Network News

X My Profile
View More Activity

When Health Care Does Become a Negotiation


As long as we're talking strategy, it's also worth saying a bit about how these pieces fit together in the legislative process. There are three distinct phases left to complete: First, the bills have to clear the House and the Senate. That means going through committees, overcoming a filibuster and attaining a majority. Then they go to conference committee to be merged. Then they come back to each chamber for a final vote.

The White House has said that its primary goal is to get a bill through the Senate and through the House and to conference committee. This is where health-care reform stops being a campaign and actually does become a negotiation. It's a fairly safe bet that the House bill will include a public option and the Senate bill will have a weak public option or some version of a co-op plan. Then the two will meet. What happens then?

The members of the conference committee are chosen by the leadership. They include the relevant chairmen of the committees -- Max Baucus will be there, and Chris Dodd will probably serve in Ted Kennedy's stead, and they will meet with Henry Waxman and Charlie Rangel and George Miller -- and a handful of others. The final bill needs a majority of both the House and Senate negotiating teams. That will be no problem on the House side. If Harry Reid stacks the Senate team with enough left-leaning senators to ensure a majority for a liberal-leaning bill (this is where Jay Rockefeller, chairman of Finance's health care subcommittee, and Barbara Mikulski, chairwoman of HELP's retirement and aging subcommittee, could play a role), a liberal-leaning bill, with a public option, is a pretty good bet.

That bill would easily pass the House. The Senate is trickier. But the conference report can't be amended. It can't be changed, or held up in committee. It can be filibustered, and it can be voted against. Those are the options. If three Democrats opposed the legislation and wanted to kill it, they would literally have to filibuster it (this is assuming that Democrats have 60 votes, which is not certain given Kennedy's health). That would be a very hard thing to do at that stage in the game. It would isolate the obstructionists, ensuring funded primary challenges and the enduring enmity of the Senate leadership and the White House. Kent Conrad can say that there aren't enough votes for a public option and imply that he's just protecting the final bill from defeat. But is he willing to be one of those "no" votes? Is he willing to filibuster? That's a different game indeed.

The White House has worked hard to imply to its liberal supporters that they need to be patient with the disappointments of the Senate process but confident in the outcome of conference committee. On July 20, Obama spoke to a group of liberal bloggers on a conference call and articulated the strategy quite explicitly:

Conference is where these differences will get ironed out. And that's where my bottom lines will remain: Does this bill cover all Americans? Does it drive down costs both in the public sector and the private sector over the long term? Does it improve quality? Does it emphasize prevention and wellness? Does it have a serious package of insurance reforms so people aren't losing health care over a preexisting condition? Does it have a serious public option in place? Those are the kind of benchmarks I'll be using. But I'm not assuming either the House and Senate bills will match up perfectly with where I want to end up.

This strategy, of course, relies on a lot of trust, and that's not something the White House has these days. But that's the administration's argument: Phase one is not a negotiation, and you can't demand a perfect product out of both chambers. In this period, the White House will do whatever is necessary to clear a bill out of the Senate, and if that means bargaining away the public option, so be it. Phase two is a negotiation, and you should trust the White House to produce a good piece of legislation. And phase three, well, that's the easy part. That's passage. Hopefully.

Photo credit: AP Photo/Jae C. Hong

By Ezra Klein  |  August 18, 2009; 10:53 AM ET
Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   StumbleUpon   Technorati   Google Buzz   Previous: The Liberal Revolt
Next: Whatever Became of Biden?



The "Gang of Six" have made it clear in a couple of comments that they'll need assurances that all of their work won't be undone in conference. IIRC, this has been discussed with Obama directly, its a issue of focus for Snowe, and there are a number of comments on this question that are on the record. Its not like they don't know everything you wrote in this post.

Posted by: wisewon | August 18, 2009 11:16 AM | Report abuse

Phase 1 is not a negotiation! Well except for secret deals with Pharma, that didn't happen and even if they did no longer matter! Trust us!

Posted by: endaround | August 18, 2009 11:24 AM | Report abuse

The trust isn't there because people feel the White House got rolled on the stimulus. I don't think they did; in the end they got what they wanted and asked for but liberals correctly wanted a larger, better targeted stimulus.

If this White House didn't look a lot like Bush's national security wise and didn't alienate the gay community as much; maybe they'd have more trust.

But now, with all the forces fighting to kill reform progressive liberals are correctly playing their own game. The White House, IMO, is helped by the liberal revolt. It clarifies matters.

There are two political realities: democrats need a bill, they need to overcome corporate hurdles.

Pushback from the left helps both get done and makes the final product better.

The White House needs to play it's game and the liberal progressive establishment needs to make it's lines in the sand clear and through a hissy fit from time to time.

That's how things get done domestically.

Posted by: Rhoda | August 18, 2009 11:28 AM | Report abuse

Thanks, Ezra. Good analysis. It would be great if the beltway boyz and girlz had a clue beyond the blather of the current 24 hour news cycle, but you've boiled it down pretty well.

The Gang of Six is increasingly irrelevant, as we can see. It's clear there won't be a single R vote, and Conrad's office said only yesterday that they definitely would vote for cloture on a public option bill, and even if they can't get 60 on cloture they will pass under Reconciliation. So I think your scenario rings true.

Any Senator who considers voting against cloture will get the memo that not only will they have a well funded primary opponent with massive union support, but also no DNC, DSCC, or DCCC funds in a general.

Posted by: cmpnwtr | August 18, 2009 11:31 AM | Report abuse

No Republican in their right mind is going to agree to a plan to kill the public option without assurances that it will endure through the conference.

They aren't stupid and most of them have read the constitution.

Posted by: cautious | August 18, 2009 11:57 AM | Report abuse

How many parts of this cunning plan require Harry Reid to be cunning?

Posted by: westofthedc | August 18, 2009 12:03 PM | Report abuse

The vote count analysis is getting closer to correct; however, I still can't ignore the State politics. Both "massive resistance" and what I'd call the "Larry Sabato" option exist, among others.

"Why can't we have good policy?" Being bullied to tow a party line isn't good policy for anyone... but it does indeed help in mob-rule situations. The comment from cmpnwtr at 11:31 demonstrates how a mob can rule its subjects: the curtailment of "safety net" programs in California, in contrast, demonstrates how easily benefits can be taken away from those who believe they have them.

Posted by: rmgregory | August 18, 2009 12:05 PM | Report abuse

"Phase one is not a negotiation, and you can't demand a perfect product out of both chambers. In this period, the White House will do whatever is necessary to clear a bill out of the Senate, and if that means bargaining away the public option, so be it. Phase two is a negotiation, and you should trust the White House to produce a good piece of legislation."

You are contradictory Ezra here - once WH has bargained away Public Option, how in the world will it be able to bring it back? Why would it be difficult for any Senator to take a principled stance that 'your President is going back on his word, I am not voting'? Why do you think it will be, for example, ever possible for WH to reopen the deal with Drug Industry? Nope.

Ezra - I just do not get it why are you so sympathetic to WH? Why are you believing Rahm and De Pearl of this world so much, along with our President too?

The right course for President was to come forward and tell honestly to his Liberal base that, 'Public Option' is not something we are going to carry now at this point. I personally do not support it much, but the kind of 'breach' Obama is doing with his Base and Net Roots is unbelievable.

This is Divorce, Ezra in case you do not see it.

Read Paul Krugman and try to understand what is happening - the 'political trust' is broken here.

President allowed Left Base all along these 2 years to build the expectations and in one of the most vulnerable momens of Left Movement, he simply drops these expectations without even courtesy talk with his base, with total news blackout and by the end of this week; he will be gone on vacation too. It is like, 'screw you guys on Left'.

Even moderately conservative Democrat in me also cringes with this thought - the total rapture of political trust here.

I mean, President and WH, literally intend to 'ram' his base here.

For the good of our Democracy, I hope Progressive Block of 100 Rep. revolt in this case and Daily Kos, Move On and Huffington Post start declaring 'primary challenges' pretty soon.

Democracy and people's will is more than counting votes. It is all right for President to negotiate things in larger interest (or even right interests); but he does not find any responsibility in explaining this to his base - that is unacceptable.

Very well, Obama may be well on his way to fulfill his own wish: be a one term President.

Posted by: umesh409 | August 18, 2009 12:11 PM | Report abuse

Well, Ezra, you sure know Chris @OpenLeft presented a bit different scenario recently:

1. The House Rules committee would merge the three existing House health care bills, and in the process make the final product weaker than any of those three.
2. The Senate Finance committee would immediately come out with a bill even weaker than the one proposed by Kent Conrad.
3. The Senate HELP and Finance committee would merge their two bills into something even weaker than the Finance committee's bill.
4. The Senate would weaken that bill on the floor via amendments.
5. The House would weaken their bill on the floor via amendments.
6. When the House and Senate bills are merged in the conference committee, the bill would get even weaker still.

Not a nice picture! So, why do you think your more optimistic view will come true, and not Chris' more cynical outlook?

Posted by: Gray62 | August 18, 2009 12:19 PM | Report abuse

"No Republican in their right mind is going to agree to a plan to kill the public option without assurances that it will endure through the conference."
Who cares about the republicans? Nobody needs them! The problem is the BlueDogs.

Posted by: Gray62 | August 18, 2009 12:21 PM | Report abuse

you did a good post on this at CJR a year ago, here is follow up , do email me at danbloom at gmail dot com, thanks

Posted by: polarcityboy | August 18, 2009 12:25 PM | Report abuse

rmgregory, I'd argue that the California example actually shows how hard it is to curtail popular public programs after they're enacted. It's taken a historic economic catastrophe for those programs to be curtailed. California's problem was that nobody was willing to cut those programs before there was a crisis and nobody was willing to adjust taxes to prevent the crisis.

Posted by: MosBen | August 18, 2009 12:28 PM | Report abuse

Yeah but the Blue Dogs won't support anything w/o Republican cover.

This has gotten particularly stupid in recent months, btw -- with people like Bayh expanding that to also mean "Republican cover, but not including Snowe, Collins, or Grassley!"

The focus of effort has to be on getting the Blue Dogs more scared of Democratic backlash than of Republican criticism.

Posted by: NS12345 | August 18, 2009 12:29 PM | Report abuse

"The focus of effort has to be on getting the Blue Dogs more scared of Democratic backlash than of Republican criticism."

Good point. Sadly, I've read that neither Conrad nor Baucus are up for reelection in 2010...

But imho it would be a good idea to implement reforms in the Dem Senate caucus that would change the chairmanships of the committees.

Posted by: Gray62 | August 18, 2009 12:35 PM | Report abuse

you did a good post on this at CJR a year ago, here is follow up , do email me at danbloom at gmail dot com, thanks

Posted by: polarcityboy | August 18, 2009 12:39 PM | Report abuse

polarcityboy, why don't you simply try to reach him through the WashingtonPost switchboard? I guess even bloggers have a phone at the Post...

Posted by: Gray62 | August 18, 2009 1:02 PM | Report abuse

Ezra may or may not come to his own defense, but I don't read his post as many others seem to be doing: as a defense of the White House approach or as especially optimistic that the White House approach will work out as planned or as beseeching readers to have trust in the President and his crew. I read it as a plain description of the White House approach and explanation of how, in principle, that approach could work, with an implied nod to Krugman's perspective that the White House does not in fact enjoy a great deal of trust on the part of progs/lefties. (Which is different from saying that Obama will let them down in the end, only the descriptive fact that they don't trust him to pull out a win at the buzzer. I am in full agreement with other commenters that Obama's failure to uphold progressive ideals on other issues -- Wall Street reform in particular -- goes a long way toward explaining that quite reasonable lack of trust.) That the approach exists at all gives me some modicum of optimism given all the gnashing of teeth going on regarding the death of the public plan. Myself, I'm withholding judgment until (if) legislation becomes law. (Withholding judgment, but not withholding letters to my Senators to get with the frackin' plan!)

Posted by: JonathanTE | August 18, 2009 1:06 PM | Report abuse

"The sun will come out tomorrow"

It'd over Ezra. Over. Obama started backing down even before the Senate Dems did.

There's blood in the water now and if the Dems push through some watered down, lame bill and try to claim victory they're going to get crucified by the public.

Then again, if they can't pass anything at all it will be even worse.

To complicate things even more, after this fiasco the Dems are going to ask people to trust them on Cap & trade and Immigration.

Don't be suprised to see Obama doing his best Bill Clinton and running for cover when the fallout starts. he isn't up for re-election next year and he's already seen how a President can survive something like this if he just steps out of the way and avoids ever being behind any major legislation again.

Of course maybe Obama doesn't care about being President as much as he does about the issues. Maybe the White House means nothing to him if Americans don't have access to free heathcare or "immigrants" aren't granted amnesty and the US's carbon footprint actually grows.

Maybe he'll go down fighting. Of course so far, after watching him two step on the public option and end of life issues, the smart money is definitely on the Clinton option.

Posted by: IUT1 | August 18, 2009 1:52 PM | Report abuse

What a great discussion. I'm dyed/wool libertarian/not a huge fan of EK, but sick of the childish comments on other pages. May just stick around here and listen for a bit, maybe a question here and there. Objections?

Posted by: bob112 | August 18, 2009 4:56 PM | Report abuse

If push comes to real shoving the bill doesn't have to clear Senate Finance and depending on how hard leadership is willing to push can avoid Conference as well. Long version at my post at Angry Bear. Short version? Rule 14.

Scenario: Reid, Dodd, a Kennedy rep, Pelosi, and the Tri-Committee chairs sit down and merge the three house bills and needed changes from the HELP bill into one bill for House passage under a strict rule limiting amendments. Once passed Reid invokes Rule 14 and places an identical bill on the Senate Calender.

At this point the Senate Blue Dogs are in a corner. They can't simply overturn Rule 14, that requires something like a 2/3rds vote. And under Senate procedure the power to move a bill from the Calender to the floor is under the prerogative of the Majority Leader. Now technically it is a debatable motion and so subject to a filibuster, but it would be a very bold challenge to Leadership and moreover it would abrogate any possibility of using Senate tradition to argue that bills should go through the appropriate Committee, Rule 14 offers an explicit path.

If they surrender and let the bill go to the Floor they are limited to offering a series of amendments, each of which is subject to a non-debatable Motion to Table which kills it. At the end of the day they are limited to choosing whether to try to kill the whole bill at Final via the filibuster.

Reid should sit Baucus down and say produce a bill that can command the solid support of the majority, or enough of the majority and the minority to get to 51 votes, or we start with the House bill via Rule 14.

Taken to its limit this process could result in an unamended version of the compromise House Bill passing as the Senate as is and so avoiding the need for Conference altogether.

Reid just has to pass the 'man or mouse' test. So I am not hopeful. But it is a path.

Posted by: BruceWebb | August 18, 2009 6:07 PM | Report abuse

Thx for this interesting, and maybe crucial, detail of Senate rules, Bruce! Very much appreciated. Would be good if Ezra would pick this up and make a blog post about that.

Posted by: Gray62 | August 19, 2009 5:49 AM | Report abuse


You're missing the point. Even if there was a way to freight train this through it really doesn't matter.

Americans have turned against it and that's that. Ramming this through with a bunch of back room deals and proceedures would be catastrophic for the the Dems in '10. They know this.

Nobody wants to be responsible for that in any way shape or form which is why very few Dems would go along with even having a vote on it.

At this point the Dem leadership is looking at exit strategys. That's all.

Posted by: IUT1 | August 19, 2009 12:49 PM | Report abuse

The comments to this entry are closed.

RSS Feed
Subscribe to The Post

© 2010 The Washington Post Company