Some smart readers with advanced augury skills are trying to sketch out what would happen if the White House were to split the health care bill in half, and try to use the budget reconciliation process to pass the more controversial parts of the legislation.
Let's assume, for the sake of argument, that the Senate parliamentarian won't sustain any objection about the germaneness of various provisions. Which comes first? The insurance reforms and the health exchange -- popular, populist, easily passable? Or the revenue enhancers and payfors -- which appears to need 60 votes?
If senators know that Democrats are going to ram through the hard
stuff through reconciliation later, why wouldn't they have an incentive
to filibuster the easier stuff? Republicans will be able to demagogue
Democrats as using the reconciliation process as a backdoor to
socialism. It's also possible that senators could add items to the easy
bill that gum up the later reconciliation process. Knowing that
reconciliation is right around the corner makes the easy vote less easy
to cast, as Republicans (and Democrats) who oppose the harder stuff
aren't blind to the ledger main.
If, on the
other hand, if the Senate tries reconciliation first, it might work.
Let's say that 50 senators and the House pass a fully-fledged
public-option-containing-drug-price-reducing bill. Yes, it'll sunset
in five years, but for those five years, the insurance lobby will be
under enormous pressure to reform itself. The insurance industry knows
this. It wants the easy bill because it fears the ramifications of not
doing anything. This is the baseline condition.
Then
-- Centrist Democrats can propose a second bill that moderates the
first bill, creates the exchange and the mandate, and doesn't sunset.
Centrist Dems can therefore claim a victory -- liberals will complain,
but not that much, because they'll get more than they would under the
reverse scenario, the White House gets exactly what it wants, and the
media might even call it bipartisan.
A my correspondent notes, "it's similar to the threat of the EPA on climate
change legislation, the EPA is much tougher regulation than a senate bill, which
gives congress cover to vote for a bill that is seen as much more moderate than
what the EPA plans to do.".
Will the individual or employer mandates have to be in the non-reconciliation bill? If so, here's what would happen:
1. Senate passes bill under reconciliation. If it stands alone, many employers will take their employees off their plans, and onto the public plan (passed out of the House), which will then use its overwhelming leverage to force hospitals/doctors to take patients.
BUT
2. If a second bill, requiring individual/employer mandate, the "firewall" between public option and employer-provided care, is passed, things are not so dire for the insurance industry.
This is an interesting gamble. Republicans might be encouraged to do everything they can to stop the second bill, as without it we'll see what will in effect be a government takeover of much more of the insurance industry, and they can milk it for the 2010 elections.
But this poses the risk of a much faster transition to a Medicare-for-all system than anyone's anticipating. If people are happy with that plan, Obama and the Dems will get the long-term credit, even if it's the result of unintended consequences.
Insurance companies will do everything they can to get the second bill through, however, and Democrats--not eager to totally disrupt the status quo while they still have an aggressive agenda to pursue--will try to pass it.
It's really hard to wargame this out without knowing how the bill could be split. Also, we don't know if some ideas--like just expanding Medicare to 50-plus and Medicaid to 200-percent poverty line--might find their way back in the debate at this point. Doing those two things are easier to explain to voters, and would accomplish much of the same things (provided that IMAC gets more power) in the end.
The public outrage at an attempt to ram-through a partisan government takeover of our health care economy will be nothing short of apocalyptic.
If you think people are unhinged about what's on the table now, wait until Washington starts messing with their lives — in a way that they can't do anything about it until 2010. It'll become crystal clear just how small (and impotent) the left-wing echo chamber really is.
Is the hatred and envy of private enterprise really so great as to justify another revolution?