Glenn Greenwald says health care reform proves that progressives can't maintain threats that they'll vote no unless legislation fits their preferences. I think that's basically right, and there are structural reasons why that's the way things are going to be. Progressives would much rather have a half-strength bill or even a quarter-strength bill than no bill. Centrists know that, and know that their votes are essential to the effort. So they're confident that the progressives will cave to some pretty hefty demands. And they're right! You didn't really need to run the experiment to prove this.
Given this dynamic, how is it that we're on the brink of passing a comprehensive bill that covers 32 million people, shuts down lots of insurance abuses, saves $130 billion in the first decade, and then saves a gargantuan $1.2 trillion in the next? Why didn't centrists manage to slice all that into oblivion along with the public option?
One thing is that a lot of reasonable centrist demands are in fact incorporated into the legislation. All that deficit cutting is good stuff, and I'd guess that some of the more conscientious centrists were genuinely brought on board by it. Not all conservative Democrats are named 'Bart Stupak.'
The second thing is that the Democratic leadership right now is awesome. Particularly in the House, where Nancy Pelosi is in charge, and the three relevant committees were run by solid liberals. And whatever negative things one might say about Harry Reid, he had to hold onto 60 votes, and if he lost the public option doing it, what can we expect when Lieberman and Nelson are the swing votes?
Simply announcing the intention to do fundamental health care reform was a big move in this process. You do that, and then if you can only pass something small, everyone will know it was defeat. Centrists don't want 'Democrats try to pass big health care reform, fail, settle for aspirin subsidies' to be the result. That reflects badly on the party and puts them in electoral danger. So they can slice off a public option here, do weird things with abortion funding there... but they have to be nervous about wrecking the basic structure of the legislation. Whoever made the call to go for comprehensive reform -- and "Barack Obama" is the first name that should be mentioned here, yeah? -- did really well for us.