, Clinton could have achieved health care reform. If Obama can keep his Democrats together, he can achieve what Clinton could not.
Democrats so far in 2009 have shown markedly more discipline than they did in 1993, a product both of Obamas impressive coattails in the election and the awareness among todays Congressional Democrats that their lack of discipline in 1993-94 cost them their majorities for a dozen years. But it gets much tougher from here on out. Midterm jitters combine with ideological divisions and the natural tendency of Democrats toward disorganization and individualization. And throw into the mix a much more belligerent, organized and amplified outside advocacy movement on the left than existed in the Clinton era.
All this requires a serious test of leadership, political skills and substantive knowledge finding ways to thread several needles to keep disparate groups of Democrats, separated by regional, parochial and ideological interests together, even as they are being pressured by Daily Kos, MoveOn.org, Michael Moore, Paul Krugman, the American Federation of State, County and Municipal Employees, the medical device community, rural doctors and hospitals, and fearful seniors, among many others. How do you keep Sens. Ben Nelson (D-Neb.) and Bernie Sanders (I-Vt.) in the same room, much less on the same page? Or Reps. Maxine Waters (D-Calif.) and Collin Peterson (D-Minn.), for that matter?
In the House, Pelosi has some slack to work with: the ability to lose nearly 40 of her own and still prevail. With just 60 Democrats, Reid has no slack, except perhaps a lone defector if he can secure Snowe on the Senate floor.