Health Care Financing Reform: (23) The Political Calculus

     I think that health care reform legislation is likely to pass Congress.  Here are my thoughts.

    Health care financing reform will pass easily in the House of Representatives.  There are more than enough Democratic votes in the House to enact the legislation.  It is in the Senate where the matter hangs in the balance.

     There are presently 59 Democrats and 40 Republicans in the Senate – and when Senator Kennedy's seat from Massachusetts is filled, there will be a 60th Democrat.  The indications are increasingly clear that Senator Olympia Snowe (R-ME) intends to vote for reform, thus giving the Democrats nominal Republican support and a one-vote cushion. 

     In addition, keep in mind that the Democrats don't need 60 Senators to vote in favor of the legislation; they only need 51.  They need 60 votes to vote for cloture.   Accordingly, the Democrats will have to enforce party unity to cut off debate, but after that the Party can allow a number of Senators to defect and vote against the bill itself. 

     Between now and the vote on final passage the fence-sitters and opponents of the bill will come under increasing pressure to vote for it, or at least not to support a filibuster.  This pressure will come in many forms. 

(1) The President and congressional leadership have a number of carrots and sticks at their disposal – patronage, pet projects, committee assignments and chairmanships, and reelection support.  Conservative Democrats like Joe Lieberman (D-CT) and Mary Landrieu (D-LA) will not vote for the bill, but they will have to think long and hard before voting to sustain a filibuster, and other Senators may seek a bite of the apple in return for their votes. 

(2)  As the bill moves closer to passage, the pressure to "make a deal" will become far more intense upon any Senator or Congressman who wishes to please or placate a particular constituency – and lobbyists and interest groups will gravitate towards members of Congress who can deliver.  For example, according to an article by Jonathan Riskind of the Columbus Dispatch, Senators Harry Reid (D-NV), Debbie Stabenow (D-MI), Robert Menendez (D-NJ), and Sherrod Brown (D-OH) are seeking a higher Medicare reimbursement rate for cancer centers in their own states like Cleveland's University Hospitals.  As we saw in a previous post, by promising to support the legislation, Senator Snowe has acquired considerable leverage – she has already altered a number of provisions in the Baucus bill, and she will no doubt continue to have a major voice in shaping the legislation.  If a Senator or Representative wants to influence the content of the bill, the price of admission is a promise to support the bill, or at least not to support a filibuster against it.  Any member of Congress who represents insurers or providers who are desperate to amend the bill will likewise become desperate.

(3)  There are powerful interest groups like unions and the AARP who want this legislation enacted, but even traditional opponents of health care reform may end up supporting it, or at least muting their opposition.  Health insurers stand to gain tremendously from the fact that employers and individuals will be required to carry health insurance, and at least some insurers will benefit from the elimination of barriers to entry and access to a national market.  Employers large and small may see their medical care costs reduced, capped, or, at a minimum, made predictable.  Medical care providers largely support this legislation, not for economic reasons, but because every doctor, nurse, and hospital or nursing home administrator is acutely aware of the suffering resulting from lack of universal coverage.

(4)  Democrats remember what happened in 1994.  The last time they failed to enact health care legislation, Republicans swept them out of power in Congress.  They may make the same mistake twice - it's never stopped me!  But I doubt it.  I see a political party that is more unified than ever, possibly as a reaction to malicious attacks like Sarah Palin's charge that Democrats are seeking to kill off senior citizens in order to save money and Representative Joe Wilson's blatant show of disrespect for the President.

(5)  The core of this bill – the creation of a competitive, national market for health insurance – enjoyed substantial Republican support in the form of the Wyden-Bennett bill, and it reflects Republican preference for a free-market approach to solving this crisis.  Many Republicans, particularly those who played a leading role in crafting and building support for that approach, will be tempted to vote for the bill – and if they do they should be rewarded with credit for designing those features.

(6)  Finally, this legislation is easily the single most important law that Congress has considered since the 1960s.  If it works it will be ranked with laws like the Social Security Act, the National Labor Relations Act, the Public Accommodations Act, the Voting Rights Act, and Medicare for its moral significance and its far-reaching effects on American society.  Everyone, Republican and Democrat, wants health care to be cheaper, better, and available to all.  The bill may not work – it may be the wrong answer to our problems - but every elected official who truly cares about the well-being of his or her constituents and the future of this country will be wondering, "Do I really want to vote against this landmark legislation?"

     It will be fascinating to watch!

Tagged as: health care financing reform, health care reform, health insurance reform, Olympia Snowe, political calculations