Health Care Reform is Dead — Long Live Health Care Reform!

by Sheri Rivlin and Allan Rivlin on January 27, 2010

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There is no way to save health care reform until everyone realizes there is no way to save health care reform. Then it’s easy.  As soon as everyone realizes there is only one way to save health care reform, then health care reform can be saved.  The House can pass the Bill that the Senate already passed, and President Obama can sign it into law.  It’s as simple as that.
In the three years until the Bill would fully take effect, the Congress and the President can agree on fixes, but none of these fixes can be pre-conditions for passage. That will slow momentum and guarantee failure.  If they can’t agree to fixes then the Senate Bill, which  improves upon the status quo, would stand as the law of the land. None of this can happen until everyone understands this is the only path to passage of Health Care Reform.
The House will not vote for the flawed Senate Bill any time soon, because they believe they can improve it.  Improving it means either passing a compromise bill through the Senate with 60 votes to break a Republican filibuster, but that’s impossible because Scott Brown (R-Kennedy) is the 41st Senate Republican; or using the Reconciliation process to pass a fix bill through the Senate as a pre-requisite to the House passing the Senate Bill.  But Speaker of the House, Nancy Pelosi, and Senate Majority Leader, Harry Reid, have been meeting all week to work this out and Reid does not yet have the 51 votes he needs to do this so Health Care Reform is dead.  There are procedural hurdles to be met in order to pass amendments to legislation in this order.
The other problem with reconciliation is agreeing what to fix. A lot of Democrats will say if you are going this route then add back the public option. But then will it pass the House? Time will tell, but time is the enemy. Every time we have delayed Health Care Reform in order to make it better, public support has dropped and the possibility of passage has grown dimmer. The perfect truly has become the mortal enemy of the good.
Except — there is a possibility that the Bill can be broken into smaller pieces and passed with Republican support as a new bi-partisan initiative.  There is a problem with this idea though.  It is not possible to pass the most important part of the Bill, the health insurance reforms – ending exclusions for pre-existing conditions, ending “recissions”, annual benefit limits and lifetime caps so people can’t lose their insurance just because they get sick – unless everyone is required to have insurance, because without the “individual mandate” everyone will not get insurance until they get sick and this will drive up costs.  But you can’t have an individual mandate without subsidies for lower middle income families that can’t afford insurance, and you can’t have subsidies without… well pretty soon you realize why the Bill that passed the Senate and the Bill that passed the House were so many pages in the first place.  Health reform is hard and can’t be broken into smaller pieces.
And it is a fantasy to believe any Republican Senators are going to come on board.  The Democrats have lost bargaining power since they tried to close differences with Olympia Snow (R-ME) in the summer, and there is no way they get votes for a bill from Republicans  that is better than the current Senate Bill from a liberal point of view.  So Health Care Reform is dead.
Except once every Democrat in the House of Representatives realizes that Health Care Reform is dead then the idea of passing the Senate Bill without preconditions becomes a lot more attractive.
Every House Democrat up for reelection in 2010 (oh yea, that’s all of them) needs Health Care Reform to pass.  If Health Care Reform passes, then the nation can debate if it is good or bad, but if health care reform fails to pass, then there is no debate – America rejected the Health Care Reform that almost all of the Democrats voted for.  There is not a single Democratic House member that benefits from reform failure.
But there is only one way to save Health Care Reform, and that is for House Democrats to realize there is only one way to save Health Care Reform, pass the Senate Bill.
If Representatives think they can change the subject to jobs, or controlling the deficit, or anything else they are wrong.  They have already cast a vote for Health Care Reform.  They need to stand behind that vote that will expand coverage for 30 million Americans, extend coverage to people with pre-existing conditions, and guarantee that insurance companies cannot drop people just because they get sick.   That is infinitely better than casting a vote for the Bill America rejected.
Once they realize this is the choice, the Senate Bill (with the vague possibility of future improvement) or nothing, the choice is simple.  The House will pass the Senate Bill, President Obama will sign it, and Health Care Reform will be law.
Long live Health Care Reform.
Update: Here are the current sticking points:
The House is not willing to pass the Senate bill until the Senate passes a reconciliation fix.
Harry Reid may not have the votes.
The Republicans found a loophole in the Senate reconciliation process that means they can submit an unlimited number of amendments.
The “nuclear option” is not an option for 11 months.

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