The Democrats' Five Stages of Grief Over Health Care

Liberals mourn the death of their top legislative priority.

Therapists looking to study the five stages of grief—denial, anger, bargaining, depression, and acceptance, in that order—need look no further than Washington Democrats struggling to come to grips with the fact that the health care overhaul they spent nearly a year crafting is now dead. Every stage but the last is well represented. The only step left for Democrats is to accept that, after Republican Scott Brown's win in the Massachusetts special election, their signature reform effort is now lost.

The facts are plain for any objective observer to see. Brown, who ran a campaign focused on opposition to the Democrats' plan to remake the health care system, represents the 41st Republican vote in the Senate, meaning that Democrats can no longer break a united GOP filibuster. Consequently, for any future bill to pass in the Senate, it must have some Republican support.

Both the House and the Senate have already passed separate health care reform bills. But these bills differ significantly in their financing mechanisms, their special interest deals, and their treatment of federal funding of abortion. For reform to become law, the two legislative bodies must reconcile their differences and each pass a unified bill. But given the Republicans' unbreakable filibuster power, it's unlikely any reconciled bill could get through the Senate. Meanwhile, as a result of both longstanding policy disagreements and an upswell in political pressure stemming from the Massachusetts election, not enough members in the House are willing to accept the Senate bill as is.

Yet some Democrats are still insisting that something will pass. Still in denial are House Speaker Nancy Pelosi and a few top members of Obama's administration, some of whom were, even as late as Sunday afternoon, still insisting that some type of health care reform—perhaps even the comprehensive Senate bill that was the final product of their year-long effort—would pass.

Their argument is that House Democrats could pass the Senate bill and amend it to their liking in reconciliation, a process which would allow the Senate to make changes without threat of a Republican filibuster. But this plan unrealistically expects House Democrats to agree to a bill that they oppose in hopes that the changes will go through later. Even more importantly, it simply ignores the fact that, as even Pelosi has admitted, there are not enough votes for this plan to work. The argument, then, is essentially a tautology—that if more legislators were willing to vote for the bill, it could pass.

But as is often the case in Washington, these official denials serve a political purpose as a face-saving mechanism designed to appease those who have moved on to grief's next stage, anger. Amongst the Democratic base of pundits, advocates, and activists, there is a widespread belief that the bill could be saved if only Barack Obama would exert more influence over Democratic members of Congress. But blaming the White House for its hands-off approach forgets that the strategy was far more successful than President Bill Clinton's distinctly hands-on micromanagement of HillaryCare in 1994.

Rather than blame the president, other Democrats have moved on to bargaining, floating the possibility that they might pass a series of scaled back reforms in multiple bills, likely focusing on popular insurance market regulations like prohibiting discrimination based on preexisting conditions.

That strategy, however, has two major problems. The first is that there is widespread agreement amongst health policy experts that, without unpopular provisions like a mandate, such a ban would be both costly and ineffective. The second is that drawing up and passing multiple new bills would take massive amounts of time and legislative effort, especially when one factors in the high likelihood that Senate Republicans would use all available procedural tactics to slow any bill's passage—and would, after that, still probably oppose such legislation entirely.

Given that the Senate has effectively washed its hands of reform, saying that it's now up to the House to move forward if it wants, and that the White House has signaled that it will move on to new legislative priorities, other reform supporters have resigned to depression. This response is particularly acute amongst the pundit class, many of whom seem to be vacillating back and forth between this and anger.

At this time, however, acceptance is still rare, and those who've flirted with it—like Massachusetts Rep. Barney Frank, who walked back a statement that "our respect for democratic procedures must rule out any effort to pass a health care bill as if the Massachusetts election had not happened"—have not yet fully embraced it. (No one ever said moving through the stages of grief was easy—or quick.)

If there is a lesson in the bill's collapse, and the ensuing anguish from disheartened Democrats, it is that those who put their faith in politics will most likely find that what they get in return is, in fact, more politics. So for those ailing Democrats whose belief in this bill has shaken their faith in the power of politics to produce political change, well, grief is a terrible thing, but as any therapist will say, it's never too late to get help. 

Peter Suderman is an associate editor at Reason magazine.