In final House debate, lawmakers frame health reform in stark terms

On a day of debate that highlighted the partisan divide in Congress as never before, Democrats and Republicans in the House agreed on one point: The health-care reform vote facing them Saturday was one for the ages.

Rep. Paul D. Ryan (R-Wis.) declared it the "most consequential vote each of us will take in our service here." Saying the plan would create "a European welfare state," he asked his colleagues, "What side of history do you want to be on?"

Rep. John Lewis (D-Ga.) spoke of a moral obligation to lead the nation into an era "where health care is a right and not a privilege." He added, "If we fail to act on health care, history will not be kind to any of us."

The rhetoric marked a departure from much of the discussion in recent weeks, when congressional committees hashed out the fine points of the Democratic proposals. Saturday's debate found lawmakers framing the issue in the starkest way imaginable.

Democrats cast the vote as a long-overdue opportunity to provide affordable health coverage to tens of millions of people and as the final pillar of economic security, alongside Social Security and Medicare. Republicans cast it as the ultimate government overreach, an assault on American liberty that would drive the nation deeper into debt.

At the same time, the politics of the moment seemed to suffuse the debate. Republicans made indirect references to GOP victories in Tuesday's elections, saying that Americans were rising up against Democratic activism. Both sides invoked the jobs crisis, aware that high unemployment is as much of a concern for voters as health care.

Democrats said the bill would provide Americans with security in an era of high anxiety by making it easier for the unemployed to get coverage. "Today when the layoff notice comes, you're also on notice you will lose your insurance," said Rep. George Miller (D-Calif.). "Your world is turned upside down immediately. . . . You know that if your children are sick, you won't be able to afford it."

Republicans said the bill would only add to the burdens weighing down a weakened economy. "Rome is burning while this Congress fiddles," said Rep. Devin Nunes (R-Calif.). "This Congress is so irresponsible, it's like watching a broke, drunk gambler continuing to double down, just trying to break even."

The more grandiose rhetoric was somewhat at odds with the substance of the bill, which is more incremental in many regards than the day's language would suggest. It would leave in place the framework of the health insurance system, based around employer-provided coverage and private insurers, despite the Republicans' warnings of a full government takeover. And it also would likely leave millions of Americans still lacking coverage.

Aware that they likely lacked the votes to block the bill, Republicans gave free rein to oppositional hyperbole. Rep. Sam Johnson (R-Tex.) declared that the bill "forces every person to purchase government-approved health care or to jail." (In fact, the penalty for not getting coverage is a fine of about $750 for the typical middle-class family.)

Rep. Jeb Hensaerling (R-Tex.) warned, even more darkly, that Americans would die as a result of a "freedom-crushing" bill that would lead the country in the direction of Britain's government-run health care system. He spoke of his father, with whom he'd gone on fishing trips since he was 5, and who recently underwent triple bypass surgery. "Guess what? At age 81, we're still fishing," he said. "If we'd been in Britain, there might not be another fishing trip and my grandchildren would have never met him. Government-rationed health care means our loved ones will suffer."

Democrats reeled out their own personal tales of medical plight to buttress their case. But their arguments in general lacked the impassioned flair of their counterparts' as they highlighted various policy planks in the bill. Notably, they focused on elements that are broadly popular but hardly central to the bill, such as closing the "doughnut hole" in the Medicare drug benefit and a provision allowing young people to stay on their parents' plans until age 27. Republicans -- and wayward Democrats -- would have to answer to their constituents for trying to block these benefits, they said.

"I defy you to go home and tell those people you voted to deny them quality, affordable health care," said Rep. Pete Stark (D-Calif.).