The mechanics of Passing the Damn Bill - Further clarifications from Jonathan Bernstein

Guest-posting at Andrew Sullivan's Daily Dish blog, Jonathan Bernstein usefully offers some further clarifications on the procedural and tactical complexities that will determine whether or not the Democrats manage to complete the passage of a health care reform bill.

Bernstein's starting-point is a New York Times article, which he read on-line in an early version Saturday, that has now been somewhat amended & improved and is also worth reading. Here are the key points, not precisely in the order Bernstein presents them:

=> First, to flesh out a point I made in one of my own posts yesterday (Sense and nonsense on "reconciliation"):

As Steve Benen has taken to shouting, it's not true that the Democrats are passing health care reform through reconciliation; they're actually planning to pass two separate bills, the main body of health care reform that passed the Senate on Christmas Eve Day, and a second reconciliation "patch" with relatively small modifications in the first bill.

This isn't just semantic; the procedure, which I think everyone agrees is the only viable path, imposes a variety of constraints on the Democrats, and NYT readers deserve to have this explained to them properly. So, for example, it is not really accurate to say that "the new version being pushed by Mr. Obama would strip out the House bill’s abortion restrictions in favor of Senate language that many of them consider unacceptable." What's actually happening is that the House is passing the Senate bill (with the Senate abortion provision), and that changes in the abortion language wouldn't work as part of the second, "patch" legislation because of technical details of how reconciliation works. The same thing is true about the structure of the national exchanges, and other some other provisions -- if it can't be done through reconciliation (because of the way that reconciliation works) then the Democrats are stuck with the Senate version, like it or not. Provisions which can be dealt with in the patch, such as how the bill will be financed, will be changed to a House/Senate compromise.

Perhaps the Times doesn't want to confuse its readers with overly technical descriptions of parliamentary procedure, and I can understand that impulse, but in this case it's impossible to understand why some things are negotiable and some aren't without at least some reference to the rules that are shaping the Democrats' actions.

=> Second, that bit about "abortion language" refers to the Stupak Amendment, added to the House version of the bill at the last moment, which would have the effect of restricting many women's access to insurance plans that cover abortion even if they buy their own insurance. For people concerned with women's reproductive rights, the "compromise" version inserted into the Senate bill at the insistence of Sen. Ben Nelson is still objectionable but not quite so bad (though opinions differ on that point--see this analysis, for example). On the other hand, for flat-out opponents of abortion, the restrictive provisions of the Senate bill are unacceptably weak.

Back in January I sought advice on these matters from a more knowledgeable friend, sociologist Carol Joffe, who cares deeply about the relevant issues and whose expertise in this area is hard to match. (Her most recent book on the subject is Dispatches from the Abortion Wars. She also blogs about health care reform; to get a sense of her basic perspective on those issues, this representative posting would be a good place to start.)

She responded (I share these portions of her response with permission) that in her judgment, "the abortion restrictions in both Stupak amendment and Nelson 'compromise' are both very negative for abortion rights, both symbolically and practically." Nevertheless, taking all factors into account, "I agree with you and the numerous others (Krugman, etc) who say a bill should pass now, even a highly imperfect one. [....] I also believe that even a minimalist bill will improve things for people who currently have no or very inadequate health care. [....] But no one should believe that this is not a very serious setback for abortion rights and access."

=> Third, one implication of the two-step procedure described above helps explain why the Republicans are so nervous about it, and why they are raising such a disingenuous hue and cry about the Democrats' intention to resort (at long last) to the reconciliation option:

Moreover, and to return to one of my larger themes over the last six weeks, the Times should let its readers know that if this moves forward the Senate will only be voting on the reconciliation fix, which is basically all ice cream and no spinach. Which is why the remaining action is all on the House side.

=> But, and this is the fourth point, all that leads up to a central political reality that may yet prove to be the rock on which health care reform founders:

[T]he important unknowns for health care reform are swing voting Democrats in the House of Representatives, not Senators (and not Republicans). There's some excellent reporting in their story, which is headed I guess to the front page of the Sunday Times. This is a hard story to report, I would think. The odds are that the margin of difference is eventually going to be Democratic Members of the House who want the bill to pass, but want to vote against it. The trick for Nancy Pelosi and Barack Obama is to get enough of those reluctant Dems to actually vote yes.

Stay tuned ... and in the meantime, for further details, see that (amended & improved) article in the NYTimes.

--Jeff Weintraub