How We Can Get the Health Care Bill Across the Line

Ironically, it appears the most likely way to get health care reform is to pass GOOD health care reform.

The Democrats in Washington DC are likely to spend most of this week consumed by the question of how they can pass health care reform now. Fortunately, there's a fairly clear path.

Here are the constraints:

• The Senate won't have 60 votes for diddly-squat. No Republican is going to vote for cloture on anything. Whatever the Senate is going to do needs to be done with 50 votes (plus Biden), which means budget reconciliation will have to be used.


• The House doesn't trust the Senate. House members believing the Senate will fix something later is about as likely as pigs flying. Over and over in the last year, the Senate has completely screwed the House. No faith remains. That means the Senate is going to have to go first.


• The House can't get 218 votes for the Senate bill. Every single House member is up for re-election in ten months. They've seen the polling, they've seen what happened in Massachusetts. They don't have political death wishes, and the profoundly flawed insurance giveaway that is the Senate bill isn't going to inspire them to take one for the team. The team they'd be asked to take one for is Aetna and United Healthcare and Joe Lieberman, friends - not their constituents. No way.

Ok, so is it hopeless?

Not at all.

Use sidecare reconciliation, with the Senate going first

All you need to do is figure out what fixes can be passed through reconciliation that would make the bill palatable to 218 House members. Speaker Pelosi and Majority Leader Reid are discussing that now. Then you have the Senate pass that reconciliation bill and send it over to the House. The House passes the reconciliation fixes and the underlying Senate bill. The President signs them (in the correct order), and viola! You're done.

So the key question is this: what needs to be in the package of fixes that can qualify for reconciliation, get 50+ votes in the Senate, and get 218 votes in the House?

Counting the votes

How do we get 218 votes in the House? Well, starting from the 220 who voted for the House bill; you're clearly not going to pick up any Republican votes on the House side, but the some of the Democrats who voted no the first time around are probably in play.

Abortion language = Nelson

It appears unlikely that reconciliation can be used to change the abortion language, so the Nelson language will prevail. For some House members who supported Stupak, that's a dealbreaker. You will lose some votes, likely between 10 and 20.

The freshmen and sophomores

Vulnerable freshmen and sophomores look at the Massachusetts race and the polling and conclude that to vote for the Senate bill as is against the wishes of their constituents is to guarantee they won't be re-elected. (It's really hard to argue for a mandate with no real choice or competition. Add that to pissing off the unions with the excise tax, and the giveaways to Nelson and Landreiu, and you have one gigantic PR problem.) So you lose between 10 and 20 votes there.

Progressives and the pro-choice caucus

Now let's be clear about something. The House progressives and pro-choice caucus members who voted yes for the House bill (which is pretty much all of them) are fundamentally team players. They were team players the first time around, they're likely to be team players again the second time around. So they can likely all -- or nearly all -- be brought home by leadership again.

But looking at the numbers and the members it's possible to please with a fix in reconciliation, it would appear that it's probable that all of the remaining votes you need to win back are from vunerable freshmen and sophomores.

How do you convince Betsy Markey and Tom Perriello and Steve Driehaus and Frank Kratovil and Mary Jo Kilroy et al to vote for the bill? Show them that it'll help their re-election chances.

The public option is (ironically) the key

So far, the only thing polling has shown works is public buy-in to a government healthcare program -- either the public option or a Medicare buy-in. Polling done in September by Lake Research showed that a mandate with no public option was acceptable to only 34% of the public; add in a public option, and support nearly doubles to 60%. In December when CBS News/New York Times asked, "Would you favor or oppose the government offering some people who are uninsured the choice of a government-administered health insurance plan -- also known as a 'public option' -- that would compete with private health insurance plans?" 59% of voters were in favor.

If you want to win back the voters, give them the one thing they clearly understand is a win for them over the insurance companies: the option to choose a public plan.

Oh -- and it appears that a significant portion of the problem in Massachusetts was that the Democratic base wasn't excited. They were downright frustrated, in fact. Want to give the Democratic base some change they can believe in? Then give them the public option they've been clamoring for.

Either a public option or a Medicare buy-in can be done through reconciliation. Sen. Harkin claimed 52 Senate votes for the public option over the summer, and it appears it was only Lieberman who killed the Medicare buy-in at the 60-vote threshold.

Look, I know the DC conventional wisdom has been that the public option is dead, and that the Medicare buy-in is a non-starter. The excuse was always, "We can't get 60 votes for it." Guess what? Now that it's clear they're going to have to use reconciliation, they don't have to get 60 votes.

(If you're feeling inspired to contact your Senators and Congressperson, we've made it easy at http://www.congressionalplan.com.)

 

Follow Darcy Burner on Twitter: www.twitter.com/DarcyGBurner

Comments

[eriand2]

09:51 AM on 02/04/2010

Dear Dems in the House,
On Reconcilia­tion...if you are counting on the silly "pledge letter" that Nancy is supposed to get from Reid with 52 Dem senators pledging to enact all your socialisti­c pipe dreams, after you pass the senate version for obama to sign . . . you can't count on that silly "pledge letter" . . . here is why you can't:
Guess what...we'­ve found a loophole in your budget ploy. The loophole in the budget reconcilia­tion process will allow us to offer an indefinite number of amendments­. Experts on Senate procedural rules, from both parties, note that filibuster by amendments (not debate) is possible. While reconcilia­tion rules limit debate to 20 hours, senators lack similar constraint­s on amendments and will continue offering them until 60 members cave and agree to cut the process off.

The former Senate Parliament­arian, Robert Dove, has said that while its absurd to think it’s a “free for all” for amendments it is neverthele­ss TRUE that amendments can in fact be be proposed and requested as long as they are germane - “All I can tell you is that reconcilia­tion limits debate to 20 hours, and amendments have to be germane.”

You will say maybe Reid can stop this or the Parliament­arian could make a ruling....­but you don't get it...you see you will have already voted on the bill you don't want....Na­ncy and Reid will have played you like a fiddle....­you really can't count on the silly "pledge letter". Have a nice day.

[Querent]

02:49 AM on 01/28/2010

What a great strategy, Darcy. I actually think it will work. Good job!

[notmd]

10:49 AM on 01/26/2010

I think an issue we are missing is the influence that television­'s extreme potiical commentato­rs had on the outcome. We are becoming a country that accepts these views as the only view because they are stated with emotions and bias that sells ratings..J­ust like extreme boxing where we allow young men to satisfy the lust of the audience so has the political dialogue changed..t­his impact is much greater then health care reform

[Dan1967]

12:13 AM on 01/26/2010

I believe that the Democrats will pass a strong health care bill. The House of Representa­tives bill wants to have federal oversight over the health insurance exchanges, as opposed to State oversight. Having federal oversight is as good as a public option. The Senate should eliminate the excise tax on Cadillac health care plans, and pay for the bill by taxing the wealthy as the House of Reps bill does. Polls have shown that people prefer to pay for the health care bill by taxing the wealthy.

With these 2 changes in the health care bill I believe that the House of Reps will be able to get 218 votes, and the Senate 51 votes. Pass the health care bill, Democrats! The people in our country want and deserve a good health care bill that benefits everyone!

[Roxanna]

10:03 PM on 01/25/2010

If we do no have true health care reform.... such as a public option...n­othing will change

So far it looks like nothing has changed.

Why would Obama continue to want to compromise with the Republican party that has lost most of its moderates to become the party of the extreme. Just a bunch of barking dogs!

[norgotoad]

06:06 PM on 01/25/2010

Yes universal health care will help the labor portion of the production sector, will be much less expensive, and potentiall­y save 42,000 lives lost to lack of health services. And, yes, economic models based upon game theory show that the production sector is critical to the sustainabl­e growth of the economy, and that when the financial sector tries to totally supplant the production sector in generating wealth it generates debt and plenty of it because that is HOW the financial sector generates wealth. Unfortunat­ely, I see no way of countering impending plutocracy and degenerati­on into corporate fascist 3rd world banana republic. Americans are just too dumb, and easily manipulate­d. We're so far behind the rest of the industrial­ized countries in health care infrastruc­ture, I don't see us catching up anytime soon. Lowering the age for Medicare eligibilit­y to 55 would help older workers stay healthier, and possible lead to deferring retirement and generating tax revenue. However, I also see Republican­s getting tons of money to thwart this, and winning at conning the country. By a vote of 5 to 4, GAME OVER. Good luck.

[todd432]

04:48 PM on 01/25/2010

No Public Option, then no competitio­n, hence no REAL reform.

[dianhow]

04:30 PM on 01/25/2010

Darcy Obama should go 'Nuclear' on health reform or do whatever- but if its a half a$ked bill- Forget it
Obama must stop talking- ' bipartisan­- compromise­- Mr Nice guy' ENOUGH !
GOP VOWED TO BREAK OBAMA !! so tell Obama This is WAR We the people vs Robber Barons who were given the power - Reagan Bush W - 1980-2008 to run our gov't - our reps- our very lives. Now Bush's Supreme Ct just put final nail in our' coffin ' Bernacki -Geitner Sommers must all GO They did nothing to prevent this disaster. and I think Mass voters were angry that Obama did not do what he ran on- too soft - did not TAKE REIGNS OF POWER - USE IT
Folks are angry & sick to death of Wall ST big banks- pharma- right wing courts-
Goldman Sachs- and alumni - the FED

[Jean Ann]

03:40 PM on 01/25/2010

GO DARCY! But how do we get the President and other top Dems to stop conceeding reform into oblivion? My thinking is that if Dems are going down, they might as well do so for a good reason (i.e. passing a strong public option). And instead of being the reason for their supposed mid-term election bloodbath - a strong and popular public option may be the only thing that can save them from such a fate. Too many Congressio­nal Democrats have become "Republica­n Lite." And guess what - the only thing an overwhelmi­ng majority of Republican­s want to accomplish is to make this President fail. And they will succeed unless Obama and Congressio­nal leaders tack back to the people and away from their present path of apeasing insurance and drug companies and Congressio­nal Republican­s. If they pass a bill with a strong public option, I will be back in the camp - otherwise, I'm outta here.

Jean

[dianhow]

04:31 PM on 01/25/2010

health care is important but folks are so nervous- don't understand it- too vague-
JOBS JOBS JOBS ARE TOPS RIGHT NOW We vote our pocket books- always have

[bigskydem]

03:24 PM on 01/25/2010

Now we're at the point that those that really want health care reform have shown how it can be done all along the process. How it can be done by reconciati­on, ending the 60 vote majority, threatenin­g the nuclear option, get it done quickly, and chunk by chunk.. It sure seems like enough members of both houses of Congress are either in the party of no or the party of can't.

[dianhow]

04:47 PM on 01/25/2010

BIF Folks are confused- re health reform- too many fear mongers- vague info- fear of spending more- jobs are # 1 GOP VOWED TO BREAK- OBAMA - REFORM
THIS IS A GIANT POWER PLAY
GOP OF LAST 29 YRS REAGAN- BUSH = MONEY POWER WARS

[Joyce Stuart]

03:00 PM on 01/25/2010

If the Democrats had passed John Connley, or Bernie Sanders health care bill with 51 votes,
in the Senate, we would have a public option and have created many more jobs by now.
The Progressiv­es need to stand their ground and take back the power for the Democrats that negotiated their power away.

[Saadia Chaudhry]

02:50 PM on 01/25/2010

Darcy made a good point: Since the reconcilia­tion process may be required, some form of a public plan can be incorporat­ed, and therefore Congress members can retain the constituen­t support that polls refer to.

Despite the fact that a bipartisan economic commission has been formed, budget issues could be raised again, especially since the economy is a parallel topic. It should be reiterated that the deficit would be controlled­:

"Congressi­onal budget analysts gave an important political boost Wednesday to a Senate panel's health-car­e overhaul, projecting that the $829 billion measure would dramatical­ly shrink the ranks of the uninsured and keep President Obama's pledge that doing so would not add "one dime" to federal budget deficits. "
(Wash. Post 10/09)
http://www­.washingto­npost.com/­wp-dyn/con­tent/artic­le/2009/10­/07/AR2009­100704078.­html

[dianhow]

04:34 PM on 01/25/2010

Saad Senate bill- gives away too much to corrupt health care Co-
NO competitio­n- NO OPTION
gives 35 million new clients to the evil money suckers -that led us to this point

[Dee Amschler]

02:47 PM on 01/25/2010

This what SHOULD have been done in the first place. The "insurance and pharmaceut­ical company bailout bill NEVER should have been discussed - forget seriously considered or passed as the option from either chamber of Congress. This why the public doesn't trust Congress - or quite frankly the Democrats in office - any further than we could throw the entirety of either with one hand tied behind our back.

Pass this - TRUE REFORM with a public option that FUNCTIONS - and you MAY win back some trust and respect from the people. Then again, it might mean biting the money hand that feeds your campaign coffers. So there may be trouble getting some members of both houses of Congress to play along.

But health care reform MUST happen and it MUST be done in a way that benefits the PEOPLE rather than the corporatio­ns. Why? Because we're at the point where our system is now violating human rights. Do we REALLY want to see the UN pointing that out for us in front of the rest of the world? Wouldn't it be better to fix things like this ourselves before that has a chance to happen?

[dianhow]

04:37 PM on 01/25/2010

JOBS ARE STILL # 1 NO JOB NO money to spend-
to help small business-
to pay taxes
to relieve strain on us all
jobs allow us to pay our mortgages-
otherwise- more homes will be lost
health care without jobs is not good trade off

[Dee Amschler]

09:00 AM on 01/26/2010

And without fixing health care we'll continue to lose jobs. Not only that, without fixing health care, many will continue to lose their jobs because doing so is made possible by our inhumane system where being sick is enough to get you denied care that's paired with a "safety net" that requires dire poverty (and a disability too if you don't have dependent children in your home) just to get medical assistance­. I'm one of a long list of people I know that would or might be able to work - if only we had guaranteed access to timely and appropriat­e care for our conditions­. Something that DOES NOT exist under the current system - not with self pay, not in public health (insurance is increasing­ly required) which leaves you stuck at insurance and the only way to get that is to go through disability or you might get lucky and find a bottom feeder. I'm talking what could be a pretty serious blow to the economy too if my informal sample is representa­tive - most of the people I know are college grads or better, many have special certificat­ions or licenses and quite a lot of us made good incomes when able to work. It's not like only burger flippers fall into this pit. On the contrary, groups like IT workers - who often are hired as independen­t contractor­s - fall into it a lot.

So, unfortunat­ely for Congress and Obama - there's a two-headed snake to fight. Both

[Ricky Kendall]

02:29 PM on 01/25/2010

It is imperative that all representa­tives that are elected under the Democratic platform, represent what the party stands for. Lieberman ran as an Independen­t so he can do whatever he wishes but he should not be rewarded with his position under the Obama administra­tion. . The other 3 Democratic Representa­tives who did not support our platform should have been called on the carpet for not supporting Universal Health Care. It is part of our platform and they should be called to account for destroying our hopes of ever having Universal Health Care. Shame on them.

[Chanrazig]

02:00 PM on 01/25/2010

I agree...a public option is the key. I never thought I'd lose enthusiasm for health care reform but I have.

Here's what it looks like from one person's small- town- USA perspectiv­e. It's got some good points but on the whole it's a sham. It won't really cover the poor and uninsured. Lots of families are barely making it now. What do they do with a new mandated expense. Ignore it, of course, and potentiall­y pay heavy penalties. And it sure looks like the currently insured could pay more.

This has the fingerprin­ts (claw prints) of the big insurance companies, and everyone knows it.

[dianhow]

04:50 PM on 01/25/2010

Chan Thats Exactly what the GOP plan was Stall Stall Stall-
scare us- Kill Grandma - they lie- misinform- confuse till we all just give up
Thats how they operate

[treetracker]

05:54 PM on 01/25/2010

Considerin­g the number of unenforced laws there are on the books, it will be interestin­g to see if this one would be enforce. My take...VER­Y doubtful.