Nancy Pelosi is telling House Democrats that there will be no last-minute fixes to the health care bill, and that the House might pass health care without voting for it–by instituting a “self-executing rule.”

Yes, you read that last party correctly.  Politico explains:

Under this scenario, the Senate bill would be automatically attached to the reconciliation package, if the House passes reconciliation. In other words, Bill A would just become part of Bill B if the House passes Bill B, and the Senate could then vote on a reconciliation package before sending it to the president. This allows House members to approve the broader measure without actually voting on it.

All clear? No? Let’s turn to Byron York, conservative commentator extraordinaire, who actually describes the self-executing rule pretty effectively:

Whenever a bill goes to the house floor for debate and a vote, the Rules Committee is required to write, and the House must pass, a rule setting the terms of debate: how many amendments will be offered, how long debate will run, etc.  The rule is normally a limited measure that applies only to the particular bill in question.  And it covers only the process; the bill itself is passed separately.  But it is possible for the Rules Committee to put in language stipulating that if the rule is passed, then a separate, unconnected piece of legislation will also be considered, or “deemed,” to have passed.  “It embodies a ‘two-for-one’ procedure,” says a 2006 Congressional Research Service report on self-executing rules.  “This means that when the House adopts a rule it also simultaneously agrees to dispose of a separate matter, which is specified in the rule itself.”

Using the self-executing rule strategy, Democrats could conceivably pass the rule, the Senate bill, and the House reconciliation “fixes” to the Senate bill all in one vote, without a single House member voting for any specific health care measure.

The obvious follow up question: isn’t this kind of sketchy? York certainly seems to think so, and I can’t really blame him. Passing health care as twofer seems somehow hollow, the equivalent of going to a great restaurant with a friend and having him shrug and say “I’ll have what he’s having.” This is supposed to be an experience, man! Can’t you even look at the Daily Specials?!

I digress, but you get the picture: the self-executing rule comes across as kind of weak sauce. But–and this is a big but–it’s not trickery and it’s not unprecedented in either party. As with reconciliation, Republicans have traditionally been pretty gung-ho about self-executing rules, even though they now poo-poo both measures. Yesterday, Media Matters highlighted an interesting 2006 column from Roll Call that gives some additional context:

From the 95th to 98th Congresses (1977-84), there were only eight self-executing rules making up just 1 percent of the 857 total rules granted. However, in Speaker Tip O’Neill’s (D-Mass.) final term in the 99th Congress, there were 20 self-executing rules (12 percent). In Rep. Jim Wright’s (D-Texas) only full term as Speaker, in the 100th Congress, there were 18 self-executing rules (17 percent). They reached a high point of 30 under Speaker Tom Foley (D-Wash.) during the final Democratic Congress, the 103rd, for 22 percent of all rules.

When Republicans took power in 1995, they…proceeded to set new records under Speaker Newt Gingrich (R-Ga.). There were 38 and 52 self-executing rules in the 104th and 105th Congresses (1995-1998), making up 25 percent and 35 percent of all rules, respectively. Under Speaker Dennis Hastert (R-Ill.) there were 40, 42 and 30 self-executing rules in the 106th, 107th and 108th Congresses (22 percent, 37 percent and 22 percent, respectively).

Still, the self-executing rule has never been applied to something as big as health care reform, and it’s true that this rule is clearly a last resort–which, depending on your interpretation, could be seen as proof that health care reform is unpopular or that Congress is corrupt and incompetent.  The bad news is that either of these scenarios will have political implications: if health care really is as unpopular as conservatives say (and for the record, I don’t think it is–transformative legislation is always controversial until it’s passed, at which point we all absorb its measures into the fabric of our lives) or if liberals are angry that Congress couldn’t get its act together to pass the right health care in the right way, it could be a bad election cycle for Democrats.

Indeed, it may be that in our current political environment, brimming with populist discontent and a disillusionment over the fact that Obama-ism didn’t breed widespread open and honest collaboration, something like the self-executing rule will be viewed as particularly loathsome to voters. On the whole, I’d venture that passing health care is worth the risk, but make no mistake–there is a risk.

Unfortunately, it’s still Democrats–and only Democrats–who are pushing that ball along. The GOP isn’t going to sign on to health care reform. So what are Democrats to do, given that the president is going to announce next steps on health care this upcoming week? Say it with me: reconciliation.

It’s pretty much agreed that reconciliation–basically, a process that lets the Senate pass a bill with 51 votes (a simple majority) instead of 60, which just ain’t going to happen for health care reform–is the only way to ram through change. Some people complain that using reconciliation is strong-arming reform undemocratically. Some of those complainers have actually defended reconciliation in the past (*ahem* Senator Judd Gregg), but you know, politics first, common sense second, I guess.

But more importantly: reconciliation is not new. It’s not even new to health care or social policy. NPR ran a great piece this week highlighting the high degree to which health care policies have been instituted through reconciliation in the past (timeline of health care-related reconciliation bills pasted to the left). Take note of how many major milestones–COBRA, welfare reform–were passed through reconciliation, as well as the even split between reconciliation measures in Reagan’s 1980s and Clinton’s 1990s.

But there’s more: in 1990, the famous PAYGO provision in federal spending was instituted through reconciliation; in 2001 and 2003 the Bush tax cuts were passed and accelerated through reconciliation; and all in all, Republicans have supported 17 of the 22 reconciliation bills passed since 1980.

Is reconciliation the norm? No. But the normal ground rules of the Senate–that any Senator can invoke the filibuster to essentially talk a given bill to death and obstruct its passage unless it has 60 out of 100 votes–is just absurd. This is why leaders of both parties regularly use  reconciliation to pass significant, sweeping legislation. The odds of any one Big Idea, whether it’s from your party of the opposition, managing to get 60 votes or not offending any one legislator to the point of filibustering is pretty low.  Republicans know this; it’s why they have relied on reconciliation so many times in the past. But now they don’t like health care reform, so they’ve flip-flopped. But if Democrats are being undemocratic by considering reconciliation, than Republicans have been guilty of the same. Let’s hear the GOP say that welfare reform or the Bush tax cuts were undemocratic; let’s hear them condemn quality control in health care, the ability to keep health insurance after being laid off, or a patient’s right to emergency care.

The truth is that reconciliation has produced a lot of the policies and measures that we take for granted as being part of our institutional fabric, and that, for the most part, people don’t wag their finger toward policies that they like today which were passed via reconciliation yesterday. So go, Democrats–reconcile away.

Meanwhile, the stalling of health care reform in D.C. has opened up the possibility of dramatic action in the states: California has proposed a single-payer system within its borders, Republican forces are mobilizing in two-thirds of all states to pass legal reforms that would outlaw have mandated health insurance (though federal law would supersede any such stipulation anyway), and Missouri, Virginia, and New Jersey are all contemplating reforms to expand coverage.

Bottom line: a lot of things may be up in the air right now. Clearly, Democrats are trying to be as overtly bipartisan as possible in order to give the GOP a chance to contribute–which, if history is any guide, they won’t. The real question is how the White House and Congress responds if Republicans continue to stonewall–how far across the aisle do the Democrats have to reach before they, and voters, feel that they’ve given cooperation a real chance? And how far states will get in implementing their own health care reform before the Beltway blowhards get their you-know-what together?

On Tuesday night, Ted Kennedy’s  Senate seat went to Scott Brown, a Republican. Martha Coakley, the Democratic candidate was a joke: as The Daily Show pointed out in a characteristically biting segment, she publicly said that Red Sox legend Curt Schilling was a Yankees fan and scoffed at the prospect of “shaking hands” with voters “in the cold”; she also said that Catholics shouldn’t work in emergency rooms because they’d probably refuse to perform abortions (Massachusetts is about 40% Catholic). Coakley only made 19 campaign stops across the state since she won the primary; Brown had a whopping 66.

By any measure, Coakley was a remarkably poor candidate, and the suave, handsome, and faux-folksy Brown a good one–at least in terms of politicking. Yet Democrats in Washington seem to have immediately swallowed the argument that Coakley’s loss was a strong statement that the Democratic agenda–and particularly, health care reform–is not sitting well with voters, and that the party is in dire need of a course correction. Wait-and-see centrists–those bold leaders who always stand on the margins, poo-pooing policies and claiming that such finger-wagging amounts to true moderation–immediately claimed that “catastrophe” was imminent for Democrats everywhere.

The guy who said that was Evan Bayh, Senator from Indiana, and his comment isn’t actually that shocking. This is the guy who has a history of opposing liberal measures. But then the rest of the Senate got into the act: Barbara Boxer from California said “every state is in play,” Majority Whip Dick Durbin (IL) said the election was “a wake-up call,” Kent Conrad (ND) said outright that “part of the problem is the [Democratic] agenda itself,” and Mary Landrieu (LA) said that her party was “overreaching” and “advocating [too much] government,” particularly through health care reform.

When I first read all this, I was speechless. Where is the courage? Where is the self-respect, the rudimentary understanding of leadership? Where is the commitment and conviction? Three days ago health care reform was utterly vital and necessary, and today it’s suddenly a bad idea for the country because a sad-sack candidate got trounced. Well, I have news for you: Massachusetts is the last state one should use as a bellweather for national sentiment when it comes to this health care plan. The state already has many of the aspects of Congress’ bill in place at the state level, meaning that for Massachusetts voters, national health care reform means higher taxes with little benefit. Is it really so shocking that the people who already have health care aren’t crazy about paying more in the midst of a deep recession in order to get it for someone else? (In fact, Brown outright discussed how unfair it was that his state would “be basically paying for our plan, and then we’re going to be subsidizing Nebraska and Louisiana,” sarcastically calling that set-up “a real bargain.”) This is not the same thing as all American voters collectively giving health care reform the finger! So why are the Democrats immediately doubting the fundamental tenets of their political agenda? It’s utterly disgraceful. The Right deserves to have a field day with Democratic leadership on this one: they’ve been acting precisely like the lily-livered, perennially ambivalent pansies that conservatives always try to paint them as being.

And, of course, there’s health care reform. The Senate is going to wait until after Brown takes office to proceed on the issue, as opposed to ramming the Senate version of the bill through and then forcing it on the House before Brown officially enters the picture. On the one hand, this is a mature, civil decision, as is Obama’s insistence that Brown and Republicans become an active part of the health care reform process. On the other hand, this reeks of precisely the sort of accommodative move that’s so frustrating: if the Democrats were better disciplined, more ideologically consistent, and bolder in their commitment to issues (all of which, I must admit, describe conservative leaders) then ramming health care reform through ASAP would have been Option #1. It would have been ugly, but the American people would not have cared so long as the results of passing reform were beneficial. Seriously, can you name the precise Congressional maneuvering that went behind a policy–any policy–over the past few years? Probably not, at least not at the level of detail that you’d need for it to serve as some sort of warning sign for Democrats.

But no. What we’re likely going to get is a “a simpler, less ambitious” bill that will likely have more Republican support (I think something is going to pass: even Democrats aren’t dumb enough to let an initiative this significant and high-profile tank after it’s received so much time, energy, and attention…I hope). I’ll try to be patient and not say outright that this new bill is sure to be worse than what’s currently being considered; but the fact is that Republicans have very little incentive to chip in, particularly since the new post-Massachusetts narrative is all about the pay-off of opposing health care reform. I’m not expecting a miracle.

But still, in the end, my feelings about recent developments are less concerned with the policy specifics and Congressional math around health care reform (again, because I don’t think it’s dead) than they are the fundamental leadership deficit in the Democratic Party. I’m an Obama fan; but from day one I thought that his message of compromise at any cost and unity was good for the country’s spirits, but perhaps too amicable for the reality of party politics–at least when it came to pushing through the policy priorities that I value the most. Think about it: if health care reform had been the #1 item on the Republican agenda while George W. Bush was President, we’d have had it in place already. Sure, there would have been a lot of irate politicos and bloggers talking trash since the process would have probably been incredibly shady and violently acrimonious; but the right heads would have been cracked to make sure that health care went through. But today’s Dems seem more concerned with procedure than outcome.

At this point, I just don’t know what to say. It’s incredibly frustrating. Brown’s win (along with today’s Supreme Court decision to let corporations and organizations spend freely in elections) makes for a powerful gust of wind in the conservative sails, and a lot of that momentum comes from the fact that Democrats are talking up the storm–and questioning their principles–all by themselves.

Man, I’m tired.

]]> http://thefastertimes.com/healthcare/2010/01/21/democrats-should-be-ashamed-of-themselves/feed/ http://thefastertimes.com/healthcare/2010/01/12/in-defense-of-harry-reid/ http://thefastertimes.com/healthcare/2010/01/12/in-defense-of-harry-reid/#comments Tue, 12 Jan 2010 16:04:47 +0000 Niko Karvounis http://thefastertimes.com/healthcare/?p=562 So a few years ago, Senate Majority Leader Harry Reid–the dude who’s in charge of shepherding health care reform to passage–said something really dumb about Barack Obama. (For those who don’t know, a new book reports that Reid privately said that Obama should run for president because he was a light-skinned black guy with “no Negro dialect.”). Now he’s supposedly fighting for his political life, and conservatives want his head on a platter. The Right is pissed off because Trent Lott, the Senate’s Majority Leader  when the GOP held control back in the early 2000s, stepped down as leader in 2002 after praising the 1948 presidential campaign of Strom Thurmond, who at the time was an explicit racial segregationist. For example, Arizona Sen. John Kyl said that it was a “double standard” for Reid to get away with his comments if Lott couldn’t do the same with his.

First off: a double standard would be okay in this case. Democrats have done a lot to support the African-American community since the 1930s, when FDR made his New Deal program available to all minorities, and particularly since JFK and LBJ were staunch supporters of the Civil Rights Movement. So if the black community is granting Reid a reprieve, then some of it might have to do with the fact that he’s a member of a party that has actually supported its people–so even Al Sharpton is willing to cut him some slack.

But y’know what? It’s not a double standard–because the Reid situation is a lot different than the Lott flub. Reid was privately expressing support for an African-American presidential candidate well before it was cool to do so; Trent Lott, on the other hand, publicly said that “when Strom Thurmond ran for president, we voted for him. We’re proud of it. And if the rest of the country had followed our lead, we wouldn’t have had all these problems over the years, either.” Yes, Lott suggested that “all these problems” in society were an outgrowth of racial integration. That’s a lot different than a 70-year old Mormon white dude from  a Nevada mining town secretly being out of touch with contemporary social norms (something you’d kind of expect, anyway) particularly since he was expressing support for pretty significant black political progress.

Obviously, Reid’s choice of words was idiotic, but frankly, the sentiment was probably accurate. Our society is obsessed with shades of skin tone, and unfortunately the lighter you are, the better off you are (or, as one study suggested, the more people in our society like someone, the more they tend to perceive their skin color as lighter. Kind of scary, right?). Lott’s comment, on the other hand–essentially, that black people are responsible for society’s ills–is a wee bit more difficult to substantiate, even if one had the inclination.

In the end, Reid should get out of this one with Senate post intact, albeit with his tail between his legs. But given the important role he has to play in health care reform–which, let’s remember, Republicans viciously oppose–don’t count on the GOP to let up on him any time soon. The thought of dethroning the Senate Majority Leader during such a critical time in the reform process is probably too delicious a thought for them to forget.

Kaiser Health News has the skinny.

The House wants to raise money for reform over the next decade by taxing wealthy Americans (specifically, millionaire families and individuals making over $500k) a 5.4% surcharge; the Senate wants to raise money by taxing high-cost insurance plans and increasing fees on insurers and other health care industry interests. Here, the House is clearly making a statement on how it feels about rich Americans, while the Senate is tip-toeing around the issue by trying to firmly place all fund-raising in the health care, as opposed to the broader inequality, space. Senators–traditionally more elite-friendly and moderate than their House counterparts–are not going to like the House’s class-based approach.

The House version of the bill has a public option; the Senate version doesn’t (thanks, Joe Lieberman!). Instead, “under the Senate bill, the federal Office of Personnel Management would oversee two national health plans from private firms offered through the exchanges to individuals, families, and small businesses. At least one of those plans would have to be operated on a nonprofit basis.” The battle lines surrounding the public option are pretty clear: liberals want it and moderates are queasy about it. As with the case of tax-based financing, the Senate has gone to great lengths to try and cobble together a rough facsimile of the liberal approach while being careful not to tread on conservative pressure points (like “taxing the rich” and “government take-over”).

Last but not least: abortion. In the House version of the bill, health plans can opt in or out of abortion coverage, with the caveat that federal funds cannot be used to pay for abortions except under extreme cases of rape, incest, etc. The Senate version allows states to prohibit abortion coverage from being offered from new plans generated by health care reform and would charge people who enroll in other abortion-allowing plans a double premium: one for their general insurance, and one for abortion coverage.

It doesn’t take a rocket scientist to understand that these three differences hew to some of the most volatile left-right issues in politics: taxation and class, the role of government, and abortion. Translation: merging the House and Senate versions of the bill could get messy. But for however messy negotiations might get, it’s fair to say that the Senate has the upper hand. As I’ve noted , health care reform will get exactly 60 votes in the Senate this week–the bare minimum for passage. Every Senate vote is a potential spoiler, a potential defector, where as in the House a bill only needs a majority of votes to go through. In other words, the Senate has more leverage here–because reform can’t afford to lose a single Senate vote–so the final outcome is likely to look more like the Senate version than its House counterpart.

]]> http://thefastertimes.com/healthcare/2009/12/23/why-and-how-the-senate-will-spank-the-house/feed/ http://thefastertimes.com/healthcare/2009/12/19/the-final-countdown/ http://thefastertimes.com/healthcare/2009/12/19/the-final-countdown/#comments Sat, 19 Dec 2009 19:21:58 +0000 Niko Karvounis http://thefastertimes.com/healthcare/?p=543 Da na NA na, da na NA NA NA….

So the Senate says it’s got a deal on health care reform. Pathological speedbump Ben Nelson, a moderate Democratic Senator from Nebraska who always wants to slow down major policy reforms with lots of finger-wagging and hand-wringing, finally “agreed after 13 hours of negotiations on Friday to back the bill, making him the pivotal 60th vote,” according to The New York Times. Assuming that all 60 votes–the bare minimum needed to pass health care–play out, the Senate should pass health care reform (by a hair) before Christmas. This is going to be close. As The Times points out, “[b]ecause the Democrats nominally control 60 seats in the Senate — the precise number needed to overcome Republican filibusters— every senator in the Democratic caucus effectively has veto power over the bill.” At the same time,  “no Republican is willing to support it.”

This, of course, is what makes the hijinks of people like Joe Lieberman so troublesome–if a Senator refuses to budge on a particular issue within health care reform, the entire process is going to have to recalibrate around his or her demands because every single vote makes or breaks this thing. As we all know, politicians are attention-whores and worse, self-righteous attention-whores. For a lot of politicos–particularly self-styled moderates and independents like Nelson and Lieberman–there is no better position than that of potential spoiler, because then you know (a) people are paying attention to you and (b) you can project the image that you are sticking to your principles in the face of party pressure. Principles like, say, getting a special program only for your state that increases federal contributions to Medicaid in order to help your state government save some money–which is exactly what Ben Nelson got for supporting health care. What a noble, selfless guy!

This is the kind of stuff that the Democrats are going to have to very delicately manage over the next few days. I think they’ll pull it off, but with so many egos in the Senate, the fact that every Senator now has the opportunity to make a name for him or herself and potentially force some self-serving contentions should make Democratic leadership pretty nervous. Right now there are 60 potential spoilers in the Senate, all itching for their chance in the spotlight…

As shocking as it is to see a self-styled moderate try and put the brakes on health care reform, Joe (and other moderates like Ben Nelson and Olympia Snowe) are going to have to come to a decision quickly: it looks like Harry Reid is pushing for health care to get wrapped up before Congress goes on Christmas recess.

What’s more interesting is that the vote came in response to a failed proposal by John McCain to “strip out all of the provisions in the [health care reform] bill that would slow government spending on Medicare.” Why interesting? McCain wanted to stop health reform in its tracks by scuttling the 10-year Medicare cost control measures currently in the bill–including hospital/provider reimbursement cuts and cuts to Medicare Advantage, a private component of Medicare formed in 2003–which McCain actually voted against.

What’s important here is less McCain’s flip-flopping than the way in which Democrats are acknowledging, at least to some degree, the importance of cost cutting measures, even when they rub against the interests of that all-powerful voting bloc of the elderly and retirees.

But not every health care battle in the Senate is going to be so cut-and-dry–already Democrats are claiming that Republicans are engaging in obstructionism and delay tactics and more generally, political forces seem to be overtaking some sound policy discussions.

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