The Democrats completely messed up the politics and policy of the stimulus bill. They let a group of “60th-vote ‘centrists’” ruin it on a policy level. A failure to pass good policy, combined with a failure to properly explain and defend the stimulus bill, made it bad politics. Now, for political and policy reasons, Democrats in Congress desperately need to pass another round of stimulus bills to make up for the failings of the first stimulus bill, but they just can’t call it “stimulus.” It seems history is doomed to repeat itself with health care reform.

Just like the stimulus bill, the health care reform bill has been ruined on a policy level by the 60th-vote hostage-takers like Joe Lieberman. These concessions have been extremely disappointing to the Democratic base, and have exposed how petty and corrupt the process is to independent voters. The health care reform bill is now very unpopular, but like the stimulus bill, it is viewed as a politically difficult “must pass” by party leaders and strategists. Efforts to sell or explain the bill have fallen flat.

Opinions about the stimulus bill did not improve after passage, partly because Obama over-promised and under-delivered, and partly because very few people actually felt the stimulus bill improved things for them personally. Does this dynamic sound familiar to anyone?

This health care reform bill has been sold with a lot of big promises, promises which are unlikely to be kept, and, even if some are, will do almost nothing to help anyone until 2014. It is very tough to defend a hard vote for a reform packaged that has not reformed anything or helped anyone yet.

If Congress does pass health care reform, the poor poll numbers will probably kill any desire to pass another bill labeled “health care reform” anytime soon.

But political reality necessitates passage of another health care bill right away. The Democrats need people to see how their reform law has improved health care in this country before the midterm election, and that is something this bill will not do. Democrats will need a second health care package with a lot of immediate relief; then hope that voter support for these immediate reforms blurs with support for the health care reform effort in general. The important thing is: just don’t call this second bill health care reform.

The politically smart solution would be to integrate a lot of health care provisions into other bills. A large, immediate expansion of Medicaid could be part of a bill labeled “aid to local governments.” Large grants and tax credits for states that immediately start an insurance exchange for the small business market, but not individuals, could be part of a “small business” package. Subsidizing and improving COBRA coverage would fit nicely in a bill labeled “unemployment relief.”

The single worst political move Democrats made with health care reform was to reduce the CBO score by delaying the benefits until 2014. You should not pass a big, expensive bill unless you are prepared to have it start helping people right away in order to defuse any potential political damage. The only silver lining here, is that if the Democrats manage to pass health care relief measures as part of the other bills, people will probably think they were part of the big health care bill. If Democrats are smart, they will slip as many small pieces of immediate health care relief as they can in any bill between now and the election.

People vote based on results they can feel now, not vague promises of how things will improve in four years. Incumbents never want to campaign on what the bills they voted for might sorta, kinda start doing in the distant future. They need to–and should–campaign on what they have already delivered.