Don't Count Health Care Chickens Yet

The smart, insider take these days seems to be that health care reform will almost certainly pass the Congress. Different encapsulations of this can be found from Ezra Klein ("that's where we sit: incredibly, incredibly close to the finish line") and Megan McArdle ("I now put the chances of a substantial health care bill passing at 75%").

Actually, Megan's number seems about right. If I had to attach a probability estimate to health care passing, it would be that one: 75 percent. But I don't think it's as high as, say, 90 or 95 percent, and my sense is that there are lot of informed observers who do.

My encapsulation last week was that public opinion on health care is now more or less fully formed, and that Democrats managed to snatch a draw from the jaws of defeat. Hardly what they'd want under ideal circumstances. But probably good enough, given that the memory of the impact of the failure to pass health care reform in 1993-94 looms large in the Democratic consioussness.

But it's one thing for some combination of the 59 Senate Democrats, plus Olympia Snowe, plus Ted Kennedy's replacement in Massachusetts, plus perhaps one or two retiring Republicans like George Voinovich, to have the intention of passing health care reform. It's another thing to actually do it. And the process itself is rather complicated, for several reasons.

1) The process will be loooooooong. There are more than 500 amendments to Senator Baucus's mark-up, some of which are dilatory or trivial, but many of which -- especially those offered by Sens. Snowe, Wyden are Rockefeller -- are substantive. Essentially every aspect of the health care debate will be revisited? The public option? There's an amendment for that. More generous subsidies for the middle class? There's an amendment for that. Some random crap about ACORN? There's an amendment for that too. (Personally, I'm surprised that no Senator has yet taken the opportunity to insert an amendment ensuring that no Al Qaeda members will be covered by the health care bill.)

A lot of these amendments, presumably, won't make it to the Senate floor. But many will. And some of them may not only be voted on -- they may also be filibustered, which could eat up days at a time.

And that's still only one-third of the process. The House still has to pass its bill, and that vote is likely to be close. And then there's the conference committee report that would merge the Senate and House versions. A lot of hurdles still have to be cleared.

2. There's opposition from both the left and the right. I remain somewhat agnostic about the idea of issuing an ultimatum on the public option -- both whether it's the correct tactic, and whether the threat is credible. But certainly, this is different from how it usually goes in Washington. Either a public option will have to be inserted -- or a lot of progressives will lose face. Neither of those things will be pretty, but one of them has to happen. It is a multi-way negotiation, and multi-way negotiations are exponentially more complex than two-way negoitations. It is not necessarily obvious that the window for a health care bill that is neither too far to the right nor too far to the left is large enough to accommodate 60 senators and 218 representatives.

3. The opposition is multi-dimensional. As we described last week, there are a lot of objections to the Baucus bill -- and, moreover, there are a lot of different kinds of objections. A particular problem seems to be the funding mechanisms. Pro-labor Democrats object to the tax on expensive health care policies; people like John Kerry have parochial objections to the tax burden placed on various industries that may be abundant in their states; governors object to what they see as a heavier load that the states will have to carry on Medicare. We can expect to hear from the booze, cigarette, and Slurpee if the various sin taxes are reintroduced. And the Senate seems anathema to inserting a broad surtax on high-income earners, as the House bill deigns to do. If the negotiations break down, it will most likely be over the funding mechanism -- not because of coverage-related issues like the public option, where the objections are less orthogonal.

4. Reconciliation is, at best, a last resort. For months now, there's been debate over the Democrats could plausibly use reconciliation -- a tactic that would allow them to circumvent the filibuster and pass health care reform with 50 + 1 votes. I'm not an expert in Senate procedure, but I've found the "anti"-reconciliation arguments more persuasive. The pro-reconciliation folks seem to be saying: there's nothing really stopping Democrats from doing this, except political willpower. But political willpower is the whole rub: it's not clear there's enough of it to get it done. If the bill goes through reconcilation, a lot of process hawks will drop out. To name names, I'm thinking of Senators Snowe, (Ben) Nelson, Lieberman, Byrd, and Conrad, probably among others -- I can imagine Russ Feingold objecting, for instance. It is also likely to be a strange duck of a bill if it goes through reconcilaition, and so you might also have people dropping their support for more substantive reasons.

Again, the point of this is not to frighten anyone. I've thought the chances of a health care bill passing have always been at least 50 percent, and are higher now than they have been in some time. But the Democrats still have a couple of first downs to achieve before it's goal to go.