Is The House Bill Our Health Care Future?

This week the House of Representatives is taking up their own health care measure, a $1.2 trillion bill which so far has the endorsements of both the American Medical Association (AMA) and the American Association of Retired Persons (AARP), two very important organizations representing the medical community and the elderly (though AARP welcomes anyone 50 or over).    House Speaker Nancy Pelosi is wheeling and dealing to get a vote by Saturday; though there are over 280 Democrats, many moderate and conservative Democrats dislike the cost and scope of this bill, she needs to find one palatable to at least 218.

While political junkies find this fascinating inside politics, most people see it as a side show.   Senate moderates in both parties have no desire to pass something as broad as the House bill, and so more attention is placed on the threats made by Joe Lieberman or Olympia Snowe to resist something too ambitious.   But what if the White House has made an unannounced change in strategy?   What if the Obama Administration, recognizing that the drawn out effort to pull in moderates and build something bi-partisan is only hurting Obama’s credibility and helping the GOP energize its base, decides to forego bi-partisanship and get passed the best bill they can pass?

In that case, the Senate would pass a bill based on the procedural maneuver of “reconciliation.”   Although the purpose of reconciliation, as put in the 1974 Budget bill, was to allow contentious bills to by pass filibusters if they are needed to cut spending, it has been used far more broadly.   Most recently President Bush used reconciliation to drive through his second tax cut, with Vice President Cheney breaking a 50-50 Senate tie.

If the Senate uses this procedure (no doubt with Joe Biden presiding), the Democrats need only 50 votes to pass the bill, Biden can break any tie.  That means they can lose up to ten Democratic moderates and still win the vote.   The Republicans will scream “foul,” but the Bush tax cut will be shoved back in their faces.   The public virtually never gets incensed about parliamentary procedure anyway, so the big story will be how close the vote might be.

This could play out in three ways.   First, once the House passes something, the possibility of reconciliation of a bill like that from the House could hang in the air as an unstated threat, subtly putting pressure on moderates.   Pundits would talk about it, but Obama would insist he still wants to find bi-partisan compromise.   However, it’s also possible that Majority Leader Ried could make it clear that if the GOP doesn’t give the Senate an acceptable bill to pass, he’ll use reconciliation to pass the House version.   Theoretically this could be done to pressure moderate Democrats and Republicans to say “if you don’t do something to get your concerns into a bill acceptable to us, we’ll ram this down your throat.”

At that point, the Republicans would have to wonder if it’s just a bluff — will they really pass something so major on slight vote margins?   This could also be used to get something this year rather than next year.   That would be an overt threat, with the White House playing hardball.

However, there is a third possibility.   What if Obama has given up on the Senate moderates, and decided to get something through sooner rather than later?  What if Reid’s statement that a bill may not come until next year, and the continuing emphasis on moderates is really a diversion to prevent people from seeing just how important the House vote on Saturday might be?

Here’s how that could play out:  The House passes a bill by a relatively narrow margin.   Reid, having already conferred very secretly with top allies in the Senate and White House, would see if he could patch together at least 50 votes for a House like version of the bill.   If he could, we could see dramatic action in a relatively short time period, with health care reform passed this year — maybe even this month.

I’m not predicting this will happen, nor do I know if the Senate has fifty votes for something akin to the bill in the House.   But at this point in time Obama is not helped politically by having this stretch out, and he needs accomplishments.   He has one year before the Mid-term elections, and needs to move on other matters currently put aside due to the health care conundrum.   Doing this quickly — and even a bit on the sly to catch the opposition by surprise — would have the added benefit of limiting the time the lobbyists have to really pressure Senate Democrats.  Many in the House might vote “yes” for Pelosi, thinking that the bill is just setting up negotiations with the Senate in the future.

All this is unlikely.   Moreover, it’s hard to imagine them working it in this way without any leaks.  Still, if Obama and the Democrats need a game changer to shake up the political world and re-take the initiative, an unexpected success on health care legislation would be a dramatic statement.

  1. #1 by classicliberal2 on November 8, 2009 - 17:32

    One thing is certain: This gaggle of clowns isn’t going to do much of anything to shape what happens with health care in congress:

    It’s distressing to me the degree to which criticism of what is being proposed has largely fallen to a gaggle of mental defectives.

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