Health reform is in the now balance, and the situation is a bit like the situation in the Middle East. Almost everyone involved—activists, policymakers, academics, and journalists–knows that there is one path to a successful outcome. This two-track approach involves in some order: (a) the House passing the Senate bill unaltered, and (b) the Senate using majority-vote reconciliation rules to address legitimate House concerns regarding an imperfect but valuable Senate bill.
As in the Middle East, the initial moves are more difficult and more mysteries than where the process must ultimately go. Executing this two-track strategy will be difficult given the close margins in the two houses, ossified Senate procedures, and the uncertainty created by Scott Brown’s election. I’ve talked to many people in Washington over the past week, after Timothy Jost and I coordinating a letter from 50 policy experts advocating the above two-track approach. Nearly everyone agreed with us, publicly or privately. Yet the acrimony in many directions is palpable. House Democrats harbor particularly deep anger directed at their Senate counterparts: because of the Senate’s long delay in producing this bill, and because of many other bills bottled up on the Senate side.
Congressional leaders and the administration are working hard to break the log jam. Since the State of the Union, President Obama has been out there fighting to get this done, too. These leaders need help. If you’ve never gotten intimately involved in the political process, now is the time. For health reform to pass, thousands of us need to contact our Senator and Representative to urge them to get this done. Even members who have been generally supportive of reform need letters and calls. After the Massachusetts special election, no one can be taken for granted, as the recent erratic statements by normally stalwart House figures remind us.
Talking with Senators, it is especially important to convey the importance of reconciliation in giving House members the space and the public support they need to get this done. The House is being asked to swallow a very imperfect bill, and to do so in formulating truly historic legislation that Representatives had spent many months refining in their own chamber. They cannot take this step without some real Senate help.
House blue dogs and progressives need to know that their Democrats supporters are united in pushing for a two-track strategy.
The message to progressive Representatives is simple. For all of its faults, the Senate bill is one of the most progressive policy initiatives in decades. By 2019, the bill would cover 30 million people who would otherwise be insured. It would move $196 billion every year down the income scale to make insurance more affordable. It would provide essential protection to millions of people living with chronic illnesses or disabilities.
Yes, the Senate bill is imperfect. Its most serious faults reside in the inadequate affordability credits for working people. Many of its defects can either be fixed through reconciliation, or can be fixed over time in other ways. Progressive Representatives need to receive a strong message that their progressive constituents want them to pass the Senate bill, that this is the progressive thing to do.
To moderate and conservative Democrats, the Senate bill contains critical elements of delivery reform, comparative effectiveness research, and long-term cost control. If this bill fails, its politically unpalatable elements will be nearly impossible to pass in a piecemeal bill. There would be too much interest group opposition, and are too easily caricatured as occurred in the “Death Panel” debate. The very failure of health reform would send a strong message that it’s too politically risky to advance fiscally responsible legislation.
Not passing this bill would be a political disaster for the Democratic party. It would also be disastrous for millions of people who need help. We just can’t miss this chance.