"Show Time" on Healthcare

After months of talk, front page and backroom deals, stakeholder lobbying, ideological outbursts on the Left and Right, town halls full of citizen indignation, it all comes down to this.

The Congressional Budget Office (CBO) has scored the Finance Committee’s “Chairman’s Mark” – not a bill, but a set of narrative expectations that have yet to be formally translated into legislative language – where the real details are. CBO decided that the Chairman’s narrative will cost less than $900 billion and not add to the deficit; sufficient to meet Obamacare’s most minimum standards, and enough cover for moderate Democrats on the Committee to vote in favor of the legislation.

On Tuesday, the Senate Finance Committee will vote on this “strawman” bill. Barring the unexpected, the only surprise will be whether the vote is 14-9 – with Maine Republican Olympia Snowe voting with the Democrats – or on a 13-10 Party line vote.

Then Senate Majority Leader Harry Reid, Senators Chris Dodd, Tom Harkin, Max Baucus and aides from the White House will gather in the Capitol and blend the health care reform bill passed by the late Senator Kennedy’s HELP Committee in July, with the more conservative Finance Committee strawman. The goal will be to have an integrated “bill” ready for the Senate floor for debate the week of the 19th, or at the latest, the week of the 26th.

No finer example of the promised transparent, accountable and participatory democracy we were promised last year will you find in this exercise.

Over in the House, Nancy Pelosi is doing the same thing; bringing together the three House-passed bills into a single version that can be brought to the House floor in mid to late October.

This is where ideology, politics and time are working against each other.

For Democrats, the dominant liberal base has been fighting with its more moderate “Blue Dog” colleagues (and Republicans) on the paramount issue of comprehensive coverage versus overall cost and control.

With Republicans united against Democratic plans that are grounded in government management of health care, Pelosi must get 218 votes from the 256 Democrats that control the House.

A deft touch is required here.

If the final bill is too liberal and expensive, it could cost the support of the 54 “Blue Dog” moderates, making for an uncertain vote. On the other hand, if the bill it does not include a robust “public option,” it may face opposition from liberal Democrats who could take the bill down for not being progressive enough. Look for a close vote.

In the Senate, Reid faces the same problem.

While Reid holds a filibuster-proof majority of 60 Senators, he has to keep both liberal and moderate Democrats in line, with up to 12 Democratic Senators openly critical of different provisions of the various bills. Republicans, with perhaps the exception of Snowe, are, like their House colleagues, uniformly opposed to an expansion of government to manage American health care.

Amid this effort to thread the needle, Reid, Pelosi and Team Obama all realize that time is not on their side.

Gubernatorial elections will take place in Virginia and New Jersey on November 3rd. As the first major elections since President Obama and the Democrats took over, the results will be viewed, fairly or not, as a referendum on Democratic leadership to date, with a feedback loop into health care in particular.

And right now, it’s not shaping up as an ideal Democratic year.

Governor Jon Corzine, unpopular and trailing in polls for months, has outspent his opponent Chris Christie 10-1 (from his personal Goldman Sachs-provided fortune), frivolously making fun of his opponent’s weight and questioning the Republican’s commitment to mammograms; all the while the state’s finances dissolve into ruin. Still, Corzine’s negative campaign has leveled the playing field after an early and sustained Christie lead, to a pick ‘em race today. A deeply blue state, Corzine may yet hang on. But a win here is hardly an endorsement of Obamaism.

Virginia is a different story. The state has been trending purple for several years, electing two Democratic governors in a row, and voting Democratic for president in 2008 for the first time since 1964. This was the kind of electorate that helped propel POTUS to the White House and represented the potential for the new coalition that Obama hoped to build.

But now Republican Bob McDonnell has a double digit lead over the hapless Democrat, Creigh Deeds, in Virginia’s governors’ race. McDonnell issues focus is in stark contrast to the Democrats’ agenda in Washington. Deeds’ response has been to essentially run away from Obama and national Democrats, a disturbing sign for midterm elections a year hence.

A loss in Virginia, a red state turned blue in 2008, where Obama won by a healthy margin, where Obama’s hand-picked DNC chairman is the current governor, would be embarrassing. It could also have unintended consequences on the national discussion.

Simply put, in this uncertain political environment, national Democrats must get health care passed before a vote where post-election narratives featuring a voter rebuke to Obama’s agenda becomes the dominant political meme.

Rarely has so much been riding on a two week legislative period.

To that end, keep an eye out for shortcuts and chicanery in the legislative process that could be part of getting a bill done before the elections that would cast serious challenges to the legitimacy of the legislation.

For instance, the very arcane Senate rules would allow Harry Reid to call up a House passed piece of legislation on a non-controversial topic, and amend the bill with the Democratic version of health care as an amendment, limiting debate time and amendments. For this, Reid would need to be assured that all 60 Senators would stay with him.

If Reid cannot hold on to his 60 votes, his other option is to employ reconciliation, a process created to streamline Senate rules to make it easier for lawmakers to achieve the spending and tax levels contained in the yearly Budget Resolution. Legislation considered under this process requires only a simple majority – 51 – and not the normal 60 votes for major legislation, and significantly limits time for debate (20 hours).

In a pre-emptive admission to this journal’s critics, Democrats correctly point out that the “controversial” Bush tax cuts of 2001 and 2003 were considered under the reconciliation process. But this was entirely appropriate as the legislation met the standards set by the Congressional Budget Act involving revenue altering bills, which the tax cuts plainly were. And as it turned out, Bush bipartisanship in the Senate was such that he gained 62 votes in 2001 for the tax cut legislation. The process was not a ploy for partisan advantage.

In contrast, considering health care under reconciliation would represent a significant break in precedent, politicize a budget process and would make a star out of an unknown Senate employee, Alan Frumin, Parliamentarian of the Senate and a potential candidate as the “Katherine Harris of health care.”

Reconciliation requires that issues included under the process are “germane.” Specifically, reconciliation prohibits the inclusion of measures that do not change outlays or revenues [of the government], or matters that would increase the deficit for fiscal years beyond those covered in legislation under debate. The proviso provides vast fields for Republican objection that would undermine the very legitimacy of the process and its outcome.

It has only added to the sense of drama that as the stakes have gone up, reading the public on health care has become more nuanced.

Gallup says that by 40-36% Americans favor Obama care; Rasmussen has it just the other way 50-46% opposed.

CBS asked whether keeping costs down or providing insurance for the uninsured was a larger priority. 59-35% favored providing insurance. But Rasmussen reports that 63% of Americans do not support a “public option” if it means people are forced from their current insurance. Moreover, 59% approve of an amendment to current legislation that would prohibit taxes fees or penalties on families making less than $250,000. The Senate Finance Committee “strawman” could not have passed CBO scoring scrutiny without these very devices.

From the many moving parts and time pressures come two very different lessons regarding health care reform.

Democrats believe that failure to pass health care cost them control of Congress in 1994 and therefore it is paramount to pass it this time both as a matter of policy and political survival.

What’s more, a defeat here would be a crippling blow to the Obama administration and leave POTUS without a significant legislative achievement in his first year, despite united and ostensibly sturdy Democratic control of Washington.

Republicans, in contrast, believe that it wasn’t the failure to pass health care in 1994 that doomed Democrats, but the overly expensive and expansive, government-controlled, bureaucracy-rationed system they devised that killed them.

Consider that for all the talk and debate about a health insurance crisis, the best health care in the world still originates in the US. Vast majorities of Americans who have health care rate their care highly. Democrats have placed themselves behind the 5-10% of Americans who do not have coverage (depending on who you count at any given time) at the expense of the other 90-95%, in a scheme whose central pillar of cost efficiency are cuts to the storied public health care for seniors, Medicare.

It is not without a touch of irony that on this day, we celebrate Columbus discovering America. Over the next two weeks, to visions of America will be fought out in Congress and on the campaign trail.