Majority Leader Steny Hoyer whispers to Speaker of the House Nancy Pelosi during a health care news conference on Capitol Hill on Thursday, Oct. 29, 2009. | John Shinkle/POLITICO 'I'm not big on showing weakness'

Even before her bill reaches the House floor, health care reform has been a lesson in the limits of power for House Speaker Nancy Pelosi — and in the immense challenge of managing disappointment on the left.

The bill rolled out Thursday is weaker than many progressives — including Pelosi — had once hoped for, but her advice is to “declare victory” and recognize that this is not the last word.


“On any given day, success that upsets business as usual in Washington can be perishable. I don’t want to get too bogged down,” Pelosi told POLITICO in an interview Thursday afternoon. “We are not passing a bill, shutting the door, turning out the lights and walking away. We will have other legislation.”

Nor is she much open to prolonging the public option insurance debate by allowing a floor debate on an amendment to insist on a more robust version than the one now in the House bill.

“I’m not big on showing weakness. It’s not my thing,” she said in the interview. “I don’t like to have predictable losses.”

At a recent caucus, she quoted her old Shakespeare favorite: “We happy few; we band of brothers.” But with a 256-vote majority and liberals leaking whip counts, she laughed and didn’t argue with the notion that it’s time to go back to her Appropriations Committee days and the Rolling Stones: “You can’t always get what you want, ... but if you try some time, you just might find, you get what you need.”

Energy independence and climate change are singularly Pelosi passions. “I’m trying to save the planet,” she once famously said. But health care is rooted deeper in the Democratic Party, and the undertaking now — all compressed into one massive bill — is genuinely enormous.

“This is a remarkable change,” said Rep. George Miller, a close Pelosi ally and chairman of the House Education and Labor Committee. “At the end of the day, ... you’ve said to Americans, ‘Never again will you be without insurance.’ Kind of stunning. Incrementalism will never get you there.”

For Pelosi, Thursday’s announcement rollout followed months of face-to-to face meetings with members— a process that forever redefined the role of the modern speaker for Democrats.

“I have never seen a speaker so involved in the details of legislation,” said House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.).

“She has the ability like the local priest to listen,” said House Ways and Means Committee Chairman Charles Rangel (D-N.Y.). “So much of it is endurance; the other is an ability to be persuasive. But whatever combination it is, they don’t teach that in school.”

Her style can be smothering. She is a legendary keeper of lists. And as much as she is devoted to building consensus within her party, this can crush the chances for more open debate on the House floor. “I consider the 78 caucus meetings we had our amendment process,” she told POLITICO. “That’s when people brought forward their ideas before and after August, and we’ve tested them.”

Senate Democrats, stung by Pelosi’s imperiousness, can speak of her as “she who would be queen.” “House mother,” “madam,” “mother superior” and a “mother bear with her cubs” are all expressions that come up in interviews. Even White House chief of staff Rahm Emanuel calls her “Mother.”

“Well it’s probably not spelled the same way,” said Pelosi’s friend Rep. Anna Eshoo (D-Calif.).

But if the speaker is tough, it is also a tough world — especially for a woman.

Baltimore-bred, she has an ear for racing metaphors, and there are days when she might be Winning Colors or Genuine Risk, two famous fillies who won the Derby only to be bumped badly or forced outside in the stretch by the boys in the Preakness.

Her poll numbers among men are devastating. Women tip slightly against her, 36 percent to 31 percent, in a recent Wall Street Journal/NBC News poll. Among men, the ratio is far worse: 2 to 1 against Pelosi. Among older men, it’s 56 percent to 22 percent.

And the big men in her own life haven’t always made this easier.

She is deeply wary of the expanded military commitment in Afghanistan now being considered by President Barack Obama. Her old ally Emanuel cut a series of deals with the Senate — often at her expense in the House. And in the midst of the whole health care debate, she has had to fend off attacks on Rangel for alleged financial abuses now being investigated by the House ethics committee.

The relationship with Obama and Emanuel is most complicated. The president spoke warmly of the speaker at an event in San Francisco earlier this month. And the two had a one-on-one luncheon meeting last week. The same night — after a meeting with party progressives — Pelosi saw Emanuel at a dinner hosted by Rep. Mike Thompson (D-Calif.).

But the next morning, many House leadership staffers were quick to blame the White House for allegedly leaking the news that Pelosi lacked the votes for the more robust public option favored by liberals. And it was considered a welcome victory that the White House spoke of the public option in its statement Thursday on the House bill.

On Afghanistan, she is not ready to commit flatly to whatever Obama should decide about increased troop levels.

“Let’s see what he decides,” she said in the interview. “I have confidence in him. I salute him for his deliberative process.”

But it’s a challenge she doesn’t relish — given the unhappiness already on the left.

“You thought energy was a heavy lift, health care, the budget, the recovery package. Nothing was as hard as funding the war in Afghanistan,” she said, recalling the battle earlier this year over war funding. “The supplemental was very hard.”

“With this,” she said in reference to health care, “you’re talking about what works in your region. You go back and forth. That was ‘I’m not voting for it.’ And no, I didn’t have my heart in it at all. I had told my members last year, this was our last war supplemental.”

“I’m a consensus builder ... My members are satisfied when they ask me a question that I am conversant,” she said, but that also required her to immerse herself in the policy details. “We have a big tent and huge challenge. It doesn’t affect every district the same way, and we have to listen.”

At times, she could grow impatient: In a show of unity, she and Rep. Earl Pomeroy (D-N.D.) each apologized for rudeness in the Thursday caucus. And as a relative newcomer to the complex debate over insurance coverage, Pelosi tended to show her appropriations background as well as her Bay Area love of science and the next big thing.

“We knew there was no way that we were going to get a robust public option in the final bill,” she said, looking ahead to the Senate. But the potential savings made it attractive as she struggled to deal with the fallout after the president surprised her by setting a $900 billion target for the bill.

Emanuel recently dismissed that White House decision as having a minimal impact, but Pelosi said it meant having to make close to $100 billion in adjustments. “I think $100 billion is not trivial,” she said, but then laughed at finding $14 billion at the expense of the drug companies — protected in the Senate by their deal with the White House.

“We did ‘a little cookie’ for the pharmaceutical industry,” she said. “A cookie out of their lunch.”

To build support, she also had to resolve regional concerns about disparities today in Medicare reimbursements, and as part of this bargain, she signed onto both studies and an enforcement mechanism to force potential changes.

Section 1160 of the bill lays out an elaborate implementation scheme that empowers the Obama administration to make major changes — which Congress will have limited power to block — that could lead to a new system of reimbursements more indexed to the value of the care provided, not the traditional fee-for-service measures.

“That’s very important,” Pelosi said, and it won her support from lawmakers like Rep. Ron Kind (D-Wis.) in pushing larger structural reforms. In the farm bill two years ago, the two found themselves at opposite ends, but here Pelosi lent her support over the discomfort of some like Waxman.

“The speaker is a person who is about change and reform,” Kind told POLITICO. “She does appreciate people who are thinking out of the box.”

Asked why he gave in, Waxman said he wanted to help Pelosi meet what he saw was a commitment she had already made. “She’d given her word, and I wanted to help,” he said.

“She knows that words matter,” says Eshoo. “Once you put feet on them, these words walk into people’s lives. There’s a reality to it; she can more than hold her own — she’s a master of detail.”

“Think of how many speakers in the past have tried to get to this point,” said Rules Committee Chairwoman Rep. Louise Slaughter (D-N.Y.) “She got here.”