The gentleman from Ohio — the last man standing on health care, as he put it in this conversation with Esquire.com just before Sunday's vote — reveals the personal moments behind his decision, and how the fate of a nation, if not a presidency, could have turned out a lot differently had he said "no," as told to Mark Warren, Sunday, March 21, 2010:

The meeting that took place on Air Force One was the fourth in a series of meetings that I had attended with the president in the last few months. There was a meeting on March 4 where the president called nine members to the Roosevelt Room at the White House, and eight of the members had voted for the bill when it passed the House last fall. I was the only one who voted against the bill. I thanked the president for inviting me even though I was a "no" vote. And in the more than hour-long meeting, the president covered a lot of territory about what he thought was important to consider. I sat quietly and listened carefully and took some notes. And at the end of the meeting, you know, we thanked each other, and I left.

When I arrived home that evening — March 4 — I still had this deep sense of compassion for the president for what he was struggling with in trying to pass the bill. And it was very clear to me that there was a lot on the line here — that he didn't say. I was just thinking about the scope of American history, and here's a president who's trying to do something, even if I don't agree with him. I told my wife, "You know I kinda feel bad about the situation he's in here. This is really a tough situation — his presidency is on the line." And I had a sense of sadness about what I saw him grappling with. I still maintained my position, still went forward in debates, arguing in meetings, arguing against the bill because it didn't have a public option, didn't have an opening for the states to pursue single-payer in a free manner. But at the same time I kinda remember the feeling that I had about watching him as he was dealing with this and, you know, trying to do what he felt was best for the nation.

Now keep something in mind about my relationship with President Obama: He and I campaigned together. A meeting with the president is always important — he and I have met dozens of times, during the campaign and since he became president — but we've met on many occasions. Four or five times about health care. So the relationship I have with him is a little bit different than other members who weren't on the campaign trail with him and who hadn't developed a relationship with him apart from the relationship that members of Congress ordinarily have with the president.

So I was really looking at Barack Obama the man, and thinking about his presidency. I've had differences of opinion with him on a number of issues. But I understand how this is a pivotal moment in America, and in his presidency. It's also a pivotal moment in American history. Of course, I carried that awareness with me into the next meeting, which took place on Air Force One on the fifteenth of March. Last Monday. So much has happened in just one week, but during that time, there had been a lot of speculation. I had done many interviews attacking the bill for its well-publicized shortcomings and I was not relenting. After we met on Air Force One, I didn't tell the president that "Look, I'm changing my position — you got me." We didn't have that discussion.

My decision came last Tuesday morning. There's a place where I go in the Capitol, just to kind of reflect — before I have to make very important decisions. It's in the rotunda — right next to Lincoln's statue. It's just a bench. And I went over there early Tuesday morning, about seven in the morning when the sun was just coming up, and no one else was around — there wasn't a sound in the Capitol at that moment in the morning. And I just sat down there in a quiet place and thought about this decision. And that's literally where I made up my mind that, notwithstanding how much there was in the bill that I didn't like, that I had a higher responsibility to my constituents, to the nation, to my president and his presidency, to step forward and say, "We must pass this bill. And we must use this bill as an opening toward a renewed effort for a more comprehensive approach to health care reform."

The Speaker and I also had many discussions about the bill. And I talked to her briefly on Monday night and told her that I was giving some thought to the appeals that she had made to me. And she said, "Oh, Dennis, you know, I just hope that you'll be with us on this. This is so important." And I said, "Well I'm giving some thought to what your concerns have been, Madame Speaker." And on Monday night, I talked to my wife, Elizabeth — at home, it was late.

Elizabeth asked how the day went. And I told her. I said, "You know I'm giving this a lot of thought." I asked, "What would you think if I decided to support this?" And she said, "Look, I'll support — whatever decision you make, I'll stand behind you." And it was important for me to talk to her because, you know, spouses live with the decisions that members of Congress make. I mean, I have had occasion to ask Elizabeth's opinion, and if she feels very strongly about something, I'm open to being persuaded. That's just what happens when you have a partnership. So I asked what she thought, and then I got up in the morning and headed right over to the Capitol just to meditate on all the discussions that I'd had — with the president, with Speaker Pelosi, with my wife, and with my constituents.

And then after being in the rotunda for about fifteen minutes, I left and went over to my office. That afternoon, I had a meeting with my staff, and I told them that I was going to come out in favor of the bill. But I had no discussions with anyone. And I did not notify the White House — the White House found out about it when I announced it from the press gallery. Because I just felt that this had to be a decision that I made on my own, without any coaxing one way or another. I wanted even people in the White House to know that this decision came ultimately from my own willingness to pay careful attention to the concerns that the president, the Speaker, and others had expressed to me.

This was a particularly hard decision because the private insurance model is something that I don't support. As I've said before, I don't take back any of the criticisms I've made of the bill. This is reform within the context of a for-profit system. And the for-profit system has been quite predatory — it makes money for not providing health care. Now, the reforms in this bill may provide some relief from that impulse. But, nevertheless, I have my work cut out for me now in continuing the effort toward a much broader approach to health care reform, which would include attention to diet, nutrition, complementary alternative medicine, and empowering states to move forward with single-payer.

When it comes to analyzing the law we've just passed, it's hard to use terms like good or bad. Because ultimately what was decisive for me was not the bill, but rather the potential to create an opening for a more comprehensive approach toward health care reform. If the bill were to go down, this whole discussion about anything we might hope to do in health care in the future is not going to happen in this generation. We had to wait sixteen years after the demise of the Clinton plan to come to this moment. And the angst that members are feeling about this bill — the temperature that's been raised in the body politic over this bill, the characterizations of the bill in a debate that's been quite distorted — all of those things argue against bringing up another health care bill in the near future if this bill were to go down.

Well I had to consider that. Because I have to take responsibility for that.

Someone in the media said that I was prepared to be the Ralph Nader of health care reform. If by the Ralph Nader of health care reform someone means someone who holds crooked corporations accountable, then that's a compliment. If they were referring to the 2000 presidential race, I think those who were closest in the Gore campaign realize that that campaign was death by a thousand cuts. And to try to put it all on Ralph Nader is, you know, historically glib.

But the synthesis of that argument was this: People were telling me, "Dennis, you are helping to gather momentum in the direction toward the defeat of the bill." That's what people were telling me. That's what the message was. And: "Is this something you really want to do?" And of course I have to consider, when the vote is close, and however the final tally turns, but whether the bill passes by one vote or five votes or more, the question of momentum was something everyone was concerned about at that point. And people were concerned that if I continued to maintain my position of hammering away at the defects of the bill that I may cause its defeat. That's a legitimate criticism. It's something that I had to take into account in terms of my personal responsibility for the position that I held, and the impact that it would have on my constituents. We always have to be open to people who may hold a view that may be different than yours. Because you might learn something.

And so as we came closer, and it appeared that I would be in a pivotal position, I realized that the moment required me to look at this in the broadest terms possible. To look at this in terms of the long-term impact on my constituents, of the moment in history in which we now stand, of the impact on the country, of the impact on the Obama presidency, on the impact on the president personally. I had to think about all of this. I couldn't just say, "Well here's my position: I'm for single-payer, and this isn't single-payer, so I'm going to defeat the bill."

Last year, seventy-seven members of Congress agreed that if the bill didn't have a public option, they were going to vote against it. And there were only two members who had kept that pledge when it was voted on the first time in the House. And I was one of them. And the other one's no longer in Congress. So I basically was the last man standing here. So I'm aware of the debate that took place in favor of the bill. My concern was that this bill was hermetically sealed to admit no opening toward a not-for-profit system, no competition from the public sector with the private insurers. Which makes the claims of a government takeover such a joke. You know, those who claim that this is socialism probably don't know anything about socialism — or capitalism.

Those claims are just part of an effort to destroy the Obama presidency. And, of course, to produce gridlock — so that nothing can happen. Because if this bill goes down, which figured into my calculus — the bill goes down, we'll be gridlocked. We will be unlikely to pass any meaningful legislation about anything. The presidency will be weakened, the Congress will be in a place where the leadership will be undermined.

But let's go deeper than that. We're at a pivotal moment in American history, and in contrast to a crippled presidency, I have to believe that this effort, however imperfect, will now have a broad positive effect on American society, and make possible many things that might not have otherwise been possible. Once this bill is signed into law, more Americans are going to be aware of this as they ask, What's in it for me? And as they become more familiar with the new law, more people will be accepting this bill. The president will have a stronger hand in domestic and international affairs, and that will be good for the country. The Democrats will be emboldened to pass an economic agenda, which has been waiting for this bill to pass. Wrong or right, as far as a strategy, the White House invested so much in this health care bill that everything else was waiting. Now, I think there's a chance that the party will regain some momentum. And if it does, then the American people will finally have a chance to see something done about creating jobs, about keeping people in their homes, about helping small businesses get access to credit, which is a huge problem right now.

And so I think that the pivot here could be toward a very exciting time where the Obama presidency gets a chance to hit the reset button. This is my hope, at least.

All of this went through my mind as I sat in the quiet Capitol rotunda last Tuesday morning. I thought about what could happen if I was willing to show some flexibility, and to compromise for the sake of a broader progress. That was all part of my thinking as I got the point where I stepped to the podium in the Capitol to announce my decision. And right after I finished what I had to say and left the room, the president called. I understood the importance of the call, and he understood the importance of the decision that I made. There was gravity in the moment. There is a lot at stake here.

I took it all into account — everything that I hoped would happen if this were to pass, everything that I hope will happen. And if those things come to pass because of the small role I may have played in switching the momentum, then my service in Congress has been worth it.