The Health-care Race to Christmas

WASHINGTON -- This is the paradox of the moment: President Barack Obama's speech on Afghanistan and his subsequent jobs summit underscored why it's essential to get a health care bill done quickly. The calendar of politics has an urgency that the dilatory pace of the U.S. Senate doesn't match.

Here's the deal. If Obama gets to sign a health care bill before he gives his State of the Union address, he starts 2010 with a historic victory to proclaim before the country, and then can pivot quickly to the issue likely to dominate the midterm elections: jobs and how to create them.

The Afghanistan speech showed that a president's power to control the agenda is limited. The last thing Obama wants is for the public discussion to focus on a war that is neither popular in his own party nor particularly loved by the middle of the electorate.

His speech on the troop buildup last week was thus from the head, not the heart. He was doing what he felt he had to do, not what he yearned to do. He wasn't elected to be a war president. But circumstances require him to be one anyway. Indeed, the line he recited with the most passion was: "The nation that I'm most interested in building is our own."

Getting a health care bill is important on its own, but it's central to establishing Obama's credentials as a domestic reformer and to proving that Democrats are capable of governing. This is why the president made an unusual visit to Capitol Hill on Sunday to push fractious negotiations forward. Senators need to get their version of a health care bill done before the end of this year so the House and Senate can come to a speedy agreement on a final bill in January.

This logic will create two dramas over the next two weeks.

Senate Democratic leader Harry Reid has been struggling to light a fire under members of his party. He needs moderates to understand they are part of a majority and progressives to figure out what they want in exchange for concessions to moderates who oppose a public option.

Liberals are absolutely right in their frustration with the Senate. It's become an absurd institution, perhaps the least democratic legislative body in any country calling itself a democracy. It makes no sense that four or five votes can trump 54 or 55 votes. But the Senate is what it is. For now, liberals have to live with this.

Republicans, in the meantime, know that delay is their friend, and they will delay and delay -- and delay some more. The emergence last week of a memo from Sen. Judd Gregg of New Hampshire to his GOP colleagues outlining all the ways they can slow action should put spine into Democrats.

In a nicely diplomatic cover letter, Gregg argued that Republicans "must use the tools we have under Senate rules to insist on a full, complete and fully informed debate on the health care legislation." Translation: Let's keep this turmoil going until the Fourth of July, or, heck, all the way to Labor Day.

The best news for advocates of health care reform is that Reid has sought to force action by convening a group of 10 Democrats, five moderates and five progressives, to work out a compromise. After several meetings over the weekend, they were focusing on an alternative to the public option modeled after the Federal Employees Health Benefits Plan, even as progressives sought further expansions in coverage.

It's a shame that a public option might be stopped by a small number of senators. But the compromise would still give government a role in promoting competition as the overseer of an alternative that would likely focus on not-for-profit insurance plans.

The core issues of this debate have been settled. The Congressional Budget Office has swept away the major arguments that opponents of reform have been trying to make. The bill before the Senate would cut the deficit, not increase it, and would stabilize or reduce health care premiums for most people, not raise them. The proposal contains serious cost-control measures that can be built on over time. Passing health care reform is thus not only morally necessary, but also fiscally responsible.

But getting there will be much harder if the Senate doesn't act this year. Obama is right that nation-building should begin at home. Health care reform will mark the beginning of domestic nation-building.

(c) 2009, Washington Post Writers Group

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About the Author

E. J. Dionne Jr. is a syndicated columnist, professor of government at Georgetown University, and a senior fellow at the Brookings Institution. His most recent book is Our Divided Political Heart: The Battle for the American Idea in an Age of Discontent (Bloomsbury Press).