This Week In Health Care

Ezra Klein is moving to the Washington Post. That's great - Ezra is one of my favorite bloggers, and I particularly appreciate his ability to drill down on health care policy. So in his honor, here's a great big health care post!

I would describe the prevailing mood from health care policy experts on the Hill as ebullient. The Senate committee chairs with jurisdiction are planning to mark up a bill by June, while working in close concert so the bills aren't all that different, and a final vote is expected by early fall. This appears to be happening.

The question, of course, is "what is happening?" What form will this legislation take? Some liberals are alarmed by the subtle shifts in the debate, and for good reason.

As Congress returns to begin an intense debate over reshaping the nation's $2.2 trillion health-care system, prominent left-leaning organizations and liberal House members are issuing a warning to their Democratic allies: Don't cave on us.

The early skirmishing -- essentially amounting to friendly fire -- is perhaps the clearest indication yet of the uphill battle President Obama faces in delivering on his promise to make affordable, high-quality care available to every American.

Disputes over whether to create a new government-sponsored insurance program to compete with private companies shine a light on the intraparty fissures that may prove more problematic than any partisan brawl.

More than 70 House Democrats recently warned party leaders that they will not support a broad health reform bill that does not offer consumers a government-sponsored policy, and two unions withdrew from a high-profile health coalition because it would not endorse a public plan.

"It's way too early" to abandon what it considers a central plank in health reform, said Andy Stern, president of the Service Employees International Union. He said the organization pulled out of the bipartisan Health Reform Dialogue because it feared its friends in the coalition were sacrificing core principles too soon. "You don't make compromises with your allies."

Ultimately, I think the Administration supports a public plan, but they're willing to make it more of a public plan in name only (PPINO?), along the lines of Uwe Reinhardt's plan, which would operate like Medicare, but not paying the same bargain rates. That makes little sense to me and doesn't do much more than add a non-profit health care provider to the space. It won't necessarily force the private market to compete on price and quality, and given that a separate set of rules would do away with pre-existing condition and rate communities with a standard price, I don't see the benefit to a neutered public option. Reinhardt's plan isn't all bad, and it's actually better than other "level playing field" options I've heard. But I question its efficacy, and think that progressives still ought to push for a real public option.

The other big fight is over budget reconciliation, allowing Congress to pass the budget, with health care embedded therein, on a party-line vote instead of it being subject to filibuster.

Under the reconciliation process, the House and the Senate first agree on an overall budget blueprint and then pursue legislation — in this case, the health care overhaul — “reconciling” the blueprint with the needed policy changes. If enough Senate Democrats support the legislation, the White House would not need a single Republican vote.

The House adopted its version of the budget with the procedural shortcut. The Senate has been reluctant to authorize it, but may ultimately follow the House’s lead as the two chambers try to work out their differences.

A health care bill written mainly or entirely by Democrats would almost surely create a new public health insurance program, to compete with private insurers. It would require employers to provide insurance to employees or contribute to its cost. Employers who already offer insurance could be required to provide more or different benefits, and Congress could limit the tax breaks now available for such employer-provided insurance.

There's actually a budget vote today that would keep the option of reconciliation alive for health care, which Democrats in the Senate appear to be ready to allow, or at least not kill for now, since the leverage from threatening it can at least get Republicans to the bargaining table. This is an option, it must be said, that is a commonly used technique by both parties over the last three decades, and does not represent anything approaching a power grab. Nevertheless, obstructionist Republicans are vowing all-out war if Democrats go the route of reconciliation.

Although Senate Democrats are far from reaching a consensus on the reconciliation issue, party leaders confirmed Wednesday that they are reserving the right to use it to pass health care reform if Republicans fail to negotiate in good faith. Senate Republicans — saying they have every intention of being a full partner in the upcoming health care negotiations — said holding reconciliation in reserve could poison the discussions, and threatened retribution.

“If they go down that road, I think the fur is going to fly,” Senate Republican Conference Vice Chairman John Thune (S.D.) said. “I suspect that there is going to be an awful lot of resistance, and we will exercise our prerogatives so that the rules of the Senate are respected.” [...]

Sen. Lindsey Graham (R-S.C.), who was a member of the 2005 bipartisan “Gang of 14” that negotiated a deal on President George W. Bush’s stalled judicial nominees, said he would be willing to tap into the Senate’s parliamentary arsenal to block the majority from pursuing its agenda.

Similarly, National Republican Senatorial Committee John Cornyn (Texas) and Sen. Orrin Hatch (R-Utah) predicted that the GOP Conference would respond to Democrats’ use of reconciliation on health care with tough action.

What's comical about this is that Republicans are CURRENTLY using everything in their parliamentary arsenal to block the President and the Democratic Congress' agenda. Just today they blocked a vote on Kathleen Sebelius for Health and Human Services Secretary, despite the fact that she has enough votes on the floor to beat a filibuster (two Republicans voted her out of committee, plus 58 Democrats). And the head of the RNC has called on Obama to withdraw Sebelius from the position, all because she supports reproductive choice, as does the President, who was elected by the American people by a wide margin. I don't know how much more Republican obstructionists could possibly slow the chamber, given the circumstances.

Meanwhile, even their leadership is off message on this. Here's Paul Ryan on reconciliation.

“It's their right. They did win the election,” said Ryan, R-Wis. “That’s what I tell all my constituents who are worried about this. They won the election. They did run on these ideas. They did run on nationalizing health care. So, you're right about that. They have the votes with reconciliation. They nailed down the process so that they can make sure they have the votes and that they can get this thing through really fast. It is their right. It is what they can do.”

More proof that the GOP is stumbling around on this health care fight, without an alternative option and without a strategy other than "block that kick." They're giving the Administration and the Democratic Congress little choice but to blow right by them, and in that case, Democrats ought to get everything they can in the absence of Republican participation.