Wednesday, March 10, 2010

The Health Care Follies Continue

Instapundit points out how Drudge is having fun with the so-called health care endgame.  I do think the most telling part of the continuing mess that is health care reform comes from this quote from Nancy Pelosi...
You’ve heard about the controversies within the bill, the process about the bill, one or the other. But I don’t know if you have heard that it is legislation for the future, not just about health care for America, but about a healthier America, where preventive care is not something that you have to pay a deductible for or out of pocket. Prevention, prevention, prevention—it’s about diet, not diabetes. It’s going to be very, very exciting.

But we have to pass the bill so that you can find out what is in it, away from the fog of the controversy.
(hat tip: Peter Suderman) It says a lot about the bill and/or the Democrats' communication abilities that they can spend a year or so discussing the concept, several months discussing the actual bills, and think that the key is to stop talking about it so people will understand it.

As to the actual endgame... there's multiple folks trying to figure out the voting breakdown.  Jay Cost at RCP has been running numbers, FireDogLake has a running whip count, and National Journal is keeping track as well.  I think two things are indisputable -- the fate of the bill lies with approximately 40-45 House Democrats (including Bart Stupak's crew), and Nancy Pelosi doesn't have the votes yet.  The fact that she's pushing back on the latest White House deadline says a lot...
The WH is anxious to get health care passed by Easter recess, just like they were anxious to get it finished by Aug. recess, then by Thanksgiving, then by Chirstmas. And Pelosi has had enough: She told WH CoS Rahm Emanuel to stop pressuring the House to pass the Senate bill by March 18, before Pres. Obama leaves for an overseas trip, according to Rep. Henry Waxman (D-CA), who sat in on the leadership meeting at the WH yesterday.

And House Maj. Leader Steny Hoyer echoed the sentiment, pushing back on a March 18 vote. House Dems have yet to schedule any votes, lending credence to the notion that they don't have the votes yet.
The problem for Pelosi and the House Dems who might be reluctant to vote on the bill boils down to three points.  First, they don't yet know what the Senate will do, even though they're getting assurances that the Senate will pass a reconciliation bill with a bare majority, but they don't know if they can trust that this will happen, especially sicne no one has seen a new reconciliation bill yet.  Second, the Stupak abortion language issue remains in flux -- one day Stupak is saying they can get a deal, another day he's saying that he won't agree to deals to fix the bill in the future, which seems to be the only way to do it (my personal belief is that Stupak and his unknown posse of approximately 12 really want to vote for the bill and may do so ultimately, but I'm sensing that this is more than just posturing on their part -- if the public opinion doesn't move toward passing this bill, they may decided that they'll vote against it on principle just to be part of the majority).

But the third issue is the one that will ultimately decide the contest -- public opinion.  Public opinion is decidedly against the the reconciliation process the Senate may use, but seemingly split on everything else...
A new Associated Press-GfK Poll finds a widespread hunger for improvements to the health care system, which suggests President Barack Obama and his Democratic allies have a political opening to push their plan. Half of all Americans say health care should be changed a lot or "a great deal," and only 4 percent say it shouldn't be changed at all.

But they don't like the way the debate is playing out in Washington, where GOP lawmakers unanimously oppose the Obama-backed legislation and Democrats are struggling to pass it by themselves with narrow House and Senate majorities.

More than four in five Americans say it's important that any health care plan have support from both parties. And 68 percent say the president and congressional Democrats should keep trying to cut a deal with Republicans rather than pass a bill with no GOP support.

Leaders of both parties in Congress say that's not how it's going to work out. After a year of off-and-on negotiations, Republicans adamantly oppose Obama's plans. The White House and Democratic leaders say it's now-or-never for a health care overhaul, which would cover an additional 30 million Americans, require almost everyone to buy health insurance and impose new restrictions on insurance companies.

The Democrats' plan relies on parliamentary rules that bar Senate filibusters. That would enable Senate Democrats to pass a companion health care bill — which House Democrats are demanding — with a simple majority. Democrats control 59 of the Senate's 100 votes, one shy of the number needed to stop GOP filibusters.

The new poll underscores Obama's struggles to wrest control of the health care debate from Republicans, who couch his efforts as a government takeover and costly intrusion into private lives.

Many of his allies are baffled, because Americans clearly want change, and some of the individual components of the Democrats' health care agenda seem popular. Moreover, the public has not embraced the Republicans' overall approach to legislating, giving lower approval ratings to GOP lawmakers than to Democrats, although both parties fare badly.

In the AP-GfK Poll, 43 percent of those surveyed said Obama and Congress should keep working to pass health care this year, while 41 percent said they should start from scratch. On Capitol Hill, the Republicans favor that new-start approach; Democrats say that's just a way to stall the effort to death.

Sandy Stemm of Springfield, Ore., would seem the ideal target for Obama's appeal. She's a Democrat and former bakery manager who recently lost her job and health insurance.

But Stemm, 47, doesn't like the idea of congressional Democrats going it alone on health care.

"I think it's important to come to an agreement," she said in a telephone interview. "We're all in this together, whether we're Democrat or Republican."

John DeHority, a Democrat from Rochester, N.Y., supports Obama's effort and thinks Republicans have "made a travesty of the process." But he suggested the GOP is winning the political battle.

"I think passing the bill in its current form would be political suicide for Democrats," said DeHority, 56, a researcher in health care imaging. He said he thinks the proposed changes would fail because they would not control costs, and "Democrats will take the fall for that."
See, that last bit is what Democrats need to worry about, unless they've now decided to accept that their political annihilation will be be okay because the bill has passed -- the downside being that unlike other entitlements, the lack of broad support for this bill might mean effects to repeal it actually gain steam.  One of the biggest problems with this bill is that the best selling point Democrats have for liberals (and it's one that some liberals, like Dennis Kucinich, aren't buying) is that it gets their foot in the door toward eventually nationalizing health care.  But passing an unpopular program that ends up being more costly rather than less costly that may be coupled with cuts and changes to people's access to health care isn't likely to drive people to want more government intervention -- it's likely to make them want less. 

And the idea that the public will forget about the crazy process used to pass the bill -- pass one bill, then use reconciliation to fix the bill -- is incredibly obtuse, even for Washington.  Part of what drives anti-incumbent and anti-Washington sentiment is the idea that politicians change the rules whenever they can't get what they want,  In this case, they'd be changing the rules to push through something that has less popularity than Tiger Woods -- even the people who like the bill aren't rushing out to passionately defend it.  Keith Hennessey summarizes my thoughts nicely...
I am struck by the enormous gap between the two parties on the strategic calculation being made by the President and Democratic Congressional leaders. If you set aside your policy views, do you think the current path makes strategic sense for the majority? Almost every Republican insider I meet shakes his or head in befuddlement and says no, I just don’t get why they’re doing this.

Dan Meyer was Speaker Gingrich’s Chief of Staff in the mid-90’s, and later served as the head of Legislative Affairs for President Bush (43). He and I survived the 95-96 government shutdown conflict between Congressional Republicans and President Clinton. I worked for Senate Budget Committee Chairman Pete Domenici at the time. Dan made a comparison the other day. Imagine, he said, right after the government had reopened in January of 1996, after Republicans had been getting hammered every day for a month, if I had run up to you and said, “I’ve got a great idea! Let’s shut it down again!” You’d think I was crazy.

That’s what this feels like. The President and his allies could now quite easily enact a massive expansion of Medicaid and S-CHIP, paid for by a subset of the offsets in these bills. I would oppose such a bill, but it would be a legislative slam dunk with few political costs (for them) outside of a disappointed left wing. To my chagrin they might pick up a few Republican votes. And yet they press onward with a super-high risk strategy. This is a classic bird-in-the-hand tradeoff.

...The leaders may be narrowly self-interested and able to exert tremendous party discipline on those with different interests. Legislative failure could harm a rank-and-file Democrat from a purple district, but it would be devastating to the President and the Speaker, who are judged on their ability to lead others. We know that some Congressional Democrats don’t like this bill as a policy matter. We know that some are afraid of the political consequences of voting aye. Yet many in both groups appear willing to vote aye.
I also like William Jacobson's claim that this bill is now Obama's Stalingrad, not his Waterloo, although I guess that would make the GOP the USSR. I would say something about what that makes Obama, but I don't want to trigger Godwin's Law.

Bottom line? There are less than 240 days until the November election. That much is certain. Everything else is a guess.

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