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    Health Care Reform: Fasten Your Seatbelts -- Congress is at the Wheel

    Posted:
    07/30/09
    Filed Under:Health Care
    The truest legislative assessment of the prospects for health care reform was uttered by none other than Bette Davis in "All About Eve:"
    "Fasten your seatbelts. It's going to be a bumpy night."
    Just when it seemed like Congress was going to slink into its August recess with everything in suspended animation, both Senate and House negotiators reported unexpected progress Wednesday afternoon in easing bills through key committees.
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    The Senate Finance Committee proudly announced that it had whacked $100 billion off the projected 10-year, $1-trillion cost of the proposed legislation. The House Energy and Commerce Committee also reported that it had cut a deal with moderate Blue Dog Democrats to limit the sweep of the bill and to curtail the scope of a government-run health plan that would compete with private insurers.
    While Barack Obama's August deadline had long ago drifted off on a summer's breeze, House Speaker Nancy Pelosi confidently issued a mid-afternoon statement, promising that the legislation would emerge from the Energy and Commerce Committee this week. But then liberals on the committee rebelled at the concessions to the Blue Dogs over watering down the public option – thereby postponing, at least until Thursday, work on the bill.
    (We interrupt this story to offer an updated Surgeon General's warning: "Trying to follow these legislative machinations is dangerous to your health and sanity.")
    The best way to understand the health care battles ahead is to remember what Vermont Sen. George Aiken shrewdly recommended as the American strategy at the height of the Vietnam War: "Just declare victory and go home." The White House and the congressional Democratic leadership are too committed to passing a bill to ever admit defeat. So whatever ungainly, mud-caked mess finally emerges from the legislative quagmire, Obama and Company are going to face an irresistible temptation to declare victory and call it health care reform.
    Media consultants and pollsters who advise vulnerable Democratic legislators are reluctant to antagonize the White House by talking on the record about the political pressures that their clients face in backing Obama on health care. But before this legislative crusade is over, many Democrats elected from traditionally Republican states or districts will face a long, dark night of the soul over the health care bill.
    The political dangers for Democrats come in all shapes and sizes. There is what might be called the Page 579 Problem – a minor provision buried in the intricacies of the health care bill could morph into a potent symbol of governmental excess when demonized in 30-second Republican attack ads. Sticker shock may also be an obstacle. No matter how it is paid for, voters may balk at the federal government spending, say, $900 billion for anything (even free drinking cups from the fountain of youth). Another political risk could come from the Medicare meltdown as voters over 65 (quite happy with their government-run medical care, thank you) angrily protest any potential cutbacks in their favorite program, wedged in under the guise of reducing overall health care costs.
    The truth is that – no matter how many town meetings and press conferences Obama holds – health care reform will remain an abstraction until there is an actual bill summary that voters can analyze. That is why polls during this phase of legislative jousting should be viewed with caution since they are riddled with hypothetical questions. (A New York Times/CBS News poll released Wednesday found that 46 percent of the voters approve and 38 disapprove of the way Obama is handling health care.) But the real political test will come in the fall. A Democratic strategist explains, "Then the big question that voters will ask about the bill is 'What's in it for me?'"
    Beneath the widespread altruistic belief that health care is a basic human right lays a self-interested personal cost-benefit analysis. This was equally true during Bill and Hillary Clinton's ill-fated 1993 drive to pass health care reform. As pollster Stan Greenberg, who advised Clinton during his first term, recalls in a New Republic article, "Judging whether the plan would help or hurt one's family suddenly became the dominant predictor... of support for or opposition to the Clinton health care plan."
    Top Democrats make the argument to each other that if the party this time around cannot pass health care reform – the Holy Grail since Harry Truman – it will face a rebellion from voters for over-promising and legislative ineptitude. As 34-year-old Virginia Democrat Tom Perriello, who defeated a six-term GOP incumbent in 2008, puts it, "The most important thing to keep in mind is that a lot of the freshman class got elected by running for problem-solving over partisanship." Perriello, who supports the public option, is staunchly in favor of reform even though he is among the 60 Democratic incumbents targeted by a Republican National Committee radio ad that ridicules Obama's proposals as "a dangerous experiment."
    There are actually Democratic insiders who believe that passing health care reform is more politically important going into the congressional elections than even the economy. In contrast, Republican pollster David Winston, who advises the congressional GOP leadership, persuasively argues, "This is ultimately going to be an election about jobs. And there's going to be one number that people will follow – and that's the unemployment rate."
    An under-appreciated problem facing Democrats in passing legislation is that many of the benefits will not kick in until after Obama runs for a second term in 2012. Yes, not until after the 2012 elections. Under the original and more liberal version of the House bill, the uninsured would not receive government subsidies to purchase their own health insurance until 2013, nor would the public plan be established until then. (Medicare, in contrast, was up and running 11 months after Lyndon Johnson signed the legislation in 1965).
    Part of the delay would be from the sheer complexity of setting up the elaborate system of rewards and penalties that will be needed to move the nation close to providing health care for all Americans. If, for example, large employers would be mandated to provide health insurance for their workers, that requirement could not be levied overnight. Also, under current congressional budget rules, the longer it takes for a program to fully take effect, the less the purported cost would be over 10 years. So as the health care legislation inevitably gets whittled down during House and Senate negotiations, the phase-in period is apt to be further extended in order to reduce cost estimates.
    Obama is also grappling with the "Why Now?" dilemma. At a town meeting Wednesday in Raleigh, N.C., the president repeated his refrain that the status quo is unsustainable. "If we do nothing," Obama declared, "I can almost guarantee you your (health insurance) premiums will double over the next 10 years, because that's what they did over the last 10 years." It is nearly impossible to argue with this long-term math. The problem for the president – and the congressional Democrats – is that it is hard to create a sense of this-is-the-moment urgency to pass legislation designed to ward off problems that are still just over the horizon.
    None of this is designed to argue that Obama-style health care reform is unattainable in political terms or undesirable in policy terms. But even with lopsided Democratic congressional majorities, even with the president's mastery of the bully pulpit, even with Wednesday's small-step legislative progress, the legislative struggle over the next few months will be daunting. So fasten your seatbelts -- the real action on Capitol Hill has only just begun.



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    Walter Shapiro

    Walter Shapiro, a PoliticsDaily.com columnist, has covered the last eight presidential campaigns as a columnist and political reporter... more

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