The Body Politics

On health-care reform, Democrats have become their own worst enemy.

As health-care reform struggles to stay afloat, Democrats are desperate to pin the blame on Republicans. But the truth is, no matter how much Democrats gripe, it's their own fault.

With the passing of Ted Kennedy, Democrats have only 59 votes in the Senate, one less than they need to break a filibuster. Until this week, Democrats held out hope that at least one Republican would sign on. But when Senate Finance Committee Chairman Max Baucus finally released his plan on Wednesday, Olympia Snowe, the most likely GOP vote, quickly backed out.

That leaves Democrats with just one option: Go it alone. And that won't be easy. Because a party that not long ago was united behind a leader and a purpose—guaranteeing health insurance to all Americans—has, in just a few short months, descended into disarray.

As the health-reform push enters its final stages, here's who's causing headaches:

Sen. Jay Rockefeller: As a member of the Senate Finance Committee, Rockefeller is a key vote. And he's repeatedly said there's no way he'd vote for the Baucus plan as it stands. He hasn't just knocked the plan, he's knocked the planner, taking aim at Baucus' feints toward bipartisanship. "You don't run a committee that way," he told Politico. The West Virginia senator is so miffed by the failure to include a government-run public plan, a favorite idea among liberals, that he took his complaints all the way to Obama—and still came out shaking his head. Nor is he willing to consider compromises like co-ops or a public option "trigger." For Rockefeller, no public plan means no way.

Sen. Mary Landrieu: Rockefeller, though, faces tough opposition from moderates like Landrieu who have expressed serious reservations about including a public option. At the beginning of last week, Landrieu worried that a public plan might "undermine the private insurance system."

Rep. Nancy Pelosi: Pelosi, the House's top Democrat, also sniffed at the Baucus plan, expressing disappointment in the bill's lack of a public option, saying she wanted "modifications" to make mandatory insurance more affordable.

Sen. Ron Wyden: Like Pelosi, Wyden, another Finance Committee member whose own more radical reform bill has been sidelined, has taken issue with the expenses the plan could impose on the middle class. Shut out, Wyden took his objections straight to the public, putting a stern op-ed in The New York Times detailing the "problem" with the Baucus bill. But increasing middle-class subsidies would also make the bill more expensive—a politically risky move.

Sen. John Kerry: For Kerry, the current Baucus plan is a non-starter. The former presidential candidate has also stated worries about the plan's cost to lower-income Americans—and said it's got to change before passage.

"It's not going to be the bill we're going to vote on," Kerry said when the Baucus plan hit.

Sen. Dianne Feinstein: Any move to make the bill more expensive would risk the wrath of Democrats like Feinstein, who recently told the San Francisco Chronicle, "There is real concern over debt and deficits, and whether this bill will create additional entitlements." Of course, Feinstein doesn't want the bill cut too much: She's also expressed concern that Obama's cost cuts will come out of her home state's public hospitals.

Sen. Bill Nelson: Nelson, a Florida senator answerable to the votes of numerous senior citizens, has expressed tacit support for the measure, but he's also taken issue with the plan's cuts to Medicare. In a strident statement on the Senate floor, Nelson said it would be "intolerable" to ask seniors to give up the "substantial benefits" they now enjoy.

But intraparty bickering isn't the only hurdle for Democrats. They also have to balance the demands of liberal interests like labor unions and major health-care players.

When health-reform efforts started, Democrats opted to buy off industry, which they saw as having killed the Clinton reform drive in the '90s. Every player got a handout—but the handouts may not add up. Insurance companies, for example, were promised comparative-effectiveness research—a government panel that would give them cover to say that treatment options just aren't worth the price. Rather than seem stingy, they can say, "Sorry, the government says this isn't effective."

The pharmaceutical lobby, meanwhile, came on board in hopes of expanding the market for brand-name drugs. But comparative-effectiveness research might slash the sales of some of those same drugs—especially the most profitable ones. The drug companies haven't jumped ship yet but they're fighting hard to nix the insurers' handout.

Cranky Congress critters. Inter-industry feuding. What's left? Oh right: Voters. As Robert Goldberg of the Center for Medicine in the Public Interest says, Democrats "forgot about the fact that health reform affects people, not just interest groups." On that front, Obama's prime-time speech before Congress was supposed to give health reform a bump. It did, but just for a few days. Heading into the weekend, the bump had vanished. And pollster Scott Rasmussen's survey of likely voters indicated that "just 42% now support the plan, matching the low first reached in August."

Still, it's hard to blame voters. If Democrats can't find a plan they all like, why should the public?

Peter Suderman is an associate editor at Reason magazine. This article originally appeared in the New York Post.