Reconciling The Path To Health Care Reform

BooMan has a must read on why it appears that the reality of the Democrats' health care reform legislation will be through the harsh realities of budget reconciliation.

But, on the Finance Committee, only Olympia Snowe of Maine shows any trace of receptiveness to voting for the health care bill. And, I don't think she's likely to vote for a public option. Given these facts, it's very likely that even if Baucus can convince Snowe to vote for the Finance version of the bill, she will probably vote against the bill on the Senate floor and on the conference report vote of the bill once it has been reconciled with the House version.

Chasing after Snowe's vote is a fool's game. I don't think we will have 60 votes for a public option, so the Senate will have to pass the bill in the budget reconciliation process after October 15th. In that process, the bill will only require 50 votes to pass. That's a hurdle that we can clear, but it comes at a cost. Any provisions of legislation passed during budget reconciliation are subject to a point of order (the Byrd Rule) if "they do not produce a change in outlays or revenues, or they produce changes in outlays or revenue which are merely incidental to the non-budgetary components of the provision."

In other words, under the reconciliation proces, during the debate over the Health Care bill the Republicans can move to strike all sorts of peripheral elements of the bill if they cannot be shown to have some non-incidental impact on the budget. Depending on interpretation, this could apply to wellness programs (which are hard to score budgetarily), or any number of other important provisions.

The result could be a very pared down version of the bill. It might have less pork in it, but it could also lose vital (but theoretical) cost-savings provisions that will come back to haunt us later. Another feature of the reconciliation process is that legislation passed under the process faces an automatic five-year sunset (like Bush's tax cuts) and therefore can be killed off later if the makeup of Congress flips sides.

On the other hand, the Democrats could pass a bill under regular order that has the support of all 60 Democrats. The difficulty with that is in getting the most centrist members to support a bill that is acceptable to mainstream Democrats in the House and Senate. And, those centrists don't like to vote for anything that doesn't have at least a vote worth of bipartisan support. Voting with the Democrats on a party-line vote as well-publicized at the Health Care bill leaves them feeling alone and exposed.

Beyond that, a few of these folks are basically ideological-Republicans. They oppose the bill for many of the same reasons the Republicans do. They're corporate whores who deplore government action in the private sector. So, get ready for reconciliation. Baucus had his chance.

In other words, BooMan is saying that no matter what kind of arm twisting Obama does over August, there's just no way he can get 60 votes for the public option. The logical conclusion given that is to focus on what parts of Obama's health care agenda can be kept in a reconciliation situation, how to pay for it in the short term, and how to get it all past the Byrd Rule.

Is this surrender on the part of BooMan? I believe he's just being realistic. Let's face it: No Republican will vote themselves into a permanent minority by signaling yes on a robust public option, and even one Democrat saying no won't get this through the filibuster. Several Senate Dems have expressed reservations: Evan Bayh, Blanche Lincoln, Kent Conrad, Joe Liberman, the list goes on. It annoys me that Kent Conrad is blathering on about how reconciliation is just too horrible to use either.

In fact, there may be enough of the "corporate whores" that BooMan rightfully bemoans to even get the 50 votes needed for reconciliation, not to mention that if too much is dropped from the final bill, there will be progressives on the left who will want nothing to do with the legislation.

So what to do? Is there time enough for Obama to make a difference? Even if he put in all on the line and said that a public option was mandatory, would it be enough to motivate the Democrats in the Senate to go along?

Enough people are convinced that fixing health care for everyone will mean a decrease in quality and increase in price for their own existing plans. Unless and until that changes, health care reform probably won't even make it through reconciliation intact. The status quo has too much invested in being the status quo, and the lawmakers they have bought and paid for are wanting those fat lobbying gigs for their families and friends as well as their selves.

So what's a progressive to do? If BooMan's right, we're wasting our time trying to go through normal channels. We're going to have to start having the much more productive discussion of how to keep health care reform together when there's a very good chance that the GOP will be able to argue for the plan's sunset after five years, as getting the changes to make health care reform robust and substantial will incur a substantial cost.

In other words, we're down to "the good is the enemy of the perfect" time. I'm not convinced we're that far gone yet.

But I do agree with BooMan that it's time to start having the discussion now, and that being prepared to move down this road is prudent over the recess.

[UPDATE 2:53 PM] Steve Benen makes a good point however. Convincing Americans that their own individual plan is "fine" is one thing. But convincing Americans that the health care system as a whole needs no reform whatsoever right now is a different matter.

As a factual matter, when you ask the American people what's the most important issue to them, health care reform actually ranks very high. Last week, an NYT/CBS poll asked an open-ended question of respondents, asking what's the "most important problem facing the country today." While the economy and job creation were on top, health care was next on the list -- with a higher score than the deficit, education, immigration, Iraq, terrorism, and the environment combined.

But as a political matter, Republicans have been on the offensive for weeks, and feel like they're in a position to kill reform before the fall. The more they argue that the system is fine the way it is, and that reform isn't especially necessary, the easier it will be for Democrats to regain the rhetorical advantage.

That's something the Democrats need to exploit. The GOP is getting intellectually lazy (real shocker, there) and assumes it can now talk people into the status quo, now that they belive the battle is all but won for them. That's going to end up killing them.