The Senate has passed health care reform, and all that remains is for their bill to be merged with the already-passed House version, for both houses to approve the compromise, and for President Obama to sign it into law. With the passage of major health care legislation looking more and more likely, many are looking back over the fight that consumed so much of 2009. From the ugly town hall protests to the razor-thin partisan margins achieved in Congressional votes, why has health care provoked such a long, vicious and frequently partisan battle? Is it something about health care specifically or is this simply the hyper-partisan world we now live in?

  • The 30-Year Road To Hyper-Partisanship  The New York Times's David Herszenhorn pegs "the culmination of more than a generation of partisan polarization of the American political system, and a precipitous decline in collegiality and collaboration in governing" to "a broader political shift that lawmakers cannot easily reverse." He quotes Senate historian Donald A. Ritchie, "In the 1970s, for instance, there was a much wider political spectrum in both parties. You had conservative and liberal wings in both parties." Herszenhorn explains, "For more than 30 years, the major parties — Democrats and Republicans — worked every angle to transform politics into a zero-sum numbers game. State legislatures redrew Congressional districts to take advantage of party affiliation in the local population. The two-year campaign cycle became a never-ending one."
  • Passing Big Legislation Isn't Easy  The Washington Post's Ezra Klein says this is just how the system works:

Passing legislation, it turns out, is a long and ugly process. God, is it ugly. The compromises, both with powerful special interests and decisive senators. The trimming of ambitions and the budget gimmicks and the worship of Congressional Budget Office scores. By the end, you're passing a compromise of a deal of a negotiation of a concession.

Bad a system as it might be, it's the only one we've got, at least for now. This is what victory looks like. The slow, grinding, ineluctable advance of legislation that looks quite a bit like what you began with, albeit not identical. It's not pretty, and it doesn't necessarily feel like winning is supposed to feel. But this bill will do most of the things supporters hoped it would do: cover about 95 percent of all legal residents, regulate insurers, set up competitive exchanges, pretty much end risk selection, institute a universal structure that we can improve and enhance as the years go on, and vastly reduce both medical and financial risk for families. 

  • Lack of Transparency  The Wall Street Journal's John Fund scoffs at the "single-minded pursuit of legislative victory." He writes, "When Democrats took over Congress in 2007, they increasingly did not send bills through the regular conference process." Fund says they instead rely on rushed, "back-room" negotiations. "Look for the traditional conference committee to be replaced by a 'ping-pong' game in which health care is finalized behind closed doors with little public scrutiny before the bill is rushed to the floor of each chamber for a final vote.
  • Too Many Compromises  The Washington Post's David Broder asks of supporters of the bill, "How do you applaud while holding your nose?" He sighs, "What should have been a moment of proud accomplishment for the Senate, right up there with the passage of Social Security and the first civil rights bills, was instead a travesty of low-grade political theater -- angry rhetoric and backroom deals." Senator Reid "reduced the negotiations to his own level of transactional morality. Incapable of summoning his colleagues to statesmanship, he made the deals look as crass and parochial as many of them were -- encasing a historic achievement in a wrapping of payoff and patronage."
  • Cowardly Opposition  The New York Times's Timothy Egan suggests the partisan fury began with President Clinton's 1993 budget measures that spurred "the greatest period of peacetime prosperity in modern times." He writes, "From then on, nobody could 'respectfully disagree.'" Moderates were called wussies, traitors and socialists. When Republicans gained control of everything, the fringe Democratic left took their rhetorical cues from their angry counterparts on the right. This year, things became coarser still with the 'tea party' extremists, who taught Republicans in Congress how to shout 'You lie!' to the president and cast aspersions on something so innocuous as a pep talk to school children."