The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Democrats Now More Likely to Move Health Care Reform Forward On Their Own

Posted by Alan on February 25, 2010

Well, so much for a breakthrough. The health care reform summit was fascinating political science. But it certainly does not seem to have generated a clear direction for anything close to bipartisan health care reform. Which means President Barack Obama and Democratic leaders will put forward a bill for an up-or-down vote, most Democrats will vote for it and no Republicans will. The only questions remaining are: 1) will Democrats invoke a rule that will allow them to move forward with a simple majority or will they permit the GOP to prevent the legislation from coming to a vote; and 2) will Democrats make any changes to the legislative proposal put forward by the President to reflect issues raised by Republicans during today’s health care reform summit. This post addresses the first question; the next one the second.

Reconciliation: My guess is that Democrats will use reconciliation as a means of bringing health care reform legislation to the floor of the Senate for a vote. As NPR has reported, it would not be the first time reconciliation led to substantial changes to America’s health care system. As Sara Rosenbaum, chair of the Department of Health Policy at George Washington University, notes in the NPR story, “In fact, the way in which virtually all of health reform, with very, very limited exceptions, has happened over the past 30 years has been the reconciliation process.”

She’s not just talking about arcane legislation, either. COBRA, the provision that allows workers to continue their coverage after leaving an employer, was passed through reconciliation. In fact, COBRA stands for the bill in which this health insurance extension was included, the Consolidated Omnibus Budget Reconciliation Act of 1985. Reconciliation is the “R” in “COBRA.” In 1997 the Children’s Health Insurance Program, which along with Medicaid now covers one in every three children in the United States, was passed as part of a budget reconciliation bill. As the NPR story reveals, the list literally goes on-and-on. It seems health care reform simply can’t wend its way through the Senate with a super majority. is this because, as the Center for Public Integrity reports, there are eight health care lobbyists for each member of Congress? Whatever the reason, reconciliation is commonly used to pass health care reform.

It’s likely Democrats will keep this streak going. Yes, Republicans will cry foul, but at the end of the day, it’s a perfectly legal process. And while not every provision of the President’s reform package is likely to be eligible for reconciliation, enough will be to enable Democrats to declare victory.

Assuming, of course, they can muster majorities for comprehensive health care reform legislation. The earlier House bill passed with two votes to spare – including one from a Republican who is now saying he’d vote against the bill. And while the Democratic caucus numbers 59 members, there are 18 members of a the Moderate Dems Working Group. Whatever bill comes before the Senate will need to hold onto nine of those moderates – and that’s assuming all other Democrats are willing to go this route. Some liberals, including Senator Jay Rockefeller, have expressed reluctance to to invoke reconciliation. In the end, the President is likely to muster enough support for a bill – he only needs 50 votes in the Senate as Vice President Joe Biden could cast the decisive vote there. The vote will be close in the House, but Speaker Nancy Pelosi has repeatedly demonstrated her ability to muster a majority when needed.

President Obama needs a vote on health care reform. Politically he needs to demonstrate to his base and moderate independents that his commitment to hang tough on the issue – even if it means he’s the captain going down with his ship. If Republicans (and some Democrats) defeat the legislation, he’ll have shown he’ tried. America doesn’t like quitters (former-Governor Sarah Palin being the most prominent exception). They do like fighters. Politically, moving forward on health care reform is a necessity.

It also makes public policy sense. The health care status quo is untenable. Change is needed. Even if his ambitious reforms fail, the effort will set the stage for more modest reforms – modest reforms that could be introduced and voted upon before the November elections.

In an upcoming post I’ll discuss whether the bipartisan health care reform summit makes it more likely the President will moderate his health care reform proposal.


8 Responses to “Democrats Now More Likely to Move Health Care Reform Forward On Their Own”

  1. nl said

    If health reform is to be guided by polls, can the polls be guided by the truth? The dissemination of misinformation about what the bill will accomplish has been so successful that all the polls show is that Americans are afraid of what they don’t understand. When polls ask if they want insurers to stop denying coverage for pre-existing conditions, they answer “Yes!” When polls ask if they want help paying their premiums and a wider choice of plans, they say, “Yes!” When they are asked about specific elements contained in the bill, they want them. If polls reflected real understanding rather than fear based on deceptions, their numbers might be relevant.

    • Those are good comments, Nl. However, I think your post is incomplete.

      Additionally, when the poll takers don’t discuss taking $500 BILLION from MEDICARE, don’t tell them that $500 Billion IS to be taken from Medicare, that, too, should be a part of honest polling.

      When the poll takers don’t discuss the EXORBITANT TAX on the “CADILLAC PLANS” and will EXCLUDE UNION WORKERS, that too, should be honestly and clearly explained, and be a part of the decision making.

      Every part of the proposed Bill, including the highly negative and taxpayer TAKEAWAYS and PENALTIES not presently clear, should be made clear so that the American Public can fully and with clarity, understand what is being done FOR them, and TO them.

      Being fair and balanced means being fair and balanced regarding all points and components of the bill, not just those favoring one side of the “discussion” while avoiding clarifying the other side.

      • Oops!

        I forgot to include that the PENALTY on those who purchase a Cadillac Plan, excluding of course, Unions (who did a deal with Obama behind White House closed doors…aka BACKROOM POLITICS) will pay a 40% TAX in their attempt to have a fuller plan, did I mention EXCEPT THE MILLIONS who work under UNION PROTECTION?

        Again, the private sector folks and self-employed will be punished, while the UNION WORKERS will be “praised”.

        Yup! Fair and equitable, if you believe in “Double-think” and “Double-speak”, as in Aldous Huxley’s book, “1984”.


        • I am not sure if you were trying to make a joke, but 1984 was written by George Orwell.

          The two did share some similar visions,at least at one point in their careers.

          From Wikipedia:

          Brave New World (1932) as well as Island (1962) form the cornerstone of Huxley’s damning indictment of commercialism based upon goods generally manufactured from other countries.

          Indeed also, Brave New World (along with Orwell’s Nineteen Eighty-Four and Yevgeni Zamyatin’s We) helped form the anti-utopian or dystopian tradition in literature and has become synonymous with a future world in which the human spirit is subject to conditioning and control. Island acts as an antonym to Brave New World; it is described as “one of the truly great philosophical novels”.[10]

        • Jim,

          My mama just came down from on high and whooped my ass! I read Brave New World, Animal House, and 1984 before I could walk (not really, but I was very young…my parents raised me to have a better vocabulary and writing ability than my 6th grade teacher!). Man, she was ticked!

          Thank you for correcting me, with “Class”!

          Now, where did I put that copy of “Les mots”…Sartre is such an enthusiastic writer, especially about himself…

  2. Alan,

    I, too, saw much of today’s “debacle”. I was saddened by the clearly pointed bias against the wishes of the American Electorate.

    I have seen what happens when the D’s control reconciliation as in the mockery demonstrated by Representative Henry Waxman and Senator Daniel Patrick Moynihan in OBRA ’93, when Moynihan signed onto Waxman’s amendment, infamously known since as “The Waxman Amendment” that allowed California (Waxman’s state), Illinois, New York (Moynihan’s state) and California to “grandfather” their Public/Private Partnerships for Long Term Care Insurance, as they simultaneously legally prevented the 22 states that had filed “Enabling Legislation” allowing them to create the same partnerships as promulgated and developed by the Robert Wood Johnson Foundation, from taking effect, if their Medicaid plans had not been submitted (to what is now known as HHS) by one month earlier in 1993 than the OBRA ’93 legislation was passed.

    I had been a rabid fan of Moynihan until that day. As we, in WA State, had already passed the same enabling legislation as had CA, IL, and a fourth state whose name now escapes me. I had personally worked hand in glove with Mark Meiners, Director, and Hunter McKay, Deputy Director of the RWJF Public/Private Partnership division of the RWJ Foundation to have our legislation pass in WA State. The disgust at Waxman’s Amendment, and Moynihan’s Accessory before and after the fact, was strongly apparent. these two yahoos had grandfathered in their own states in order to keep their political shields shining, while preventing other states, over half of the United States, from enacting the same legislation and filing it with DSHS for approval. Selfish, arrogant, self-serving and abhorrent acts by those who should have held themselves above the fray. Until that day, until I discovered Moynihan’s betrayal of his office, I had admired him immensely. Not one day further. It came as one of the most devastating moments of my political “upbringing”.

    As a result of this sham, experienced and validated by those whose opinions really are important (mine aren’t), I cannot mention nor hear Moynihan’s name without feeling tremendous sadness, since. A hero was revealed as being naked, and it wasn’t a pretty sight.

    So…bringing the Health Care Reform bill, as proposed and as usual being shoved down the throats of Americans who do not want this legislation to pass, into a Reconciliation, is to me, disgusting. It is also typical of the arrogant Democrats who think that they are entitled to bring any form of political change to the citizens of the USA by demanding that it be so. Kind of reminds me of Captain Pickard of the Starship Enterprise. “Make it so, Mr. Spock!”. No democracy there. Only dictatorial behavior, and actions. Should Obama continue on this course, he can fire all of those working on his 2012 Campaign. He will not be believed, again. Nor should he be.

    • Alan said

      I disagree with the substance of your comment, Spencer. First, blaming President Obama for what Senator Moynihan did more than 15 years ago is hardly fair. And just because they are using the same rules doesn’t mean the rule itself is evil. President Bush passed his tax cuts using reconciliation. A Republican Senate (with the support of a Democratic President) passed sweeping welfare reform in 1996. Reconciliation is a legitimate legislative tool. And in the post after this one I explain how it will probably be used, within the rules, to enact health care reform in the next few weeks.

      Second, why is it we criticize politicians for legislating based on poll results except when we like the poll results? I have no idea where you stand on the Iraq war, Spencer. But many of those who encouraged President Bush to pursue the war in the way he did admired him for ignoring polls showing the war was unpopular with a majority of Americans thought his approach was wrong are the same people saying President Obama should abandon his principles and simply do what the polls say is popular. but there’s a difference between “leadership” and “electability.” Leadership is about doing what one thinks is right. Electability is about doing what the polls say is popular. While I disagree with much that is in the President’s health care reform plan, I would not want him to change it because the polls say he should. I want him to make changes to his plan because many of his reforms will do more harm than good.

      But there’s another far greater concern with your comment, Spencer, that I simply cannot allow to go uncorrected. Captian Pickard never said “Make it so, Mr. Spock.” Captain Pickard was in Star Trek: Next Generation. Mr. Spock was in the original Star Trek. And although their paths did cross (Vulcans are very long lived), Mr. Spock never served under Captain Pickard. However, Captain Pickard would have said “Make it so, Commander Data.” And I’m sure that’s what you meant.

      • Yes, Alan, that is absolutely what I meant. LOL

        Regarding Iraq, I was 100% opposed to our invading Iraq. I was 100% for our going into Afghanistan, with 100,000 or 200,000 troops and wiping out al Qaeda, and Osama bin Laden. That was GWB’s charge and he failed America miserably. I served in the Army (1964 through 1970) and I know what following orders means. IMO, we desperately need to reinstate the draft, as is required by Israel, Switzerland, and other countries whose peoples don’t worry about terrorist acts. I think it ludicrous that those whose children are born in this country don’t feel that it is a privilege to live here, not a right. As in countries like Switzerland and Israel, some form of national service should be a requirement, and those as GWB should not be leading this country if they don’t have a clue what it means to dodge a bullet, or work in EarthCorp, or Doctors Without Borders, and give something of themselves to earn the privilege to live here.

        The poll results demonstrated by Rasmussen, Gallup, and Pew shows that the American Public does not want HCR as envisioned by Obama and the Democratic controlled Congress. That is a pretty respectful lineup of pollsters.

        I will look forward to your explanation of how reconciliation works, Alan. I respect you. I have served under you. Should you be able to demonstrate that the Ds can conduct reconciliation better today than in 1993 I will tell you so. I have never had a problem with “correcting” myself. I do have a problem when legislation is promulgated behind closed doors and the public only finds out what was done to them after the fact.

        You made a comment about Leadership, and in my opinion, that is precisely what has been missing from this Administration, Leadership. I’ve heard a lot of very articulate rhetoric, and have seen not a scintilla of substance. I voted for Obama, and encouraged many of my friends to do the same. He has disappointed me greatly, having exhibited no Leadership abilities whatever, since taking office. Perhaps, had he served for a term or two on the Board of Trustees of NAHU he might have learned about Leadership. I ran a tight ship, both as President of WAHU, and As Chairman of HITC, which I helped found, for NAHU. We learned about Leadership and what happens if you are full of hot, articulate air, and have no meat to put behind in between the bread. This president needs to learn the same, or he will not see a second term.

        The American Public deserves to be well represented in Congress and by the Administration, and IMO, thus far we have not been. No, I do not think the Republicans can do any better a job than the Democrats. I think that both party’s are exceptionally corrupt. I am hopeful that the “independents”, (not Independents) will be able to exert some influence over coming elections and bring a semblance of moderation and balance to the process.

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