The Treatment

How to Pass the Bill--Whatever Happens Tuesday

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After a weekend of interviews with Democratic staff, officials, and operatives, I've come to the conclusion that health care reform is not dead even if Martha Coakley loses on Tuesday--unless, that is, the Democrats let it die.

On Friday, my colleague Jonathan Chait outlined the options if Scott Brown wins the special election in Massachusetts, giving the Republicans enough votes to sustain a filibuster. One would be to approach Olympia Snowe, the lone Republican who voted for health care reform when it was before the Senate Finance Committee and who, at one point, seemed interested in voting for it on the floor.

On paper, this is a perfectly viable option. While full details of the House-Senate compromise are not known, it’s likely the final bill will look a lot more like the Senate’s version than the House’s. And the Senate bill, in turn, looks a lot like the bill Snowe supported in Finance. But ever since that Finance vote, Snowe has grown increasingly disenchanted with health care reform. And after her vote against it on the floor, the Democratic leadership has become increasingly disenchanted with her.

Snowe's main complaint--that the process seemed rushed--makes no more sense to me now than it did when she first raised it. But whether I or anybody else thinks it makes sense is ultimately irrelevant. Clearly Snowe does. And that would make winning her over difficult.

Option number two would be to have both houses vote on the bill quickly, before Scott took his seat in the Senate, so that the man he’d be replacing--interim Senator Paul Kirk--could cast the 60th vote to break that Republican filibuster. It would require very quick scoring by the CBO, which seems possible. And Kirk has said he’d vote “yes,” whatever the outcome of Tuesday’s election.

It could work--but it'd be difficult. Republicans would attack the move as illegitimate. And while the GOP has exactly zero moral standing to make this argument--when was the last time Republicans let procedural fairness get in the way of the results they wanted?--a lot of people would listen. Even if the Democratic leadership was willing to risk that backlash, there’s no guarantee that the entire caucus would stay in line. And it’d take just one defection to make the GOP filibuster stick.

That’s why (slightly) preferred option, at least among those who I interviewed, was to have the House simply approve the Senate bill, as it was written.

Such a move could be quick; unless I’m mistaken, the House could hold such a vote this week. It would also be perfectly legitimate: When a chamber votes to pass a bill, as the Senate did when it passed health care reform on Christmas Eve, it’s effectively offering to make that bill a law, pending the other chamber’s approval. And that offer is good through the end of the Congress, even if the chamber’s membership changes.

Would House Democrats go along? It's hardly a given. Centrists, many of them as ambivalent about reform as their Senate counterparts, would be tempted to use Coakley’s defeat as an excuse for voting “no.” Liberals, meanwhile, would chafe at supporting a bill that includes so many unpleasant compromises.

But there are good substantive reasons why both sides should be willing to vote “yes.” And there are some good political reasons, as well.

For centrists, the substantive reason is that the Senate bill is, in most respects, closer to what they originally wanted anyway. Centrist Democrats skittish about the House bill typically complained that it was just too much--too much spending and too much regulation. But the Senate bill has less of both.

The Senate bill also has two key cost-control provisions, the tax on expensive benefits and the commission for calibrating Medicare payments, that many centrists have at least claimed to support. If they are truly concerned about cost control, as they claim, the Senate bill should address those concerns.

Liberals would have a more legitimate complaint. By and large, they hate the benefits tax and Medicare commission. And it’s not as if the Senate bill has other provisions to make those features go down easy. Remember, the Senate bill lacks a public insurance option. It doesn’t extract as many savings from the health care industry. It doesn’t provide as much protection against out-of-pocket costs. And it doesn’t promise as much regulation of employers or insurers.

But the arguments for voting for the final House-Senate compromise are just as relevant here: Flawed though it is, the Senate bill would represent a monumental policy achievement, one that would benefit tens of millions. And House Democrats could always try to fix the bill later on--maybe even quickly, if they can take advantage of the reconciliation process, which would remain available.

I know, I know--it’s politics, not policy, that would determine how Congress reacts to a Coakley loss. But Democrats from both ideological sides ought to consider whether voting against it now really spares them political blow-back. All of them have already voted for a health care bill. And that means they can expect one of the following two advertisements this fall:

Candidate X is an out-of-touch liberal who voted for the horrible health care reform bill that passed.

Candidate X is an out-of-touch liberal who voted for the horrible health care reform bill that almost passed.

It seems to me the two ads would be equally effective, unless Democrats can counter it by touting the benefits of reform--by reminding voters that, in the future, they won’t have to worry that insurance will run out when they get sick, that they’ll be able to have a binding appeal when insurers deny coverage, that they’ll be guaranteed emergency room coverage without prior approval, that they’ll be able to change jobs worrying about losing insurance, and so on.

But the only way to make that argument is to pass health care reform. No matter what happens on Tuesday.

P.S. For more on the state of that race, check out Nate Silver's projection, David Wiegel's dispatches, and Talking Points Memo's accounts from folks on the ground. Also watch the Boston Globe for updates over the next two days.

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