One day historians of the health care debate will puzzle over a curious distinction. Why was so much ink spilled over the difference between “process” and “substance”? The terms seem suited to a discourse on phenomenology, not politics. Nevertheless, future historians will note that early 21st century liberals decried the process of legislating because they felt it blinded their subjects to the beneficial substance of social reform. Look beyond the turbulence, tumult, and messy compromises of democracy, their argument went, and the goodness of the liberal cause is self-evident.

But of course it is not self-evident. And to separate process from substance is to create, as somebody likes to say, a false choice. When you bake a cake, everything depends on the selection of ingredients and the manner of preparation. So, too, with the law. Health care reform’s inputs—the partisanship, the special deals, the procedural tricks, the budgetary gimmicks—will directly affect its outputs, i.e., its consequences. They are part and parcel of a $1 trillion-plus health bill that will raise taxes, cut Medicare, become ridiculously expensive sooner rather than later, and poison politics for a long time to come. Liberals miss the point. The process is the substance.

And the process has been immensely revealing. Consider what has happened since Congress took up health care reform in earnest last summer. The Democrats quickly shut out the GOP. The legislation rapidly became unpopular. The people voiced their opposition in rambunctious town hall meetings and at a massive march on Washington in early September. They were mocked and vilified for their efforts. The congressional majority pressed on despite public resistance. The House passed its original bill by five votes last November. Only one Republican supported it.

Brute force rules the House. But not the Senate. The rules there demand general agreement, reflected in the support of 60 senators, before a measure is passed. And because there is no general agreement on the Democratic proposal, it has been unable to pass the upper chamber by regular order.

What to do? First, sweeten the deal. Last December, the Senate leadership traded favors with Democrats from (most famously) Louisiana, Florida, and Nebraska. The logrolling gave us a handful of catchy names to describe the various corrupt bargains: The Louisiana Purchase. The Gator Aid. The Cornhusker Kickback. Defend them? The Democrats don’t even try.

And yet the deals were enough to win 60 votes. The Senate passed its initial version of health care reform on Christmas Eve. And then the unbelievable happened. Massachusetts replaced the late Edward Kennedy with an obscure GOP state senator who drives a pickup truck and campaigned explicitly on a pledge to stop the health care bill. The import of Scott Brown’s election was obvious. A Republican hadn’t been elected to the Senate from Massachusetts since 1972. Brown had nationalized the election by campaigning against the Democratic agenda. The president flew to Massachusetts at the last minute to try to rescue the campaign. The voters rebuked him.

Once the shock wore off, the Democrats decided that if they could not pass their reform following normal procedure, they would simply change the procedure. Hence the decision to pursue “reconciliation,” a parliamentary measure under which budgets can pass the Senate by a simple majority. Except even that wasn’t enough. For reconciliation to happen, the House would have to pass the original Senate bill—a bill which even the speaker of the House admitted no one wanted to vote for.

Solution: Change the procedure again, this time “deeming” the Senate bill passed without actually voting for it. Dismiss the public outcry over all these changes as flippant objections to mere “process.” And in order to ensure a positive score from the Congressional Budget Office, game the system so that the taxes come first, the spending comes later, Medicare “savings” are double-counted, and a student-loan reform applies to health care’s price tag.

One cannot judge the full consequences of health care reform. What can be judged is the manner by which Democrats have governed over the last year. They have been partisan and ideological, derisive and dismissive. They try to legislate massive changes to American society and the American economy by the tiniest of margins and the most arcane of methods. The process has taken on a substance all its own.

And it’s repellent.

—Matthew Continetti

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