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Few surprises in health-care reform


Today, the Senate begins debate on its health-care reform bill. That may confuse some folks who tuned in last week and saw the Senate debating a health-care reform bill. But that debate, you see, was a debate over whether to begin the debate. Today's debate is the actual debate. World's greatest deliberative body, don'cha know.

Health care has been at the forefront of the legislative process for about eight months now. In that time, the public option has seen its fortunes rise and fall, Ben Nelson has said supportive things and critical things, the Congressional Budget Office has released helpful reports and unhelpful reports. Things have happened. Enough things to fill the front page of this blog, and keep Politico's Pulse coming out every morning, and give the cable shows and newspapers grist for their daily editions. But as we enter the final stretch, the only surprise is, well, how few surprises there have been.

If you had tuned in six months ago for 10 minutes, you would have had all the information necessary to predict exactly where we'd be today. Democrats commanded exactly 60 votes, which meant that they had enough potential supporters to overcome a filibuster, but that each individual senator had sufficient leverage to extract enormous concessions in the final days. You would have known that the most controversial issues were the public option and the total cost of the bill, and both of those would be targeted by conservative Democrats like Nelson, Landrieu, and Lincoln. You would have known that liberals would be furious if any concessions were made on these issues, and would organize aggressively to protect their priorities.

And that would have been enough, really. Pretty much everything else has been a distraction, at least so far as the bill's ultimate fortune is concerned. The chaos of August didn't change a single vote. The Gang of Six didn't net firm bipartisan support. The president's speech didn't end the controversies. The deficit reduction embedded in the bill didn't assure a large majority.

The exception, as often happens, comes in the substance: A fair amount has changed beneath the hood of health-care reform over the past six months. The excise tax was added, and so too was the Medicare Commission. The delivery-system reforms became more concrete, and the bill was lashed to an arbitrary $900 billion price tag. The individual mandate was weakened a bit, and the employer mandate was weakened a lot.

But none of those changes have been particularly important so far as the politics of health-care reform go. Instead, we're still fighting over the same small patch of ground, and the same few votes from the same handful of conservative Democrats (with the admittedly unexpected addition of Joe Lieberman). The process has gone pretty much as you would have predicted six months ago, because the politics of health-care reform, like everything else that happens in a Congress dominated by fairly strong political parties, is much more about the votes you have and the votes you need than it is about the policy itself.

Photo credit: Brendan Hoffman/Getty Images.

By Ezra Klein  |  November 30, 2009; 10:43 AM ET
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