Democratic health care reform bill passes in House of Representatives by narrow majority, 220-215

President Obama and his Democratic Party’s efforts to pass a health care reform bill has cleared its first real hump.

By a rather narrow vote of 220-215, (218 being the bare minimum needed for passage), the House of Representatives agreed to pass the bill. At about 11:07 pm ET, cheers broke out on the floor of the House floor as Democrats reached the 218th vote, with about 7 minutes left to go in the voting.

39 Democrats voted with the Republican minority in Congress. One Republican voted with the Democratic majority, Rep. Joseph Cao (according to C-SPAN), the Louisiana Republican who was elected in a heavily Democratic district last year that was formerly home to Rep. William Jefferson, who was found guilty of a variety of corruption charges earlier this year.

Official roll call vote now available from the House Clerk’s website.

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How much of a victory this bill will be for Speaker Pelosi and the Democratic caucus in the House, let alone for President Obama, remains to be seen.

Beyond the fact that the Senate Democrats are struggling to build the 60 votes needed to get beyond a filibuster for their own version of the bill, their final legislation is likely to be significantly different from the House bill. If the Senate bill severely waters down what the House passed, it could either peel off some of those 39 Democrats from the ‘nay’ side. Or, it could result in so many of the 220 ‘yeas’ bailing on the bill that we will end up with no consensus between the two chambers. Knitting up these two bills will be a monumental task for the White House if the Senate passes a bill in short order. Even more difficult if passing the Senate version of the bill takes a long time.

Additionally, as Austan Goolsbee, a top adviser on economic matters to President Obama, keeps reminding us, the Republicans have established themselves as something like the Cold War-era East German judge at the Olympics when it comes to health care. Which is to say that the GOP will exploit every division they can in the hopes that it will further frighten Democrats into bailing on the final product, regardless of what it is. In passing the Stupak anti-abortion amendment, they demonstrated they could do this once. They’ll try again.

But if a bill does pass, in historical terms, it will be interesting to see how many of the minority’s big objections to Obamacare become afterthoughts a couple of years down the road. On NPR’s Planet Money podcast this week, they interviewed Joseph Califano, a top adviser to President Lyndon Johnson, who was heavily involved in creating Medicare. Califano noted that there was a lot of doomsaying and opposition about Medicare when it was created. And in two years time, the people in America who hated it most, particularly the doctors, loved it, and didn’t want it to be changed in any way.

Certainly, this shows the myriad dangers of creating entitlements. But it also demonstrates how much hot air gets emitted whenever Congress pursues a major reform that will shape the lives of most Americans. We elect these guys to do big things for us, and every five years or so, they actually do it, and it’s a good show. But so much of what we see in that show winds up being so inconsequential to how we actually live our lives once these laws take effect.

And I think this might be one of the reasons the Republicans are having trouble prevailing in their opposition to Obamacare. Watching Rep. Dave Camp of Michigan, who managed floor debate today on the Republican alternative legislation, I was struck by the thin reed the Republicans are standing on. Camp made the case that the GOP had a good health care record because it had been addressing problems over the years incrementally, resulting in the creation of things like Medicare Part D and the Children’s Health Insurance Program. He also made the case that Congress should continue to deal with the problems of health care step by step, and that the GOP alternative was the best means of achieving that approach.

Nowhere in making that case did he offer some kind of reminder that things weren’t nearly as bad as many Americans believe they are with our nation’s health care system. And if the Democrats win that narrative – health care is a disaster, and it needs a major overhaul – incremental repairs, however sincerely intended, are not going to fit the bill.

If Senator Joseph Lieberman winds up being the lynchpin in the Senate’s health care debate, it is worth keeping this idea in mind. His opposition to Senator Reid’s proposed legislation came down to the argument that he supports reforms, but not a major overhaul like the public option. I wonder if he, like the House Republicans, will ultimately find himself so buffeted about by the desire for a major change that he won’t be able to withstand his former party’s onslaught.

Hopefully we’ll find out during this calendar year. Otherwise, we might not find out at all.