Friday, March 19, 2010

Health care showdown - One side is about to freak out big-time

The moment of truth may arrive on Sunday, in the form of a House vote. It has been clear for a while that the legislative strategy would involve a two-part operation in which the House approved the Senate version of the health care reform bill, which already passed the Senate in December with a 60-vote supermajority, and both Houses passed set of fixes negotiated to harmonize the House and Senate bills, using the device of budget "reconciliation" to circumvent a Republican filibuster. For the final text of the overall package, plus an "easy-to-read, essential-for-understanding breakdown" of what it contains , see here. For a nice procedural overview of how this drama will (probably) unfold this weekend, see here.

If this package passes the House, then most analysts seem to think it will almost certainly pass the Senate, too. If it fails to pass the House, then the game is over.

=> On Thursday the chances of passage got a big boost when the non-partisan Congressional Budget Office released its estimates of the bill's long-term cost and impact. Among other things, the CBO concluded that this final package would extend coverage to 95% of all legal residents of the US by 2019 and would reduce the federal deficit by $138 billion over the next decade. Whether or not those estimates prove to be correct (serious people find them plausible, but making such projections is not an exact science), those deficit reduction figures are politically very significant. They can help reassure wavering Democrats who want to think of themselves as "fiscally conservative," or at least provide them with some political cover, and they appear to guarantee that the amendments can be passed in the Senate using "reconciliation" (which can only be used for measures projected to reduce the deficit).

In addition, over the past few days the health care reform bill was emphatically re-endorsed by both the AMA and the AARP. It also picked up unexpected endorsements from the Catholic Health Association and from a group of nuns representing a wide range of Catholic women's religious orders--the CHA endorsement, in particular, being a fairly dramatic public break with the condemnation of the bill by the US Conference of Catholic Bishops. Again, these are the kinds of factors that might have at least some marginal effect on wavering Congressional Democrats--along with the fact that health insurance premiums have been going up substantially and conspicuously across the country.

Nate Silver at FiveThirtyEight, whose skill at political counting is regarded with universal respect, concluded Thursday that passage now looks probable, though not certain.
It's sure starting to look like both the momentum and the math favor the Democrats and that something will have to go wrong to prevent them from getting to 216 votes on health care.
On the other hand, various things could still go wrong (Silver also explains some of the reasons why that might happen). So this remains a cliffhanger. We'll just have to see how it turns out.

=> Meanwhile, we can look ahead to some likely consequences The Day After. The odds are that one side is about to freak out big-time.

If the Democrats fail to pass this bill, then that will constitute a political debacle of the first order. Back in January, after the Democrats lost their nominal 60-vote majority in the Senate, Obama and the Congressional Democratic leadership could, hypothetically, have decided to abandon the whole effort to enact health care reform, whether or not they admitted this explicitly. Instead, they decided to make a full-scale push to finish passing it, and have effectively staked everything on getting that done. If they fail, then--quite aside from the fact that this will be a disaster in substantive policy terms-- the resulting demoralization among Democrats will almost certainly dwarf their reaction in January, when they went into a complete panic and spent weeks running around like a bunch of chickens with their heads cut off. The more long-term after-effects will probably include legislative paralysis for the rest of 2010 and a greatly increased chance of a crushing defeat in the November elections.

On the other hand, if the bill passes ... then I suspect we will see the result foretold on February 20 by Jonathan Chait, who looked ahead to the prospect of "The Coming Conservative Health Care Freakout". In retrospect, Chait's analysis looks very prescient, so it's worth revisiting some of of the highlights:
Ever since Scott Brown beat Martha Coakley, conservatives, with very few exceptions, have been convinced that health care reform is dead. [....]

Some of us realized all along that there was no rational reason that the Massachusetts election had to kill health care reform. Fundamentally, the main barrier -- getting sixty votes in the Senate -- had already been crossed. [....] All the Democrats needed to do was have the House pass the Senate bill. If they insisted on changes, most of those could easily be made through reconciliation, which only requires a majority vote in the Senate. Most conservatives paid no attention to this basic reality, though they did indulge in some gloating mockery of those of us who pointed it out. [....]

But the mustache-twirling bonhomie has started to give way to the realization that the legislative door to health care reform is wide open, and Democrats simply need to walk through it. By no means is it clear that they'll succeed. But I've been waiting for conservatives, filled with hubris at having swept liberalism into the dustbin of history, to wake up to the fact that health care reform is very far from dead, and start to freak out. [....]

You can imagine how this feels to conservatives. They've already run off the field, sprayed themselves with champagne and taunted the losing team's fans. And now the other team is saying the game is still on and they have a good chance to win. There may be nothing wrong at all with the process, but it's certainly going to feel like some kind of crime to the right-wing. The Democrats may not win, but I'm pretty sure they're going to try. The conservative freakout is going to be something to behold.
We've already been seeing some of that right-wing freakout (I wouldn't call a lot of these guys "conservatives") over the past month. But if health care reform passes, then the freakout will really be "something to behold." Stay tuned ....

--Jeff Weintraub

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