Can Health Reform Be Saved?

And the reluctance of Senate leaders and the White House to strongly embrace even at this late date the ​“reconciliation” approach to improving the relatively weak Senate bill as a way to ensure House passage prompted even some centrist Senators to say that health reform is ​“on life support.” At the same time, some powerful Senate Democratic leaders, such as Budget Chairman Sen. Kent Conrad, remain open to the approach of using majority rule to pass key elements of a stronger bill.

But the slow-down has also led to mounting concerns from some policy experts that delay could spell further political trouble for the imperiled bill, even as both labor advocates and health reformers said they’re continuing to push for action now to ​“finish reform right.”

Supporters of reform now portray this pause or ​“reset” as an opportunity to rework the bill in a way that could be even more progressive (with some House members even demanding the Senate use reconciliation to return to the public option still favored by most of the public but rejected by the Senate). Meanwhile, prospects for passage drift away while Democrats are still reeling in shock from the upset victory of a Republican Senator-elect in Massachusetts. It seems too many have bought into conservative spin that Scott Brown’s victory was a referendum on national health reform, when, in fact, Massachusetts already has health reform and post-election polling showed that, as Think Progress pointed out:

…only 19 percent of Brown voters want Brown to ​“stop the Democratic agenda:”

- 70 percent of voters think Brown should work with Democrats on health care reform, including 48 percent of Brown voters.

But the political reality is that more delay creates a negative political momentum against health reform’s final passage. Even so, as Jacki Schechner, the communications director for the progressive Health Care for America Now coalition, told In These Times, ​“We are continuing to push. It was obvious after the the State of the Union Health care reform is going to get done. There’s still a lot of talking about how and when that will happen, not if it will happen.”

She added, ​“I think having the heat on jobs now and taking away the spotlight on health reform is a good thing: Legislators can take a calm look at the best way forward, without being nitpicked in the press over every conversation.It’s a chance to regroup, and gives them a breather.”

But the troubling signals sent by Rahm Emanuel in a New York Times interview Thursday also indicates that the White House is now looking at health-care reform, the signal legislative initiative of the Obama administration, as almost a back-burner issue after jobs creation, financial reform and even deficit reduction. And if health care reform goes down, after so much attention and wrangling in Washington, it could brand Democrats as ineffectual for years to come.

Ezra Klein, the Washington Post journalist who covers healthcare, pointed out in a grim posting headlined, ​“Rahm Emanuel Makes Me Very Pessimistic About Health-Care Reform”:

It is very, very, very important to be clear on what the death of health-care reform looks like. It is not a vote that goes against the Democrats. It is not an admission that the White House has moved on from the subject. It is continued statements of commitment from the key players paired with a continued stretching of the timetable. Like everything else in life, policy initiatives grow old and die, even if people still love them.

The timetable Emanuel is laying out makes little sense. The jobs bill will take some time. Financial regulation will take much longer. Let’s be conservative and give all this four months. Is Emanuel really suggesting that he expects Congress to return to health-care reform in the summer before the election? Forgetting whether there’s political will at that point, there’s no personnel: Everyone is home campaigning.

Moreover, there’s a time limit on health-care reform. The open reconciliation instructions the Senate could use to modify the bill expire when the next budget is (there’s disagreement over the precise rule on this) considered or passed. That is to say, the open reconciliation instructions expire soon. Democrats could build new reconciliation instructions into the next budget, but that’s going to be a heavy lift. The longer this takes, the less likely it is to happen. And Emanuel just said that the administration’s preference is to let it take longer. If I were a doctor, I’d downgrade health care’s prognosis considerably atop this evidence.

Nevertheless, yet another shrewd observer of the political scene, Chris Hayes of The Nation, sees some reason for hope as it becomes clearer that reconciliation with strengthened provisions passed as an adjunct to House passage of the Senate bill is the only possible way forward:

After spending much of yesterday talking to folks on capitol hill, it’s clear there is increasingly consensus on a path forward: As I explained last night on Rachel Maddow, it involves a few steps, but is relatively straightforward. The House has to come up with a list of changes to the Senate bill that will get them to 218 votes (and will also pass muster with the procedural constraints of ​“reconciliation”. For more on that you can listen to last week’s episode of The Breakdown.) They then send those changes to the Senate leadership, which can pass them through reconciliation, a process that requires a simple majority. Once that process has moved forward or (better!) is completed, the House can then pass in quick succession the Senate bill, and the amended fix.

Now that’s it, clear reconciliation is the only real option forward, we’re suddenly operating in this bizarre alien universe where majority rules. So when I read Ben Nelson this morning expressing his discomfort with reconciliation I took great satisfaction in the fact that his opinion on the matter was more or less meaningless. It was always the razor thin 60 vote majority in the Senate that produced the agonizingly slow process of death by a thousand cuts. But that is, in the world of reconciliation, no longer operative.

In fact, now that reconciliation is on the table, the public option has regained a pulse. After all: it already got 218 votes in the House, remains one of the most popular parts of healthcare reform and once upon a time enjoyed majority support in the Senate. Today, Ryan Grim reported that two House members were circulating a letter to their Senate colleagues telling them to put the public option into the reconciliation package, and the PCCC, DFA and Congressman Alan Grayson delivered 250,000 petition signatures to Harry Reid this morning calling for the same.

This does not mean, by any earthly means, this is a done deal. If ten Senate Democrats get scared and back away from reconciliation the bill is sunk. That would be a massive and stunning rebuke to leadership, so this is a true test of Harry Reid’s ability to see this through. So far, there’s still been a startling lack of leadership both within the Senate caucus and from the White House…

So there are obstacles. And if the last year has taught us anything, it’s that the congressional process is exceedingly ugly. So much so, that I think it’s largely responsible for the drop in public support for health care reform legislation. At today’s petition drop-off Alan Grayson made this point forceful: ​“I think that this endless discussion about process is cheating the entire country and it needs to stop,” he said. ​“We need to go ahead and deliver to people what they voted on in 2008, which is affordable, universal and accessible healthcare.”

But there’s a very doable path forward, and there are almost certainly the votes to get it done. It really is a question of political will and pressure at this point. That may not be very comforting given the lack of leadership demonstrated over the last two weeks, but it’s something.

Unfortunately, such a common sense approach can only happen if the Senate leadership and the White House show a strong sense of leadership, courage, effective messaging and political will that they have, so far, lacked.

UPDATE: In contrast, the scabarous self-titled ​“Rude Pundit,” a regular guest on the Stephanie Miller Show, paints another, darkly comic picture from an alternative history outlining what Republicans would have done if they had somehow favored universal health care ( read the full posting on Jan. 20^th, the day after Brown’s victory, for the unexpurgated rant):

Rhetorically, Republicans were articulating this message: ​“You will die and the government will take your money.” Democrats, meanwhile, were stammering, ​“But, no, wait, pre-existing conditions, insurance exchange, ​‘Cadillac’ health plans.” [Correction: Progressives were challenging the idea of so-called ​“Cadillac” plans needing to be taxed.] While he might not have been the slickest messenger, Rep. Alan Grayson had the message right: life and death. ​“What if you lose your job? What if your kids need the doctor?” That would have required a bill that was clear in its objective…

If Republicans had wanted universal health care, you would have seen commercials with heartless insurance agents stabbing babies and drinking their blood. You would have seen ads with desperate, laid-off old men offering to blow people for quarters so they could afford their insulin. You would have seen ads about how sad it is that a depressed middle-aged woman with a dream of a scrapbooking store is now suicidal over not being able to follow her small business dream because if she left her shitty office job, she’d lose her health care. The ad would have ended with a gunshot in darkness. People would have been begging for health care reform because Republicans would have made it seem like the world would fall apart without it.

Democrats waited far too long in even starting to take a hard-line approach in demonizing their opponents, and as The Washington Monthly’s Steve Benen recommends, they ought to start thinking like Republicans strategically:

Every reckless, irresponsible, hypocritical, dangerous, and incoherent step Republicans take, they do so ​“with impunity…”

Let’s look at this in a different light by imagining a hypothetical.

Let’s say Democrats ran the government for several years, and ran the country into a ditch.

Democratic rule led to near-cataclysmic results on everything from the economy to national security to the budget. Disgusted, voters elected a Republican president with a huge mandate, gave Republicans the biggest House majority either party has had in 20 years, and the biggest Senate majority either party has had in 30 years.

Then imagine that, despite the overwhelming edge in our imaginary scenario, Democrats decided – during times of foreign and domestic crises – that they simply would not allow the GOP majority to do much of anything. Dems ignored the election results and reflexively opposed literally every bill, initiative, and nominee of any consequence, blocking anything and everything. Republicans could hold the reins of government, but they would not be allowed to use them.

In this hypothetical, despite two wars, Democrats rejected funding for the troops. Despite a terrorist plot, Democrats rejected the qualified nominee to head the TSA. Despite an economic crisis, Democrats rejected economic recovery efforts, a jobs bill, and nominees to fill key Treasury Department posts. Despite a health care crisis, they opposed a modest reform bill and recommended privatizing Medicare.

Now, in this hypothetical, what do you suppose the political climate would look like? Would the huge Republican majority simply wring its hands? Would GOP officials decide it’s time to try ​“bipartisan” governing? Would Republicans shrink from pursing their policy agenda? Would political reporters just accept this as how the system is supposed to operate, a dynamic in which a huge majority is simply preventing from governing?

Or would every single day be another opportunity for Republicans to be apoplectic about Democratic obstructionism? Indeed, how many marches on Washington would Fox News organize, demanding that Democrats allow the governing majority to function?

It’s not enough for Democrats to say, ​“If we stopped Republicans from governing, they’d scream bloody murder.” If Dems believe that, then maybe it’s time to scream bloody murder.

Put simply, I’d like Democratic leaders to think about what Republicans would do if the situations were completely reversed. Then they should do that.