One more go-round on health care

It might yet happen that Democrats would break the 2,000-page health care measure into individual bills imposing increments.

By that scenario, Democrats would offer these individual bills as parts of a package and pass whatever parts they could, maybe even with an occasional bipartisan vote on some of the more popular concepts.

You could claim partial victory. You might do marginal good for people.

But apparently that will not happen first.

That's because leading Democrats -- President Obama and House speaker Nancy Pelosi, primarily -- have concluded they owe the party base another good-faith if probably ill-fated run at passage of singular comprehensive reform.

It's also because Democrats sense that mere trying, if communicated better this time, could reap political benefit for them in defining Republicans as more complicit in obstruction than they.

It's also because of what happened last week in California. Blue Cross announced it would raise health insurance rates in that state by as much as 39 percent on March 1.

Republicans, getting wind of another Democratic go-round, began assailing the idea last week that Senate Democrats might use the budget reconciliation process to pass a comprehensive health care reform bill with 51 votes.

But Senate Democrats are not talking about passing the health care bill itself with budget reconciliation. They are talking about how to achieve an improved bill from combining and amending the House and Senate versions.

And, yes, they're talking about using budget reconciliation to put purely fiscal amendments on the measure in the Senate by 51 votes. But some Democrats resist that, including Blanche Lincoln, Democrat of Arkansas, who is in so much trouble for re-election at home, where Obama has a near-60 percent negative rating, that she is running even from her Blue Dog shadow.

As always, the challenge is daunting. That's because two changes Democrats are talking about would cost the plan money, meaning those funds would have to be made up elsewhere to keep the measure fiscally defensible.

First, Democrats are discussing that the way to handle Nebraska Sen. Ben Nelson's getting that offending special Medicaid deal for his state would be to extend it to all states.

In other words, benefits paid to new Medicaid enrollees dictated to states by this bill would be paid for in full indefinitely, not merely for the first few years, by the federal government.

It's not that much money in the grand scheme of things. It would be favorably received by the states.

And it would help nationalize a part of health insurance. It could be seen as Public Option Lite.

Second, this so-called "Cadillac" tax on high-benefit health insurance plans, intended to tap fat cats, would be dropped, at least for union plans.

This "Cadillac" turned out instead -- irony of ironies -- to apply to some union workers who, in negotiations over the years, were persuaded to give up generous raises in exchange for better health insurance benefits.

You'd have to replenish that money in both cases, and seniors have been frightened enough already with cuts in the rates of growth in Medicare reimbursements.

Some in the House still like the idea of a surtax on the very highest personal incomes.

But tax increases aren't so much in vogue in the current climate.

How all this plays politically depends on the extent to which Obama, who needs to get front and center, can explain the Democrats and their bill and get understood amid the noise.

The emergence of yet one more delicate and complex Democratic congressional negotiation simply won't cut it.

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.