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Toward a better bill

Paul Starr looks at the path forward:

If things go as well as may be realistically expected, the Senate will pass a bill no later than January. Under normal circumstances, a House-Senate conference would then write a final bill, which would have to be approved by each house. But because of the difficulty in keeping all 60 votes in the Senate, congressional leaders may have to weigh another option: just putting the Senate bill up for a vote in the House.

If that approach proves necessary, there should be one last effort to incorporate some of the stronger provisions from the House in the final Senate bill. The House bill would create a national program with clear federal regulatory authority, while the Senate bill would probably result in an uneven patchwork of state programs. The House has also set an early date for the extension of coverage -- Jan. 1, 2013, which would make the reforms a fait accompli if a new administration takes office later that month.

Liberals in Congress should also recognize that with either a 2013 or 2014 date for implementation, there will be time enough to revise the program before it goes into effect (indeed, time enough for the opponents to roll it back). Many of the specifics, such as the level of subsidies, almost certainly will be changed in the intervening years. And many of those specifics can be changed through budget reconciliation, which requires only 51 votes to pass the Senate.

You take what you can get, and then you go back and get a little bit more. Do that for long enough, and you've got a pretty good bill.

By Ezra Klein  |  December 17, 2009; 9:35 AM ET
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I'm not sure about this, but if there was no conference bill, wouldn't it need to originate in the House, as it is a revenue-raising measure?

Posted by: stephenholland06 | December 17, 2009 9:45 AM | Report abuse

Dean/Olbermann 2012!

Posted by: obrier2 | December 17, 2009 9:54 AM | Report abuse

How similar is the senate bill to the plan John Edwards put out during the campaign? I think they're pretty close.

Posted by: ctabesh | December 17, 2009 10:15 AM | Report abuse

Ezra is exactly right. It's disappointing that this bill is the best we can get right now (and admittedly we could have gotten a better one if different strategic decisions had been made i.e. reconciliation used from the beginning), but you have to start somewhere. We aren't getting a better bill next year when the Democrats have even fewer votes in the Senate. Pass this bill now then immediately start working towards future legislation to improve it.

Posted by: redwards95 | December 17, 2009 10:15 AM | Report abuse

And still the anti-abortion forces could kill the bill at the last minute through Ben Nelson. Ironic how those who claim to be pro-life want to continue the 45,000 deaths a year from lack of health insurance.

Posted by: cmpnwtr | December 17, 2009 10:27 AM | Report abuse

It's just amazing how detached the wonks are from political reality. What would really happen between 2010 and 2014 if this piece of crap passes is that the deficit hawks would succeed in shrinking the subsidies further or even killing them off altogether, and we'd be left with only the mandates. Can you say, "massive backlash"? I knew you could!

Posted by: labonnes | December 17, 2009 10:30 AM | Report abuse

I don't see how these changes make the difference between the bill being a giveaway to insurance companies or not.

The subsidies to buy insurance from those companies were in place from day 1 of the debate and remain unchanged.

All that changed was one option that might have helped with health care costs, and would only be available on the Exchange anyway.

It's a symbolic loss. Mourn it and move on. It was bound to happen as long as our negotiating position was make-or-break, and the other side would get along fine politically with or without a bill.

Even if that's not enough, it can and will be added to and modified later anyway.

I'd rather call this a victory (it is), and give us a chance to be the ones who do the modifying. Go against it and it'll be guys who have hated reform all along-- the same creeps now salivating at our misfortune.

Posted by: itstrue | December 17, 2009 10:30 AM | Report abuse

"You take what you can get, and then you go back and get a little bit more. Do that for long enough, and you've got a pretty good bill."

Sneak stealthily down the slippery slope till you are finally able to enact the "Liverpool pathway" provisions that prove Sarah Palin was right. Yeah right.

Either put your proposals forward and fight for them or don't but do not endorse creeping incrementalism and expect anyone on the other side to ever trust you again.

This is why it is so difficult to get bipartisan cooperation. No deal is ever final. Each bill merely sets the stage for further demands. Better for opponents to dig in hard at the very begining, regardless of how reasonable the initial proposal. Cooperation on enacting even the most moderate reforms is merely the first step toward being saddled with the most damaging.

Posted by: WoodbridgeVa1 | December 17, 2009 10:34 AM | Report abuse

Ezra : "You take what you can get...."

Well, what exactly are we getting with the new plan?

Ezra, please answer the following types of questions. Until they are answered, no one has any business supporting or fighting this new plan....

- Will the NEW plan allow insurers to charge older or sicker Americans more for the same policy as younger and healthier Americans? If so, how much more?

- How much savings will occur under the NEW plan in the next two decades?

- Will recisions be banned and exactly what mechanism will exist to ensure that policy holders are not being denied health care payments? Will we have to hire a lawyer or call a watchdog agency?

- If someone is denied coverage due to pre-existing conditions, or they can not afford the quoted policies, how will he/she obtain insurance if no gvmt option or subsidies exist?

- How high will co-insurance or deductibles be allowed to go?

- Can insurers establish arbitrary maximum annual and lifetime deductibles and change them after I get sick?

- Does the NEW plan require states to substantially expand and increase funding of medicaid? If so, how does my currently bankrupt state afford this?

Posted by: Lomillialor | December 17, 2009 10:38 AM | Report abuse

Ezra is reported to be thrilled with the gold-plated dog turd he's receiving for Christmas.

Posted by: pseudonymousinnc | December 17, 2009 10:58 AM | Report abuse

Lomillialor, brah, gotta stop with the trolling.

Another argument to consider in favor of incremental reform was mentioned by Nate Silver today, mainly that passing this bill as the first step in future progress now will allow Congress to move on to other issues like financial regulation and climate change before revisiting HCR pre-2013. That's enough time for progressives to campaign on the need for a PO, better cost control, etc. and get a mandate, or at least mount some primary challenges to Blue Dogs.

Posted by: etdean1 | December 17, 2009 12:12 PM | Report abuse

"Many of the specifics, such as the level of subsidies, almost certainly will be changed in the intervening years."

... and that's what I'm afraid of. Without a public option or Medicare buy-in, there is absolutely no constituency to guard against future cuts in the name of "deficit reduction." As you and MY argued continuously over the summer, it's the governmental structures which matter. All we got with this bill as far as universal coverage is handouts -- and we know how that plays politically. Besides guarding against attacks based on the mandate, the PO and Medicare buy-in would have provided a constituency to protect the bill coming out of this long, drawn-out from future attacks.

Posted by: Chris_ | December 17, 2009 1:27 PM | Report abuse

Rather than the House's simply passing the Senate's bill as is, it would make more sense just to put the Senators providing the last few votes on the conference committee.

Yeah, that means Lieberman (vote #59) and Nelson or Snowe (vote #60) on the conference committee. But if they okay the conference report, they can hardly vote against cloture when the bill reported from conference returns to the Senate.

In some ways (other than the public option, such as better subsidies and a 2013 start date), the House bill is the better bill, and the conference report is the only way of getting the best of both bills (again, other than the PO) into the final bill.

Posted by: rt42 | December 18, 2009 9:02 AM | Report abuse

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