This hasn't been a debate. It's been two sets of marchers shouting at each other. The country has become confused, rather than convinced.
In the absence of anything approaching an actual deliberative process, health-care reform became a question of partisan fundamentals: How many votes did the Democrats have in the House and the Senate? In the House, the answer was "more than enough." As that would suggest, the bills have progressed smoothly. In the Senate, the answer was "just barely enough, if no one defects." As that would suggest, the process has been slow and delicate, but it's moving forward.
I think that's wrong. There has been a lot of bargaining and deliberation -- it just hasn't included the Republicans.
First of all, bargaining and deliberation never includes rank-and-file people outside the Beltway. That's not really different than it was back in 1994, or different than things were in 1954 or 1924. It is possible for ordinary folks to mobilize themselves to the extent that it has some immediate pull on national policy, but those sorts of things are very, very rare and are generally in reaction to some outrage (segregation, Vietnam). It's not going to happen over the details of health care reform.
Public opinion, which is very different from people mobilizing themselves, is a much more passive thing, and it tends to be led by elites, rather than reasoned out, deliberated, or debated by engaged actors.
That's where we get to the real difference between 1994 and 2009: the decision by Bill Clinton in 1993 to have Ira Magaziner write a bill in secret, compared by the decision by Barack Obama in 2009 to buy off the key interest groups who might be inclined to oppose reform. Ezra thinks that Betsy McCaughey was stopped this time around because of the emergence of the blogs, MSNBC, and Jon Stewart, all of whom took on the crazy and explained to people what was truth and what was wacko lies. It's true that those people all generated information, but I don't think that's what convinced anyone; liberals didn't believe McCaughey in 1994 even without Keith Olbermann to transmit the counterarguments. No, what was different this time is that the stakeholders -- the doctors, the hospitals, the drug companies, and the insurance companies -- either stayed neutral or took Obama's side on some of the key factual questions. Again, they didn't do that because they were smarter or had more information than they had in 1994. They did it because they changed sides. And they changed sides because Barack Obama realized that the way to make this happen is to get as many allies as possible, even though that strategy has its own costs.
Ezra is of course absolutely right that it mattered a lot that there were 60 Democrats in the Senate instead of 56, and while he doesn't say it he could add that it also matters that the most conservative of those 60 were still mainstream Democrats, and not old-style southern Democrats such as Richard Shelby. But that just set the parameters of the game; Obama still had to make the right plays.
I've been thinking all day how to respond to Kevin Drum's interesting argument that Obama has been negligent in what Kevin sees as the important presidential task of affecting public opinion in the long run, and I think what I said above leads into it. John Zaller tells us (that's the citation above) that public opinion is led by elites, and that people basically are ready and willing to adopt the opinions of those they like and respect, while they are pretty good at ignoring and rejecting what they hear from those they don't like and don't respect.
Given that, if I had to advise a president, I'd say to think in terms of two audiences (with a third audience, solid partisans of the other party, beyond reach). For partisans, the president should reinforce basic beliefs, pushing them, if he wants, in whatever directions he thinks best. So Bill Clinton, for example, could, by repetition, convince Democratic elites and mass publics that "responsibility" was an important value of the party. Notice that with this task the president will have eager allies among the (other) opinion leaders of the party. But notice too that this job is basically pretty easy, especially if the president is relatively happy with where the party is. I think that's the case with Obama; he's a mainstream liberal, and so he really doesn't have much to do to transmit his Big Picture Values to rank-and-file Democrats.
The other audience is different. It's composed of loose partisans and true independents. It's not going to suddenly adopt new political ideas; Reagan didn't suddenly make loose partisans and true independents into real conservatives. You can't really do that. Loose partisans and true independents aren't ideologues and are unlikely to become ideologues. What you probably can do -- what Reagan probably did -- is to teach them, if they like you, to say that they're "conservative" or "liberal" and to adopt a handful of public policy positions that you advocate (and since the specific issues fade, and since most people won't change their views on public policy to match the "conservative" or "liberal" label, you aren't really getting very much). But you don't do that by reasoning with them, or with inspiring them with great speeches. You mostly do that, as crude as it sounds, by winning. You do it by creating winning coalitions that put Establishment People on your side. You make it so that the rank-and-file sees that the people they're willing to listen to, opinion leaders in their own groups, support the president's positions. And that's what Obama is doing.
Now, I should add one thing. A president would be foolish to surrender the bully pulpit. It's important that those who want to accept what the president has to say actually find out what he's saying. But the convincing doesn't happen, either in the short term or the long term, from presidential eloquence. The convincing comes when, for example, you've been a Republican main street AMA member all your professional life, and you suddenly find that the AMA is supporting health care reform while the Republicans are attacking the AMA. Even then, you may still be resistant to Obama...until you start hearing him saying the things that you're reading in the AMA newsletter (or however the AMA communicates with doctors. I don't know).
One more thing. I suspect that presidents can have a more direct effect on the very small group of people who become (or, that is, have the potential to become) political activists. Since those people are disproportionately important, it's worthwhile for the president to use the opportunity he or she has to try to influence them. And, as is always the case in these things, it's certainly possible that there could be some real but small direct effects on the margins, although since we're talking here about passing legislation rather than winning elections, it's mostly irrelevant if public opinion moves a couple of ticks one way or another.