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Health care now, reconciliation later

A lot of e-mailers have asked whether Congress could pass health care now and then come back in a year and pass the public option, or Medicare buy-in, through reconciliation. The answer is yes, they absolutely can. They'd need to plan for it in the budget, as reconciliation instructions have to be passed at the beginning of the year. But there's nothing stopping them from doing that.

The question, in fact, is not "can they," but "will they?" And that depends, I guess, on a couple of things. First, the amount of sustained attention activists give to the issue. Second, how the issue plays in the 2010 midterms. If health care feels like a liability to Democrats, they'll probably edge away from it for a few years. But if they run on it as an accomplishment and slam Republicans for doing the bidding of the private insurance industry and killing the public option, they may well come back to it. Third, the actual implementation of the bill. If people are happy with the private choices and costs are relatively controlled, there will be much rejoicing in the land, and the bill will carry on. But if the private insurers don't offer good choices, and costs are not controlled, then Democrats will need something to rebut Republican criticisms, and that something may be the public option.

By Ezra Klein  |  December 15, 2009; 10:30 AM ET
 
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Comments

If Dems had had the guts to run on serious health reform (curtailing private profit), they would have included it in the bill. Obviously Dems are not going to run against Republican obstructionism -- that would be impolite. That's the whole story of why we've seen such an absurd process seeking to pass this pitiful bill.

Posted by: janinsanfran | December 15, 2009 10:40 AM | Report abuse

Good. Back on track Ezra. Clear concise post that explains the options at this stage. and for all the chatter about reconciliation needing sunsets. Not true. IF, the CBO scores the bill as not significantly adding to the deficit beyond ten years, which it will. Satisfies the Byrd Rule, where Bush's tax cuts did not, ergo sunsets.

See Welfare Reform Reconciliation bill from 1996, not sunsets with that.

Posted by: arnold104 | December 15, 2009 10:43 AM | Report abuse

Good post, EK. And to repeat what Atrios just posted:
As Amanda says, the disappointed-voters-staying-home issue isn't about plugged-in people like me stamping my feet and declaring that I am so mad that I won't vote, it's about that great mass of people who generally see voting as an optional activity. Turnout varies, and off-year turnout is significantly lower (roughly 40% in 2006 versus 60% in 2008). In an ideal world everyone would vote all the time, but they don't, so voter enthusiasm is one thing politicians have to deal with.

Posted by: AZProgressive | December 15, 2009 10:51 AM | Report abuse

Not directly on topic, but I have a related question:

Are Snowe and Collins too "honest and principled" to take a five or ten (or twenty for that matter) billion dollar pile of pork for Maine in exchange for their votes, or are Reid, Obama, etc. too "honest and principled" to offer it?

(I won't bother asking if they're all just too afraid of Fox News.)

Posted by: jeb_mn | December 15, 2009 10:56 AM | Report abuse

ezra, aren't most of the reforms (or at least the most noticeable ones) in the bill not kicking in until 2014? if so, i can't see how healthcare will be seen as something to run on. won't most people just know that healthcare passed but no benefits are actually being felt? same goes for the 2012 elections. why is it a good idea nothing kicks in until then? is it solely for a good CBO score?

Posted by: spacerokmm | December 15, 2009 11:20 AM | Report abuse

Slam the Republicans as tools of the private insurance industry? The DEMOCRAT bill forces people to buy insurance from PRIVATE INSURANCE COMPANIES and the insurance industry has been running ads in support of the DEMOCRATIC bill, and you are attempting to portray the Republican party as the tools of the insurance companies. Give me a huge freakin break.

Posted by: Bob65 | December 15, 2009 11:28 AM | Report abuse

We should trumpet this as a success in 2010 (which it is), campaign on the value of adding a public option/medicare buy-in, get a mandate for it in that election and then do it through reconciliation. That makes a lot more sense than a protest at the white house against the president who has gotten more of what Truman advocated 60 years ago than LBJ thought he could ever hope to get.

Posted by: gregspolitics | December 15, 2009 12:44 PM | Report abuse

Why do Democrats have to wait a year to use reconciliation? If I understand correctly, there are already reconciliation instructions in place for a health care bill to go through that process this year. It seems to me that Senate progressives should vote to pass the current bill only upon getting a commitment from Reid to bring some sort of public option through reconciliation ASAP, i.e. this year if possible.

Posted by: williamperdue | December 15, 2009 3:35 PM | Report abuse

Also, let's think a little longer term. We've had failed attempts and gotten nothing for one-hundred years. It's been 16 years since the last attempt. If we can't get a public option, or Medicare buy-in, or lowering the Medicare age, etc. through reconcilliation in the next year, it can still be done three years from now, just after Obama is hopefully re-elected, or five years from now, or seven. These are relatively short time periods compared to another complete failure, and who knows how many more decades it would be until we would even get a starting point bill passed, if we end up with nothing on this attempt.

Posted by: RichardHSerlin | December 15, 2009 5:05 PM | Report abuse

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