Now or Never?
It almost seems absurd to repost information that is available in dozens of other places on the Internet, but a few folks have asked my take on the current health care endgame.
After legislative maneuvering last week that led to the excision of the so-called “public option,” the Senate Democrats have 59 of the 60 votes they need to pass a motion to end debate on the bill (known as “cloture”) and move to a vote. Assuming the bill then passes, it gets sent to a joint House-Senate conference committee where it gets reconciled with the House reform bill. The consolidated bill is then sent back to both chambers for up/down votes. In the Senate, this vote can also be filibustered.
So where is the final vote in the Senate going to come from? There are two plausible options at this point. The first is Ben Nelson (D-NE), a relatively conservative Democrat who has raised concerns about the bill’s treatment of abortion (he supported the failed Senate version of the Stupak Amendment) and the fiscal burden it would place on states.
The second is Olympia Snowe (R-ME) a relatively liberal Republican. Snowe has been concerned about the financial impact of the individual mandate and was more open to a “triggered” public option than some conservative Democrats. She has also stated that she is less inclined to support the bill if Reid tries to hold the Senate vote before Christmas. Snowe is also pro-choice, so any changes that move the bill in a more pro-life direction are not going to be much help in getting her vote.
Which Senator is more likely to come on board? Reid seems to be focusing on Nelson right now. Yesterday, Nelson reportedly rejected a compromise on the abortion language drafted by Bob Casey (David Gibson has the details). Today he spent the morning in a meeting with Harry Reid. His comments after the meeting suggest that he is still negotiating seriously. One key question is whether improvements to the abortion language would be enough to bring Nelson aboard, or whether he will use an impasse on abortion to justify a vote against a bill he clearly dislikes on other grounds as well.
Meanwhile, rage on the Left about the excision of the public option has reached a fever pitch, with Howard Dean and MoveOn.org now actively campaigning to defeat the Senate bill. Rich Trumka of the AFL-CIO has strongly suggested that the labor federation may oppose the bill, but SEIU’s Andy Stern is (somewhat reluctantly) on board. The split in labor reflects differences in their base. SEIU, which left the AFL a few years back to form a rival federation known as Change to Win, represents health care workers and low wage service workers, both of which stand to gain from reform. The AFL-CIO represents industrial and buildings trades workers who are unhappy about the tax on high-end health benefit plans.
A lot of the criticism from the Left has focused on Obama’s leadership. They think he could have done more to pressure senators and build support for a public option. I think it’s true that the White House did not have the “fire in the belly” for the public option (nor do I, for the record). I think the critics vastly overestimate, though, Obama’s ability to bring pressure on the senators who have created the most difficulty for him. Obama is relatively unpopular in places like Arkansas and Nebraska. I joked to one colleague today that the only way that Obama was going to be able to pressure Blanche Lincoln (D-AR) was by threatening to come to Arkansas and campaign for her.
What does seem clear is that Obama and the Congressional Democrats need to end this impasse soon. Obama’s poll numbers, while relatively stable in recent weeks, have fallen markedly since early in the year. Congressional Democrats have lost the generic ballot advantage they had over Republicans early in the year. If this struggle carries over into 2010, there is an increasing risk of losing Democrats facing tough re-election fights.
If health care reform does not get done in this Congress, it is fair to ask whether it can ever be done. The political parties have become more ideologically homogenous and the ideological divide between them seems to be increasing. There is now an effective 60 vote requirement in the Senate on many major pieces of legislation. Historically, the United States is a center-right country that generally embraces solutions from the left only in times of economic crisis (and sometimes not even then). The Democrats are almost certainly going to lose several seats in both the Senate and House next year, giving the Republicans an effective legislative veto. Advocates for health care reform can quibble about the details, but in terms of passing major reform, the time may well be now or never.
Tags: abortion, health care reform, Nelson, Senate, Snowe
The first thing you can do Peter, is edit out your repitions on paragraphs in your post. Otherwise, nice job in summarizing this problem. Nelson was quoted in tonight’s news as saying he would still have problems with the bill if his abortion concerns were met as he has concerns about where the money will come from. Seems like he is taking something out of Lieberman’s book.
Dean and MoveOn are up to what?
Peter:
What’s in the bill?
Seriously.
*What’s in it?*
And with all due respect (and I do respect you), I wish you’d not use the phrase “health care reform” in relationship to this bill (whatever it says) as if this bill represents the only option for “health care reform.” There are plenty of other options out there – innumerable – plenty of suggestions and proposals that have the intention and goal of reforming delivery of and payment for health care in this country. You know what they are, we’ve been over this.
So I guess we can look forward to yet one more comments thread in which proponents of “health care reform” heap moral indignation on opponents of *this legislation* (whatever it says) without ever once getting specific about the legislation and the reasons reasonable and yes, even ethical and socially-concerned citizens might oppose it.
Yawn.
This W/E it looks like the Dems have the 60 votes and no fed funding for abortions. Anyone on the ‘right’ hoping that pro abortion Dems would kill reform by insisting on the measley amount of abortion funding need to take a HS political science course. And no Waterloo for Obama. Those on the right who were on suicide watch hoping the Dems would commit suicide on prime time can cancel their cable TV. [ Saves money for the tax increase.] 30 Million un-insured now have some hope. How many of these 30 million will register Republican next Fall? As for specifics, they are much more available and spelled out than the rush into the Iraq war.
It seems that getting “something” through has become getting “anything” through. In an attempt to stem the tide of falling poll numbers we have congress remaking one of the largest segments of the economy behind closed doors with only a handfull of politicians and their staffs having any real input. Is this about the president’s popularity and political viability, or helping solve the problem.
I think Howard Dean is right. This thing is a giveaway to insurance companies. We have pretty much the same system here in Massachusetts for three years now, and we have the highest insurance premiums and some of the highest health care costs in the country. The system absolves them from having to compete for our health care spending, and as a result they will profit. If this passes, watch the stock prices of the for profit insurers. That will tell you who stands to profit.
There are only two ways to control health care costs. One is a single-payer system. The other is to shift health care spending decisions to the lowest level possible, and remove barriers to competion (e.g. drug reimportation and a nationwide market) and systemic waste (e.g. tort reform).
This mostrosity does neither.
While I think it is terrific that so many uninsured people will now be able to get insurance, I was wondering, too, what there is in the law to control costs. As a small employer, I was seeing double-digit premium increases every year for a decade (and the quality of coverage was eroding at the same time). Like Sean Hannaway above, Robert Reich in his blog says this is a huge windfall for insurance & pharmaceutical companies. Is he correct? http://robertreich.blogspot.com/
So, for example, what of Yural Levin’s summary of the bill at NRO?
http://tinyurl.com/y8a8ftb
“We are going to raise taxes by half a trillion dollars over the next ten years, increase spending by more than a trillion dollars, cut Medicare by $470 billion but use that money to fund a new entitlement rather than to fix Medicare itself, bend the health care cost curve up rather than down, insert layers of bureaucracy between doctors and patients, and compel and subsidize universal participation in a failed system of health insurance rather than reform or improve it. Indeed, this bill will make it exceedingly difficult to fix our health insurance financing system in the future, since it sucks dry the potential means of such reform but leaves the fundamental cost problem essentially untouched (and in some respects worsened.)”
Any comment on Levin’s evaluation? Is this accurate?
Mark asked: “Any comment on Levin’s evaluation? Is this accurate?”
David says: “No.”
I do not understand why the good senators could not come up with a bill that fulfills two simple requirements i.e., 1) Not paying for elective abortions and 2) Universal coverage.
This senate bill would have us paying for elective abortions, and it does not cover indocumentados.
The problem of taxpayers paying for elective abortions is clear enough. But why in the world would the bill not cover the 10 million or so (mostly Mexican) indocumentados?
Regardless of anyone’s opinion of how to handle illegal immigration, these folk cost the system money by waiting to receive medical attention until their condiition deteriorates to the point where they need to use the emergency room. Much money can be saved by including them in a national medical plan, and tending them sooner rather than later. They are the very ones who should be covered.
Two simple things, just two things, and neither our senators nor our representatives can seem to get them through their apparently incredibly thick skulls.
Geez!