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Health Reform Options Narrow

For the first time since Harry Reid put together 60 votes for a motion to proceed to consideration of health care reform, the long struggle to enact this legislation has hit a wall in the Senate. And in what must seem like the ultimate nightmare to many progressives, the wall is the heresiarch Joe Lieberman, who hastened to the Sunday shows last weekend to make it clear he would not vote for cloture on any bill that included the proposed Medicare buy-in for selected near-seniors, or the kind of quasi-public option that offered consumers a choice of private health plans sponsored directly by the federal government.

Anyone cruising the news or blog sites yesterday was treated to an orgy of recriminations aimed at Lieberman, at his flip-flopping on the Medicare buy-in issue, and at the poor logic of his overall position, accompanied by considerable psychotherapeutic speculation on the motives for his destructive behavior.

But the fact remains that there are only 58 reasonably assured votes for cloture on the recently negotiated Team of Ten "deal" for health care reform. Assuming Ben Nelson can be brought aboard without highly divisive concessions on the abortion issue, that still leaves one vote to be secured from a universe of just three senators: Lieberman, Snowe and Collins. So what are the options left to the White House and the Democratic congressional leadership?

(1) Forget about Lieberman and go after Snowe and/or Collins. It would obviously be satisfying to most Democrats to deny Joe Lieberman the opportunity to be King of the Senate and Arbiter of Health Reform, or more to the point, the chance to screw up or kill the legislation down the road. But on the Medicare buy-in and quasi-public-option issues, there's not much evidence that either of the Mainers is any more amenable to compromise than Lieberman. (There are also Democrats who dislike Snowe's version of a "triggered public option" a lot more than what the Senate is now discussing). Both are also under intense pressure from their Republican allies to maintain a united front; the idea that they could be trusted to hold the line through a House-Senate conference and a conference report vote is questionable at best

(2) Give Lieberman what he wants and then fix the legislation later. The key argument here is that the very items Lieberman is objecting to--an option for some younger Americans to buy into Medicare, and any sort of public option--are budget savers which could without question be added later (say, next year) via the budget reconciliation route, which only requires 50 votes. Additional subsidies are also clearly budget-relevant, and could be added by reconciliation as well. The downsides of this strategy are pretty obvious: caving to Lieberman could create a huge backlash among Democratic activists, and/or backfire entirely by reducing Democratic support for the bill in both Houses (most notably Sen. Bernie Sanders, and any number of House Progressive Caucus members who feel they've already compromised more than they should have). "Manana" promises on future reconciliation bills will be difficult to sell, and --if Democrats lose a significant number of seats in either House in 2010--might be even more difficult to redeem beyond next year.

(3) Threaten Lieberman with loss of his seniority unless he votes for cloture. Without question, it was a major mistake for the Democratic Caucus to allow Lieberman to maintain his seniority after the 2008 elections without an ironclad pledge that he would support the Caucus on all procedural votes, including cloture votes. He had just campaigned for the other party's presidential candidate. His vote was no longer needed for Democratic control of the Senate, and his contribution to a 60-vote Senate was largely irrelevant without a pledge to support the party on cloture votes. Now it's not clear he is amenable to any sort of threats or inducements that don't involve substantive concessions on health care reform. Moreover, at present he is a key player for the administration and congressional Democrats on climate change legislation, which the Senate is due to take up as soon as health reform is resolved. An ultimate score-settling with Lieberman is now a major psychological necessity for a lot of Democrats, but it's unlikely it would do any good on health care reform, and there could be unpleasant repercussions on climate change and perhaps other issues.

(4) Reframe the bill to use reconciliation. This is the strategy many progressives have been urging all along, for the obvious reason that it gets rid of the need for more than 50 Senate votes and also would make it vastly easier to craft a Senate bill that's close enough to the House bill to avoid friction in a House-Senate conference. The downsides are also pretty clear, and help explain why the strategy wasn't pursued earlier: (a) a real if hard-to-nail-down number of Senate Democrats would strongly oppose use of reconciliation on principle (most visibly Sens. Robert Byrd and Russ Feingold); (b) big chunks of health reform, including essentials like private insurance regulation, would be highly vulnerable to an adverse parliamentary ruling in the Senate that they are non-germane to the budget--a ruling that would require 60 votes to overturn; (c) there are all sorts of problems associated with the normal five-year "window" of provisions that can be enacted through reconciliation, which could make the bill a budget-buster while also requiring a lot of future action in Congresses where Democratic majorities are by now means assured. Aside from those factors, shifting to a reconciliation strategy would take considerable time, and it's already mid-December.

(5) Go back to the drawing board. Before resorting to any of the above unsavory options, health reform supporters will undoubtedly make some effort to devise yet another compromise that can obtain that 60th vote without losing existing supporters. After all, the Medicare buy-in was a freshly unveiled rabbit-out-of-a-hat just a week or so ago. But if Lieberman, Snowe and Collins really are dead-set against any feasible alternatives to private health insurance for the uninsured, there may be no more rabbits in the hat. And that's aside from the strong possibility that all three senators are demanding not compromise but unconditional surrender as the price for their votes.

Maybe I'm missing something, but these seem to be the options at present, and none of them are particularly good. We may be once again at a crucial juncture where progressives--and most of all, the President--simply have to decide what percentage of a loaf is acceptable.

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Government run healthcare in any form is a pure joke and will harm the country and bring it to socialism.

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