Being a former elected official myself, as well as a person with a number of politicians as personal friends, I can tell you that one of the common phrases you hear is "Is this a hill you’re willing to die on?". It’s basically a variation on the "pick your battles" sentiment, but goes to a far more personal level. That being "Is this issue so important to you that you would be willing to accept the possibility of being defeated in your next election?"
Health care is one of those. The so-called "blue dogs" are being put in the unenviable position of making that choice. It’s a true Sophie’s choice. Most are in conservative districts, and were recruited by Rahm Emmanuel and Chuck Schumer in order to give the democrats a majority in the house and senate.
The political reality is this: If they vote for the health care plan that is being presented, they are going to be attacked mercilessly by the Republican challenger, and have a very difficult time getting re-elected. On the other hand, if they vote against it, the Democratic party will go after them, and refuse them contributions in their next elections - thus they are going to have a very difficult time getting re-elected.
Talk about damned if you do, or damned if you don’t.
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