Its over.Seventeen years ago, I was a health policy analyst for the Service Employees International Union and having the time of my life. President Clinton had been elected in November of 1992, and the union became deeply engaged in the fight to pass comprehensive health care reform legislation. In addition to writing countless reports, fact sheets and pieces of congressional testimony, I got to fly around the country speaking to union members about the bill and encouraging them to support it. We were working days, nights, and weekends. I felt like a warrior in a great and holy cause.In the summer of 1994, however, it all came crashing down. The Presidents bill was complex and difficult to explain. It was criticized by both liberals and conservatives within the Presidents own party. Support for the bill withered in the face of an advertising campaign led by the health insurance and small business lobbies. Eventually, the Democratic Congressional leadership ran for the hills, not even bringing the bill to a vote on the floor.I remember the last few days before it became clear that health care reform was dead. We were rushing around, trying to find something, anything that we could take to the floor that would pass. The idea that we could have worked this hard for two and a half years only to end up with nothing was just too painful to contemplate.Sound familiar?A few weeks ago someone asked me how I was feeling about the prospects for health care reform, given that the legislation had moved closer to passage than in any previous attempt. Im like those Boston Red Sox fans in 2004, I responded. Im not going to believe it until the final out.Well, it turned out to be 1986 not 2004. Again.Im joking because if I dont laugh, Ill cry. I work in health care. I know that health insurance makes a difference in peoples lives. It means that we catch cancer early, that people with hypertension avoid a heart attack, that diabetics hold on to their kidneys and toes, that people with depression get the treatment they need to face down soul-crushing sadness.My mother had an Uncle Bobby who was a driver for a small New England trucking company. He had 10 kids. He died in his early 40s from a heart attack. His kids grew up without a father and his wife was a widow at a terribly young age.If Bobby had been alive today, wed have the tools to help keep him alive. Weve got drugs to manage cholesterol and hypertension, health educators and nutritionists to help him develop new eating habits, and patient registries and alerts to track him if hes overdue for tests. Our patients have a cardiac death rate 30 percent below the statewide average. Health insurance and access to high quality health care makes a difference.Yes, yes, I know, the bills werent perfect. But they were better than a lot of people realize and probably the best that we were going to get in the year 2010. As Donald Rumsfeld might have said, you go to war with the Congress you have. With 30 million more people getting coverage, Im sure we would have saved more than a few Uncle Bobbies.Its possible that we may still be able to move the ball downfield. In the wake of the collapse of comprehensive reform in 1994, Congress passed the Health Insurance Portability and Privacy Act (HIPAA) in 1996 and the State Childrens Health Insurance Program (SCHIP) in 1997. The latter was the most significant expansion of public health insurance since Medicaid began in the 1960s.Painful as it is to say it, though, I dont expect that we will see much progress this year. The Obama Administration has clearly decided they need to focus more on job creation and financial reform in the run-up to the November elections. Without presidential leadership on health careand perhaps, to be fair, even with itmany members of Congress will not be willing to take any more tough votes on this issue.At times like this, I am inclined to recall words from the late Senator Edward Kennedy, who championed health care reform throughout his legislative career. They were words that he offered in the wake of another difficult defeat:

For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die.

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