The Health Care Follies Continue

Well, put on your seatbelts, folks. It's on like Donkey Kong...

President Obama outlined his final version of a health care bill Wednesday and urged Congress to bring the plan to a conclusive vote within the next few weeks.
The president said his nearly $1 trillion proposal is a compromise plan that combines the best ideas of both Democrats and Republicans. He asked Congress to "finish its work" and end what has become a yearlong vitriolic legislative showdown over his top domestic priority.


"Everything there is to say about health care has been said, and just about everybody has said it," he said. "Now is the time to make a decision about how to finally reform health care so that it works, not just for the insurance companies, but for America's families and America's businesses."


He also came out in support of a controversial legislative maneuver known as reconciliation, which would allow changes to the health care bill to be passed by the Senate with only 51 votes -- a bare legislative majority.


The bill "deserves the same kind of up-or-down vote" that was used to pass President George W. Bush's signature tax cuts and welfare reform in the 1990s, Obama said at the White House.


"At stake right now is not just our ability to solve this problem, but our ability to solve any problem," he said. "The American people want to know if it's still possible for Washington to look out for their interests and their future. They are waiting for us to act."


He said he doesn't "know how this plays politically," but knows that "it's right."

Politically, Mr. President, it plays about as well as a wet fart on a first date. But let's get to the response and the reality in any case. Dan Riehl's hopping mad response is what I'd expect will be the response of the conservative base if this travesty passes. But to me, it's more important to examine what the Democratic arguments are for passing the bill and understand why they are mostly, if not all, BS.

1. "It's been a year of debate on the issue, and it's time to act; the staus quo sucks, and we can't let it go on like this." This is the Obama public position substantively, that we can't wait anymore, so it's time to do something. Of course, under the same logic, if your house is suffering from a radon problem, it might make sense to go with the solution where you burn it down for the insurance money.

2. "The Dems will lose at the ballot box in November anyway, so sacrificing a few moderate Democratic seats in exchange for accomplishing the Holy Grail of the Democratic Party is okay." This fails on two counts -- first, the moderates who might lose their jobs probably don't like being the sacrificial lambs for the Democratic Holy Grail -- noble political deaths aren't a concept politicians favor if there's a decent alternative. Second, the moderates may not be as wedded to idea getting comprehensive health care reform as a committed liberal.

3. "The bill will be popular once it passes, because individual pieces of it are popular." Yes, because people love big changes, particularly when it forces them to make changes to their own plans that the President promised wouldn't happen (remember the "If you like your plan, you get to keep it" line?  That will show up in a few campaign ads if this passes).  This misses two more key points.  First, there's a committed number of people who are passionately opposed to the bill, numbering around 40%.  They will keep opposing it unless the bill suddenly creates leprechauns who drop off pots of gold at their house.  Second, the public has to get over the outrage of being told to take its medicine by politicians despite vocally and viscerally registering their discontent with Democratic obsession with this issue while the economy's in the crapper.  My guess is that this won't happen before November.

4.  "Reconciliation is just a process maneuver.  People will forget about the process as soon as the bill is passed."  This assumes the right will let it go, and that Independants will be allowed to forget about it.  By November, if the substance of the bill is still unpopular, the reconciliation method used to pass it will be toxic as hell. Remember these quotes from the now-President regarding what one needs to pass reform...

Change to Win Convention 9/25/07


The bottom line is that our healthcare plans are similar, the question once again is, who can get it done? Who can build a movement for change? This is an area where we’re going to have to have a 60% majority in the Senate and the House in order to actually get a bill to my desk. We’re going to have to have a majority to get a bill to my desk. That is not just a fifty plus one majority.


Obama Interview with the Concord Monitor 10/9/07


You’ve got to break out of what I call the sort of fifty plus one pattern of presidential politics. Maybe you eke out a victory of fifty plus one. Then you can’t govern. You know, you get Air Force One, there are a lot of nice perks, but you can’t deliver on healthcare. We are not going to pass universal health care with a fifty plus one strategy.


Center for American Progress Conference 7/12/06


Those big-ticket items: fixing our health care system. You know, one of the arguments that sometimes I get with my fellow progressives, and some of these have flashed up in the blog communities on occasion, is this notion that we should function sort of like Karl Rove where we identify our core base, we throw ’em red meat, we get a fifty plus one victory. See, Karl Rove doesn’t need a broad consensus because he doesn’t believe in government. If we want to transform the country, though, that requires a sizeable majority.

I think using reconciliation in the weird way Dems plan to use it (have the House pass the Senate bill, then pass a reconciliation bill, then have the Senate pass a new bill via reconciliation) points out that this is an abuse of the process designed merely to get around not having enough votes. Put simply, the process is rigged now because of the loss of one Senate vote (thank you again, Scott Brown), which shows how precarious the reform deal was.  Liberals want to sell this as a done deal, saved by the President, but conservatives will have plenty of traction selling this as an underhanded, dirty deal, put together by the utterly corrupt Congress.  Even stuff that only looks bad and almost certainly isn't (like nominating the brother of a  House Dem with a swing vote to an appellate court) will get tossed around as part of a "culture of corruption" themre.  And if it were a done deal, they'd be voting by now, as even honest liberals acknowledge.  Which means they're still twisting arms.... which means more chances that there will be corrupt deals.

5.  "This bill may not have everything, like the public option, but there's enough there that makes it worth it.  And it will eventually lead to nationalized healthcare."  Perhaps the worst argument, and one that is aimed at liberals who might be hesitant to support it.  I'm in no position to tell liberals if this is what they want, but I'd caution them against accepting a half-baked proposition that is extremely unpopular.  The logic underlying the debate has been that once the bill passes, we have a new entitlement, and entitlements are impossible to kill.  Perhaps that has been true throughout history, but almost all large entitlement programs had popular support.  This one does not.  What happens if the unintended consequences of going halfway to nationalized healthcare makes the system worse and costlier (as I believe it will)?  Would the public later buy an argument for full  nationalization?  A public option?  Anything involving government?  If the liberal base doesn't buy the argument (and they don't like a bill with a mandate and no public option), they may not materialize at the ballot box this fall... which means a GOP tidal wave may become a tsunami.

6.  "We need to do this, or Obama's Presidency is toast."  This is perhaps the best political argument in favor of passing the bill (and maybe the best argument, which says much for the substance of the bill), except that the lie to this statement is recent history, in the form of the last Democratic President.  Clinton survived the death of his health care reform package politically.  Obama can as well, but the real question is whether his Presidency would extend beyond one term if he passes it.  I think the White House, liberal bloggers, and Democratic strategists are underestimating the public anger about what will happen if the bill passes through the clown show process being put in place, after a year's worth of bad press in what should ahve been a favorable climate.

If the bill does fail, Obama can lean on the Clinton example... although Slick Willie was much more capable of a rally.  The Comeback Kid had done it before -- we don't know whether Obama will cope well with political adversity.  Thus far, he certainly has not done so.

Now, the real question is simple -- does Pelosi have the votes in the House?  The Senate story is simple -- 51 votes is all that's needed, and they can lose up to nine Dems (assuming that Biden can break a tie on a reconciliation bill, which I assume he can... then again, I'd have to wonder if Biden would screw up and vote the wrong way), which seems hard to do in the Senate.  The GOP can delay via amendments, but they can do little else, although a public input amendment process driven by the blogosphere would be entertaining as hell.  Besides, the GOP would then be delaying things that would in part fix bad portions of the already passed piece of crap.  But the House is a different story. Tim Noah does some counting...

The answer begins with the fact that since Nov. 7, when the bill passed the House quite narrowly, 220-215, House Speaker Nancy Pelosi has lost three votes. John Murtha, D-Pa., died; Robert Wexler, D-Fla., resigned to become president of the Center for Middle East Peace and Economic Cooperation; and Neil Abercrombie, D-Hawaii, resigned to run for governor. Balanced against these yeas is one nay, Nathan Deal, R-Ga., who just resigned effective March 8 to run for governor. That narrows health reform's victory margin from five votes to three (217-214). If President Obama is serious about acting within six weeks, then the final House vote will come before special elections to replace Wexler (April 13), Murtha (May 18), and Abercrombie (May 22), and probably before any elections to replace Deal, too (though no date has yet been set). Even if the Democrats wait till late May, there's a pretty good chance the special elections will keep the victory margin at three votes (219-216), because Murtha's district tilts slightly Republican; McCain eked out a narrow victory there in 2008. (The other seats are unlikely to change party, judging from the Cook Political Report's partisan voting index.)


We will assume, then, that Pelosi starts with a victory margin of three.


Take away from that three Rep. Bart Stupak, D-Mich, and Joseph Cao, R-La. Stupak is the author of a House amendment on abortion that has the imprimatur of the U.S. Conference of Catholic Bishops. Both Stupak and the bishops say they won't support the Senate bill's language on abortion. Neither will Cao, the sole House Republican to vote for health reform on the first go-round. Why not resolve the dispute by putting the Stupak amendment into the reconciliation bill? Because Senate rules won't allow it. To be included in a reconciliation bill, a measure must have some impact on the federal budget.


...Take away Stupak and Cao and the House health-reform bill lacks a majority if the vote is held before the special elections (215-216). It also lacks a majority if the vote is held after the special elections and Murtha's seat goes Republican (217-218). Health reform retains a one-vote margin of victory only if Murtha's seat stays Democratic (218-217). But before you whip out your checkbook and give all your money to Pennsylvania's Democratic party, read on, because health reform's troubles don't end here.


Stupak and Cao aren't the only pro-lifers in the House who will change their vote from yea to nay if health reform doesn't include the Stupak amendment. Stupak says he counts 15 to 20 Democrats who will do so. (Previously, he said there were 40.) Most calculate the Stupak bloc at about one dozen. A Feb. 24 memo by House Minority Whip Eric Cantor, R-Va., identifies, in addition to Stupak and Cao, 10 House Democrats who may bolt over abortion. In January Nate Silver of the Web site FiveThirtyEight.com calculated only 10 likely Stupak bloc bolters, but six of Silver's 10 (including three of those he deemed most likely) weren't on Cantor's list at all. So lets call it 12.


Take away a dozen votes and the House health-reform bill fails by a 25-vote margin before the special elections (203-228). If the vote is after the special elections and Murtha's seat goes Republican, it also fails by 25 votes (205-230). If Murtha's seat stays Democratic, it fails by 23 votes (206-229).


Pelosi needs to pick up a baker's dozen votes to pass health reform. Where will she get them?

This is really simple math. Pelosi needs to get to 216 votes.   She had 220 last time.  Three votes are gone, and a fourth (Cao) has said he will switch.  Either Pelosi placates the Stupak faction on abortion language (which is possible) or she flips one member who voted no last time for each member of Stupak's coalition.  While losing no one else.

Noah goes on to note that there are Dems who might flip, including committed liberals like Dennis Kucinich and Eric Massa.  But Kucinich is smart enough and principled enough to actually think argument #5 is a load of BS.  And Massa now has other issues, which may or may not play into getting his vote. The AP had a rundown of nine potential members of what Jim Geraghty termed "Pelosi's Suicide Squad"...

The Associated Press did a head-count and concluded that “at least 10 of the 39 Democrats — or their spokesmen — either declined to state their positions or said they were undecided about the revised legislation, making them likely targets for intense wooing by Pelosi and Obama. Three of them — Brian Baird of Washington, Bart Gordon of Tennessee and John Tanner of Tennessee — are not seeking reelection this fall. The others are Rick Boucher of Virginia, Suzanne Kosmas of Florida, Frank Kratovil of Maryland, Michael McMahon of New York, Walt Minnick of Idaho, Scott Murphy of New York and Glenn Nye of Virginia. Several lawmakers’ offices did not reply to the AP queries.” After the AP article appeared, Minnick quickly issued a statement that he wasn’t willing to vote “yes.”

Those are the nine members who will likely face the most pressure in the next two weeks, along with the Stupak group. Of course, some of the nine are already folding, and some other yes votes now look like they're flopping to no.

So what's the bottom line?  Megan McArdle is astute as ever when she notes that conservatives/libertarians and liberals seem to be on different planets on the likelihood of this passing, but she's also right in noting that there is no middle ground.  To that end, I think conservatives have been cautious on pronouncing the thing as dead, in part because they know the last rites need to be administered by Democrats, and relying on them to be prudent is tough.  Liberals have a different motivation -- if you keep saying the deal is done, people might believe you, and the self-fulfilling prophecy becomes true. Or they might be telling the truth. Maybe the best thing about all of this is the final line in Peter Suderman's piece...

On the other hand, at least it's almost over. (Maybe!)

Hope and change. Catch it.