Health care reform by Christmas?


Senate Democrats are thinking about passing health care reform with only a majority vote.

That's big news. It could mean that federally mandated universal health care with a public health insurance component could be coming down your alley by the end of this calendar year.

It's all about the Senate. The House is a cinch for the Democrats. Nancy Pelosi has their back over there.

This way, Senate Democrats would need no Republicans. And, by following a process requiring only 51 votes in a hundred instead of the towering 60 to break a filibuster, they also could let as many as seven or eight of their center-right Democrats go their own ways to tend to any personal qualms or, more likely, political fears.

Even with all that, they could still give President Obama the only victory he's likely to get this year, save that early stimulus, the victorious spoils of which have not yet been realized. He's not going to get that carbon tax and he's not going to be able to pay off the unions with card check.

Health care would trump all that. It would be a signature. It's only been 60 years since Harry Truman gave it a shot.

The pundit talk in Washington is that cramming health reform down Republicans' throats could be risky for Democrats. But Republicans haven't been receptive to Obama's conciliatory overtures. Anyway, the tactic is less risky than the policy.

If health care reform passes and makes positive changes for people in our health care financing morass, Democrats will reap the benefit whether they got 51 votes or 60. And vice versa.

Process matters to political animals. Product matters to people. So if you trust the value of your product, then don't sweat so much the process.

Here's the operative circumstance: The Senate in the modern day has evolved into a culture in which only a supermajority of 60 votes can pass anything substantial. That's because the minority party invariably invokes a filibuster -- a passive one, not a dramatic one like Jimmy Stewart's -- and it takes 60 votes to end that filibuster. Except ...

Budget and budget reconciliation measures require only a majority vote. So, if they wanted, Senate Democrats could pass a budget outline encompassing the necessary additional money for health care reform. Then they could plug the vast public policy particulars into that plan -- reconciling, it's called -- and get all this accomplished with 51 votes.

Republicans are aghast, naturally.

Sen. Michael B. Enzi, R-Wyo., said such a move by Senate Democrats would be a "declaration of war." Business lobbyists and health care industry lobbyists say it would be horrid to impose such massive reform without reaching out to the other side, meaning to them.

But reaching out hasn't much worked, and wars sometime need to be declared and fought before they can be won.

Anyway, Ronald Reagan did this budget-reconciliation trick all the time in 1981. George W. Bush passed his infamous tax cuts with it. Bill Clinton availed himself of it for welfare reform.

Now it's Barack's turn.

But there is one problem. The Senate operates on budget reconciliation under a Byrd Rule, which says budget bills may not contain "extraneous matter" that doesn't actually spend money.

Some elements of reform, such as guidelines on pre-existing coverage, don't actually spend money. Objections can be raised. The parliamentarian has to rule. Sixty votes -- the dreaded 60 votes -- are needed to waive a rule.

Some Democrats worry we'd end up with a "Swiss cheese" reform bill. But if the issue is cheese with holes or no bite at all ...

John Brummett is an award-winning columnist for the Arkansas News Bureau in Little Rock and author of "High Wire," a book about Bill Clinton's first year as president. His e-mail address is jbrummett@ arkansasnews.com.

 

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