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But she made a more subtle point, too. “Think of what it does to the other side, who do not believe in government,” Pelosi said. “This will now be the legitimate political debate in our country. What is the balanced role the government should have in controlling the cost, of expanding the coverage, holding the insurance companies accountable.” In other words, the full measure of this bill isn’t simply the impact it will have on lives in the short- to medium-term. It’s also the impact it will have on politics.
Republicans say they welcome this debate--because, they say, government’s inevitable failure will reinforce their worldview. But the historical record on this is pretty clear: One government makes a promise of something like health benefits, that promise never gets revoked. (This is why Bill Kristol famously advised Republicans to oppose Clintoncare in 1993 and 1994.) And if enacting reform manages to make more ambitious changes possible later on, Pelosi made clear she intends to seize that opportunity: “Now we go from here. We kick open that door and there will be other legislation to follow.”