Take a Bow

I do not think it was politically wise for Obama to have attempted major, comprehensive health reform in his first year, if ever. The risks were high. The outcome was uncertain. The political consequences remain unclear. However, as all readers of this blog know, I am glad he made the effort anyway. I am pleased with the outcome.

Having said that, I concur with Aaron Carroll that a victory lap is the wrong metaphor. I’m not interested in the “in-your-face” political trash talking we’re likely to see among the commentariat. Nevertheless, an historic event has occurred despite very high obstacles. That warrants some special attention. And a number of individuals deserve credit for their extraordinary efforts.

News reports indicate it was Nancy Pelosi more than anyone else who championed health reform, convinced the White House to continue the pursuit of it, and found the votes to pass it. The Hill reported last night that

Nancy Pelosi showed Sunday why she is one of the most powerful Speakers in history.

In shepherding one of the most controversial bills through the House, Pelosi achieved what some thought what was impossible after Scott Brown’s victory in Massachusetts two months ago.

Pelosi had a lot of help. In fact there is a large class of government employees, consultants, and non-governmental analysis who have toiled mightily to craft and analyze health reform policy over the last year, if not longer. Under tremendous pressure, CBO and congressional staff, officials and analysts in many administrative agencies and elsewhere, academics, and policy consultants have worked and reworked reform provisions and analysis thereof, responding to the thousands of shifting political and policy imperatives generated by the debate.

Moreover, all those folks nearly saw their hard work tossed into the dustbin after Scott Brown’s victory in the Massachusetts special election earlier this year. With health reform near death, after having come so far and been so close to passage, at the time many policy analysts no doubt felt demoralized and understandably so. Theirs was not a political game, though they were caught up in one. They were sweating the challenging policy nuances. How much is saved if the excise tax is crafted this way? How many more people are covered if the cost sharing support is designed that way? And so on.

I know from my own experience working on much simpler policy-relevant analysis that such work is incredibly hard. To achieve even one arguably credible result that can withstand the scrutiny of public disclosure takes hundreds, if not thousands, of person-hours. Many people put their heart and soul, and no doubt many all-nighters, into getting health reform right and analyzing it properly, within the constraints of the political necessities dictated by their ultimate masters, our elected representatives.

Nancy Pelosi deserves Person of the Year status for her efforts and her mark on history. But it is the largely invisible and un-thanked analysts I want to recognize. They receive too little credit relative to the amount of work they do. Though convention and institutional objectivity prevent most of them from taking a deserved bow I applaud them anyway. If you contributed to health care policy analysis that shaped health reform and its debate, thank you. Excellent job. Stand proud. And then go get some rest.

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