Tuesday, September 1, 2009

Health Care Tuesday: Reconciliation Edition

Josh Marshall: Who Said That?

In another sign that the Gang of Six is fast becoming the Deep Six, Senate Finance Committee Chair Max Baucus today told the AP that while he still has hopes for a bipartisan deal, health care reform is happening this year with or without the GOP.

What caught my eye though this passage down in the story (emphasis added) ...

"I think the chances are still good," Baucus told The Associated Press in an interview Monday. "I talked to them, and they all want to do health care reform. But the sad part is a lot politics have crept in. They are being told by the Republican Party not to participate."

If it falls apart, Democrats will have to turn to the "nuclear option" -- forcing through an inferior bill through a process that only requires 51 votes instead of 60, Baucus said.

I don't want to jump to the conclusion that this was some weird editorial gloss by the AP. Perhaps this is what Baucus said, and he meant that it would not be the ideal outcome, etc. But why would a bill passed through reconciliation be 'inferior'? And, that's only half a rhetorical question.

Late Update: A few readers suggest that what they mean by inferior is that a bill passed through reconciliation comes with sunset provisions. So it would have to be passed again or renewed later. Candidly, we've spent a lot of time over the last few days going over the intricacies of budget reconciliation and the Byrd Rule. And I confess that at this late hour I do not remember whether the sunset provisions apply regardless or only if the legislation does not meet the budget savings requirements over the different time frames. On top of this, Sen. Conrad wrote the reconciliation provisions for this year to make it particularly difficult to get health care legislation through in this way. More on that tomorrow. In any case, this is a plausible explanation for what the author of the piece meant, though I still have my doubts.

A bit more on the topic of though. It's not just the sunset provisions. What's not being factored in to a lot of the discussion about pushing the bill through reconciliation is that the procedural hurdles of reconciliation may require that the bill may need to be distorted in some key ways. By 'distorted' I mean, changes that don't serve any particular logic from a left or right perspective but would be required to simply to get passed certain obscure qualifications needed to get you to where you can pass the thing by 51 votes.

Party of no Aug. 31: Sen. Bernie Sanders, I-Vt., joins Rachel Maddow to talk about the latest Republican tactics trying to derail the health care reform bill.



Norm Ornstein (WP): Obama's Health-Care Realism - His Flexible Tactics Match Reform to Political Reality

The conventional wisdom is that President Obama and Democratic congressional leaders are on the run, that we seem to be heading for a replay of 1994, when the Clinton health-care plan went down in flames. The conventional wisdom includes the refrain that the White House is too weak, too slow, too naive, and, in the words of respected health policy analyst Susan Dentzer, "they're panicked."

But having watched the lawmaking process in all its glory (and messiness) for 40 years, as well as having watched the meltdown of the Clinton health plan up close, I am seeing from the administration signs of savvy, not weakness. While health reform is far from a done deal -- and could still be derailed by the lack of a vote to replace that of Sen. Ted Kennedy, an economic double dip or an international crisis -- the issue is actually on a fairly predictable path that fits both the realities of public opinion and politics in an age of sharp partisan and ideological conflict.

The Obama strategy since his election has been based on a gimlet-eyed and pragmatic assessment of the prospects and limits afforded by public opinion and the political process. A naive president would have assumed that, after a landslide victory, huge coattails, swollen partisan majorities and a high approval rating, he could have it all -- and pushed hard and early for a far-reaching, soup-to-nuts upheaval of the health-care system. Obama and his strategists understood that would not work.

On the public front, it was clear that there was no groundswell for broad change. There is public dissatisfaction with the health-care system, but it is framed most by the universal public definition of reform -- "I pay less." Without some guarantee that reform thus defined will be enacted for the vast majority of Americans, the likelihood has always been that the closer government gets to enacting change, the more nervous voters would get about embracing the devil they don't know. And the closer one gets to broad change affecting 16 percent of the economy and a hefty slice of the workforce, the more those whose incomes depend on the current system will fight to keep their share.

At the same time, enacting reform the way it should be done -- with broad bipartisan leadership support and broad bipartisan majorities -- was simply not in the cards in today's political universe. Bipartisan support was clearly a non-starter in the House, if less so in the Senate, but past experience also showed that finding partisan majorities, even with healthy margins in both houses, would not be easy. Bill Clinton had almost identical Democratic support in the House and Senate, but he could not find a formula to keep his partisans together. Trouble with Blue Dog Democrats in 1994 nearly derailed health reform in the House and slowed it enough to prove disastrous in the Senate. Ideological, regional and urban/rural splits always make uniting Democrats a challenge. In 2009, unlike in 1994, every issue has a filibuster line drawn in the sand, making the hurdle 60 votes more often than 50.

How to prevail under these difficult circumstances? The only realistic way was to avoid a bill of particulars, to stay flexible, and to rely on congressional party and committee leaders in both houses to find the sweet spots to get bills through individual House and Senate obstacle courses. Under these circumstances, the best intervention from the White House is to help break impasses when they arise and, toward the end, the presidential bully pulpit and the president's political capital can help to seal the deal.

No health reform bill can be enacted unless the House and Senate each pass a version, and that has been the single-minded goal of the White House. If the Senate has to resort to reconciliation, it can only work if more than 50 Democrats are convinced that it is the last resort -- that every effort was made to compromise to include significant Republican support. Thus, the White House signal on the public option. Once both houses pass versions, no matter how disparate, a conference committee can find a way to meld the bills -- no doubt with heavy White House input -- into one plan that goes back to each house for up or down votes. There, the pressure on lawmakers to support health reform will be much greater, as will the ability to break filibusters by urging all Democrats, even if they can't support a bill, to vote for cloture as a procedural issue.

The odds remain reasonable that a solid, if not dramatic, health reform bill can make it through this process and become law. Any bill, under these conditions, will be a major accomplishment. The odds have been improved, not damaged, by the president's approach.

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