Even with the new push by President Obama and Democrats finally coming around to the need to ignore Republicans and pass health reform through reconciliation, important obstacles to that goal -- and any health reform passing this year -- still remain.
For instance, on Sunday, Sen. Kent Conrad (D-ND), the chairman of the Senate Budget Committee and one of the Democrats who long opposed the public option, declared on Face the Nation, "Reconciliation cannot be used to pass comprehensive health care reform. The major package would not be done through reconciliation." He overlooked, though, that the proposed fixes to the House and Senate bills by the White House are in fact budgetary changes, as Steve Benen of The Washington Monthly observes, "The next step isn't passing health care reform through reconciliation; the next step is passing a budget fix that improves the legislation that's already passed. That, of course, is why reconciliation exists."
The political landscape has changed so profoundly since Democrats were shell-shocked by the Republican Senate victory in Massachusetts that a new wariness among centrists and vulnerable Democrats makes the challenge for passing ae bill even harder. That's in part due to the failings of the administration in trying in vain to appease Republicans and conservatives, and most mainstream advocacy groups in letting them do so for so long --and refraining from full-throated, high-profile attacks on the insurance and hospital industries while the White House was negotiating with those stakeholders. The New York Times reported last August (hat tip to blogger Miles Mogelescu ):
"Several hospital lobbyists involved in the White House deals said it was understood as a condition of their support that the final legislation would not include a government-run health plan paying-Medicare rates...or controlled by the secretary of health and human services. 'We have an agreement with the White House that I'm very confident will be seen all the way through conference', one of the industry lobbyists, Chip Kahn, director of the Federation of American Hospitals, told a Capitol Hill newsletter...Industry lobbyists say they are not worried [about a public option.] 'We trust the White House,' Mr. Kahn said."
Meanwhile, some progressive critics are offering increasingly harsh assessments of the role of the Democratic leadership and the White House in undermining the now-fading public option, a dispute widening the division among liberals even as passage in the House rests on a razor-thin margin requiring centrists and conservaDems. Yet Glenn Greenwald of Salon argues about Democratic leaders and the President:, "They're willing to feign support for anything their voters want just as long as there's no chance that they can pass it. "
(For the full story, see this article at the Working In These Times blog.)
At this point, though, it seems that most progressives in Washington, including the House Progressive Caucus, are now willing to support the President's bill without a public option. As the CBS News political blog reported, an increasing number of progressive groups are falling in with the President's drive to just get it done:
Some progressive groups and Democratic congressmen are applauding President Obama's appeal for an up-or-down vote on his health care reform proposal, even though it falls far short of the goals they once had for reform.
The president today said he has asked Congress to vote on his proposal within a matter of weeks because Congress "owes" that to the American people. The plan is for the House to pass the Senate bill and then for both chambers to take an up-or-down vote on a separate "fix it" reconciliation bill...
Along with the process of passing the bill, certain provisions are less than ideal for reform advocates. Nancy Keenan, president of NARAL Pro-Choice America, released a statement decrying the provisions in the health care bills that restrict abortion coverage but praising the bills overall.
"The Stupak and Nelson measures are outrageous, but the health-reform bills do have many positive provisions," she said. "They will significantly improve women's access to other reproductive-health services, including family planning and prenatal care."
NARAL says it is continuing to lobby members of Congress to drop their insistence on keeping the abortion language in the bill. Yet it's unlikely the language could change in the reconciliation process, since it can only be used for provisions that impact the federal budget.
House Speaker Nancy Pelosi (D-Calif.) said yesterday that abortion was not a central issue in the Democrats' plans.
This "is not an abortion bill," she said. "It is a bill about affordable health care for all Americans."
Health Care for America Now, a group that has largely aligned itself with the president's goals, put out a statement saying Americans can no longer wait for reform -- even though Mr. Obama has dropped calls for a public option.
"We now call on Congress to listen to us - not the insurance industry - and allow a majority vote on a health care reform plan that will lower cost, increase competition, and put regulation and oversight in place to guarantee we get access to quality, affordable health care once and for all," Richard Kirsch, HCAN's national campaign manager, said in the statement.
Meanwhile, the justifiably angry netroots activists are ramping up pressure on Senators to support it, with nearly 35 Senators signing a letter of support.
Some House leaders are predicting they'll have enough votes in the House, where centrist and conservative Democrats pose the biggest obstacle, but reform's prospects in the House -- and whether Democratic Senators will go along with reconciliation -- are still unclear. As the Hill reported:
On NBC's "Meet the Press," Chief Deputy Whip Debbie Wasserman Schultz (D-Fla.) agreed that the votes are there.
"When we start counting the votes will be there," she said.
Senate Majority Leader Harry Reid (D-Nev.) has not yet said whether or not he will use the reconciliation process to pass fixes to the bill. And it's not clear whether or not 50 senators will support its use.
Some expect that the House will pass the Senate bill and then approve President Barack Obama's fixes to the bill with the Senate approving the fixes using reconciliation. But House Speaker Nancy Pelosi (D-Calif.) said on ABC's "This Week" that Democrats are still finalizing their plan.
But it also remains unclear if the House can marshal the votes to pass a health bill on a second go-around. Republicans have said they don't but Democratic leaders have left it an open-ended question this week.
A key progressive interest group that can make a difference in passing a bill, labor, has so far given modest support to the President's package, but is eager to see more improvements in the legislation, even though time is running out as we get closer to election season. But even if labor and progressive leaders fall behind the President's realpolitick proposal, there's no massive outpouring of grass-roots activity on behalf of salvaging health reform in the House with Obama's modest plan. That's because, as one progressive advocate told me bluntly, "It's hard to get the base fired up about the compromise."
At the same time, interest groups for and against health reform are gearing up for what could be the final battle, with the health industry deploying eight lobbyists for each member of Congress. As the Washington Post reported:
Washington interest groups have burst back into action in hopes of bolstering or defeating a new Democratic push on health-care reform legislation, sparking another wave of rallies, lobbying efforts and costly advertising campaigns.
The fresh round offers a clear signal that the industries and advocacy groups most likely to be affected view the coming weeks as the final battle in determining whether Democratic proposals become law.
Their efforts suggest a return to the frenzied pace of last year's health-care debate, which prompted more than $200 million in advocacy ads and broke records for lobbying. Companies and trade groups last year hired more than 4,500 lobbyists to influence health reform -- amounting to about eight lobbyists for each member of Congress, according to an analysis released last week by the Center for Public Integrity.
Progressive groups also have their own plans, but it's not clear if their urgency can match the hostility of the right wing and the greed of most health industry players in stopping reform. As the Post noted:
Democratic and liberal activist groups, meanwhile, are rallying with their own efforts in hopes of pushing legislation across the finish line.
MoveOn.org, for example, said that a "virtual march" organized Tuesday bombarded lawmakers with more than 1 million pro-reform e-mails. The group also released a television ad Friday targeting House Minority Leader John A. Boehner (R-Ohio) for opposing the antitrust bill.
"We have the votes; let's get it done," said Ilyse Hogue, the group's political advocacy director. "We're focused on sending that clear message to the House and Senate."
One glaring exception to the renewed activity is AARP, the 40 million-member seniors group, which has spent millions on advertising and other efforts over the past year in favor of Obama's health-care plans. A. Barry Rand, the group's chief executive, called on other groups last week to lower the temperature in the debate so that "compromise is possible."
"We promise to make no new statements, send no new letters, run no new ads about health reform, and we are urging all other interest groups to do the same," Rand said in a statement. "Let's turn down the volume on the outside noise so that our leaders might actually listen..."
Organizing for America, the grass-roots arm of the Democratic National Committee, is tapping into Obama's 13 million-deep e-mail list to solicit campaign volunteers on behalf of Democrats who support health-care legislation, according to Lynda Tran, a spokeswoman. The effort has so far resulted in nearly 9 million hours of pledged volunteer work, Tran said; the idea is to guarantee electoral support for lawmakers nervous about the November midterm elections.
The group also launched a new campaign last week aimed at helping Obama supporters make their views known on talk-radio stations around the country, Tran said.
Richard Kirsch, national campaign director for the pro-reform group Health Care for America Now, said the organization plans a large-scale demonstration in Washington on March 9 targeting a policy conference by AHIP, the insurance lobby.
The group also ended an eight-day march last week from Philadelphia to Washington in honor of Melanie Shouse, an Obama supporter whom activists say died of breast cancer because she had no access to health insurance.
"The message we have is simple: Congress should listen to us, not the insurance industry," Kirsch said. "They have to make a decision and decide whose side they're on."
Amid the challenges of winning over centrist and conservative House Democrats concerned about abortion or deficits, progressives also need to keep in mind what will happen to not just Democratic election prospects but health care itself if Democrats fail now. As Reed Abelson points out in the New York Times:
Suppose Congress and President Obama fail to overhaul the system now, or just tinker around the edges, or start over, as the Republicans propose -- despite the Democrats' latest and possibly last big push that began last week at a marathon televised forum in Washington.
Then "my health care" stays the same, right?
Far from it, health policy analysts and economists of nearly every ideological persuasion agree. The unrelenting rise in medical costs is likely to wreak havoc within the system and beyond it, and pretty much everyone will be affected, directly or indirectly.
"People think if we do nothing, we will have what we have now," said Karen Davis, the president of the Commonwealth Fund, a nonprofit health care research group in New York. "In fact, what we will have is a substantial deterioration in what we have."
Nearly every mainstream analysis calls for medical costs to continue to climb over the next decade, outpacing the growth in the overall economy and certainly increasing faster than the average paycheck. Those higher costs will translate into higher premiums, which will mean fewer individuals and businesses will be able to afford insurance coverage. More of everyone's dollar will go to health care, and government programs like Medicare and Medicaid will struggle to find the money to operate.