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How the Democrats may solve their health-care problem

There is no question that Democrats have looked weak in responding to the Massachusetts election. The notion that they would just shelve health care after all they have put into it -- the message they have gotten across, even if that’s not exactly what they have all been saying -- paints a portrait of a party that, to say the least, lacks persistence and conviction.

But there is a good reason behind all the confusion. The core problem is that the House Democrats no longer trust the Senate Democrats. And let’s be honest: There is no reason in the world for House Democrats to trust the Senate Democrats at this point, or even to feel very kindly disposed toward them.

That’s why there is resistance in the House to the most straightforward solution, which is for the House to pass the Senate health-care bill and send it to the president, and then to use the reconciliation process (which requires only 51 votes in the Senate) to pass the changes in the bill that House and Senate negotiators have agreed to -- or, at least, as many of those changes as is procedurally possible. They can’t get all the changes into law that way, but they could get a lot of them.

The catch is that the House Democrats don’t believe the Senate Democrats will necessarily keep their word and pass the reconciliation bill containing the amendments. And it’s not only the question of trust: anyone who has watched the Senate for the last year can be forgiven for wondering if it is even functional enough (given Republican obstruction and a lack of cohesion in the Democratic caucus) to keep a promise sincerely made.

So here’s an idea, I have been told reliably, that leaders of both Houses are considering: The House would pass a version of the reconciliation bill containing the various amendments and send it to the Senate. The Senate would change it slightly (in ways that the House agreed to), which would require the House to vote on it again. Only after it got the revised reconciliation bill would the House take up the Senate bill. The House could then pass both bills and send both to the president. Problem solved, health-care passes, and we move on.

Not all the difficulties with this scenario have been worked through, and it is not a slam dunk. For one thing, House Speaker Nancy Pelosi faces a revolt on her left against passing the Senate bill without changes. Some may still have to be persuaded to make sure it gets the votes it needs. There are also some House Democrats from moderate-to-conservative districts who are wary, after Massachusetts, of voting for a health-care bill, period. And there are a lot of procedural issues that need to be ironed out.

Nonetheless, for those (and I’m one of them) who believe in health-care reform -- and who think the Democrats would be committing suicide if they gave up on health care now -- it’s heartening to hear that serious people are making serious efforts to get a health bill through. In a pinch, I think that enacting the Senate bill into law without changes is far preferable to passing nothing. But I also understand that there are aspects of the Senate bill to which House members have legitimate objections. Solving this problem will require Democrats to pull themselves together across many lines of division -- notably between the House and the Senate, and between moderates and liberals. Can they do it? The answer to that question depends in part on leadership from President Obama. Can he do it?

By E.J. Dionne  | January 22, 2010; 3:18 PM ET
Categories:  Dionne  | Tags:  E.J. Dionne  
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Comments

EJ - your still delusional. The current plan is DOA as it should be. Between its costs and special favors - not even the dumbest of Dem (unless of course - its the left loon lib) would vote for it. It is a 3rd rail - it would be political suicide.....so go ahead - keep encouraging them ignore the will of the people...That's what caused NJ-VA-MA...and you still don't learn. Face the facts...the 30% liberal loonies...should not and can not dictate to the will of the majority. Healthcare will cecome as good as the Dems handled SS......Remember that? FDR stated voluntary and 1%...it became mandatory and is above 6% and failing. LBJ moved the funds to the general revenue and placed a bunch of IOUs in its place. Bill Clinton along with Al Gore then cast the 51st vote to allow then SS benefits to be taxed....and let us not forget ole Jimmy Carter allowing immigrants aged 65 to tap into SS as well - nevermind they paid nothing into it.

And you Dems claim its the repubs destroying our SS? And now you want to control my healthcare? LOL..LOL Thanks but NO THANKS! We have seen how big government works..or should I say does not work?

Posted by: short1 | January 22, 2010 4:13 PM | Report abuse

This is very interesting tactical argument, but avoids the essential question no one is willing to debate: whether in addition to "life, liberty and the pursuit of happiness" man's inalienable rights as expressed in the Constitution include a right to the goods and services of others (i.e. health care). The problem is that the electorate - and the founding fathers for that matter - say it doesn't. Health care is not an inalienable right of man, and legislative efforts to ascribe that right to men have, will, and should fail.

So what to do about a problem that everyone agrees if left unchecked will bankrupt this country and its businesses? First off, drop this progressive fantasy about health care being some sort of civil right. It's not, full stop. Second, pass legislation that implicitly recognizes the main problem with health care costs: there's no market mechinism to control costs in the current business model. Who decides to buy a car only to find out the price of the car one month later? That's basically the situation with health care delivery today. We need legislation to focus on making health insurance focus on insuring risk, and get away from a being a financing plan for all things medical. This means mandating high dollar deductibles in all insurance policies (say $2500 minimum), and assisting the poor and elderly with these deductible payments where necessary. This will force us health care consumers to shop around for services and bring a market mechinism to health care delivery. There's no "risk" that you will need to visit a doctor for a checkup once a year, but our "insurance" pays for it so consumers don't bargain the price down so it goes up at twice the rate of inflation and eventually bankrupts the country. This is what needs to change. Third, the more inhumane practices of the insurance companies need to be prohibited, such as not renewing the insurance of people who get chronic illnesses while they are insured. This violates the basic premise of insurance - that you pay an insurance company to insure against the risk of illness.

I submit that these strategic changes to the health care reform effort will produce real results, rather than some kind of tactical shift. It's the game playing on a tactical level that got the bums thrown out in Mass.

Posted by: fltacks | January 22, 2010 4:27 PM | Report abuse

I believe Dionne is sincere when he says he is for health care reform. However, neither the House nor especially the Senate bill is a health care reform bill. He and other liberal pundits supporting the Senate bill do not seem to understand this.

I do not understand how the House could pass a reconciliation bill that would probably contradict some of what is in the Senate bill, then pass the Senate bill.

Posted by: Aprogressiveindependent | January 22, 2010 4:27 PM | Report abuse

The interesting concept these days is that one can't get ANYTHING done via the Senate (health care included) without 60 votes. And since you can't get 60 Senators to agree on squat even if they are in the same party, nothing will be done and no bill will pass.

While the supermajority requirement is simply a Senate Rule, it increasingly has become cast in concrete.

As politics in the US have become flat out adversarial over the past two decades, that 60 vote rule has become increasingly obstructive -- especially when employed VERY effectively by a very disciplined party.

It seems pretty clear that the tactics employed by the Republican party in the past year (the Nancy Reagan approach of just vote no) will dictate a very much do nothing election year. Health care reform -- out, but that will be just the start of nothing getting done. As postings requiring Senate consent occur - no one gets approved (filibuster).

The thing is, the only way that supermajority rule would get tossed out is if there was a Republican majority in both houses and the executive -- our current ACTIVIST Supreme Court would declare it unconstitutional for a Democratic minority to obstruct the business of a Republican majority.

We are likely in for a very rough ride for several years, as there is much for the Federal Government to do, and NOTHING that it will do if it requires Senate approval.

Posted by: Barry8 | January 22, 2010 4:30 PM | Report abuse

So, basically, Dionne posts a very interesting piece of news - a story about possible steps the congressional leadership is taking to get a health care bill passed.

Washington Post readers commenting so far:

1) Right winger who hates health care reform

2) Right winger who thinks health care reform is unconstitutional

3) Holier-than-thou left winger who thinks the bill is "not true health care reform"

4) Somebody who hates the filibuster.

Good job, guys! Way to stay on point.

Posted by: jlk7e | January 22, 2010 4:48 PM | Report abuse

Before they rejoice too loudly about breaking the super majority the Repubs need to remember that their "NO" philiosophy will bounce off their foreheads for the next 3 years in the form of Obama's VETO on anything THEY want to pass!..and they cannot escape THAT..

Posted by: RPLCO | January 22, 2010 4:54 PM | Report abuse

Obama goes on national TV and says, "Sorry, folks, I went about national health care reform in the wrong way. So here's a bill that has already garnered important GOP support: Join me in encouraging your congressman to vote for Wyden/ Bennett." It's a better bill anyway and Republicans will look craven and stupid when they gang up on it.

Posted by: newsraptor | January 22, 2010 4:55 PM | Report abuse

Well, Dionne, it's good to see you come clean at long last. All of your ranting against Republicans was a load of hooey, which you now admit. It was Democrats all along who obstructed, wasn't it? Instead of giving Dems and the Vanishing Leader of the World cover by blaming Republicans, don't you feel better now 'fessing up to the real problem: Democrats.

Guess what? We all figured that out months ago. And the way we will vote in November will confirm it.

Posted by: jpfann | January 22, 2010 4:56 PM | Report abuse

What is it about "NO!" that you don't understand EJ? Jam this bill through and the voter outrage will be so loud that no Democrat seat would be safe in November. I dare the Democrats to follow your advice.

Posted by: delusional1 | January 22, 2010 5:01 PM | Report abuse

Tread carefully Democrats on Capital Hill. Any attempt to move Health care forward via reconciliation will be met with true disaster at the polls in November. Open up your ears and hear the people...no one likes this bill and you cannot do what the extreme left (nationalization single payer) or extreme right (change nothing in the current system) want.

You need to start over and incorporate modest changes supportable by both sides and go from there. Anything else will truly create a revolution in the streets.

Posted by: jlarranaga | January 22, 2010 5:04 PM | Report abuse

Here's the point that's going slightly everyone's radar right now which already has huge implications for the upcoming midterms...

Democrats in the House and Senate ALREADY voted to pass a health care reform bill.

To the low information voter that's all that matters. The GOP attack ads write themselves.... "so and so voted for health care reform. Democrats also failed to get 'results' after an entire year." Democrats need to pass it, claim results, and tout its accomplishments... "after 60 years of debate, we delivered."

Moderates who posture about killing this fail to realize that at their own peril. Likewise, Democrats in solid seats do so too because letting it fail puts their majority in serious jeopardy.

Posted by: kingfish247 | January 22, 2010 5:06 PM | Report abuse

And to those suggesting "jamming" anything through will be met with disaster at the polls... this trope is tantamount to 'heads I win, tails you lose.' No matter what happens Democrats will be attacked. Shelf it... they're feckless. "Jam" it through... voters are mad because why? That people can no longer be dumped due to preexisting conditions, kids can stay on parent's insurance until 27, eliminates Medicare copays for preventive visits, prohibits insurance companies from rescinding policies due to coverage limits etc.

The GOP would be stuck campaigning to repeal PARTS of the legislation. Wow, that hurts.

Posted by: kingfish247 | January 22, 2010 5:17 PM | Report abuse

To jlk7e:

First of all, I'm a 50yo lifelong Democrat so if that qualifies me as a "right winger" that would be news to me. It's certainly the first time anyone has called me that. Second, your response is exactly what I'm complaining about - everyone talking past each other. I don't think "health care reform" is unconstitutional, I'm just saying that the left is proceeding as if this were some kind of basic human right, which I submit it is not. We may choose to extend our collective generosity towards helping out the less fortunate, but don't pretend that there's any kind of obligation to do so, especially if it means we run deficits indefinately and bankrupt the country. Third, there's "health care reform" that reforms the practices of the industry, and there's an expansion of the welfare net that provides health care insurance to those who don't have it at no (or little) cost to them. Those are two very different legislative exercises, and reasonable people can be for one and against the other. But you sound like Dionne, who wants to ram both down the throats of the electorate when there's obviously an appitite for the former and not the latter.

Half a loaf is better than none. We don't have the money for free health care. Deal with it.

Posted by: fltacks | January 22, 2010 5:18 PM | Report abuse

@fltacks - okay, I apologize for misconstruing your political philosophy. Your post still has nothing to do with Dionne's, and could have been written at any time in the last year.

Posted by: jlk7e | January 22, 2010 5:22 PM | Report abuse

kingfish247 hit the nail on the head. All of the right wing yappers that have posted on this thread miss the point (they are partisans). The dems have already voted on this legislation and passed it. Any backtracking now to satisfy the "will of the people" whatever that is will be pointless. And you think John Kerry was charactorized as a flip flopper in 2004--you haven't seen anything yet.

The revolution in the street arguments are a bunch of crap. Once the bill is approved you move on to jobs and banking regulation. The HCR bill changes affect 10% of the insured population (people in small groups and in individual plans). Once people realize that the death panels, losing your health insurance arguments are garbage, we can deal with the serious economic issues which are the primary reasons why dems lost in VA, NJ and MA (besides crappy candidates).

Posted by: joe_potosky | January 22, 2010 5:23 PM | Report abuse

Mr. Dionne, I have a difficult time believing that anything will be accomplished. I feel as though democrats have simply folded, they said so I take them at their word. I feel like I vote for republicans give them an overwhelming majority and what happens we still get republicans.

Posted by: teresa_mccarthy | January 22, 2010 5:24 PM | Report abuse

I have to say fltacks is absolutely correct, just worded a little inartfully. I would argue that as a humane society, everyone should be afforded the right to access care and to not go bankrupt if they need care.

What is destroying this debate is that the solutions that the house and senate to a large extent rely on subsidies for low and moderate income people to buy up coverage from insurance companies. That is insane.

Where all of the parties screwed up in this debate--dems, republicans (who sat out the conversation), and the pres is that no one seriously looked at how to control costs now.

In the current environment you have three parties to a healthcare transaction, the people with the money, the providers delivering the care and the consumer accessing the care. Until we get a control over that equation (ie high deductible arrangements and staff model delivery system) none of this will solve our problems.

Of course this means dealing with the AMA--and admitting to the American people that you can't go to any doctor you want to at any time for any reason---because the economics will force them to choose a less expensive provider.

Posted by: joe_potosky | January 22, 2010 5:35 PM | Report abuse

This is growing more and more insane by the day. Now we have opinion columnists opining on the best tactical approaches to pass a bill that the American public doesn't want. Dionne has just elevated tone deafness to high art. Not passing a bill would be political suicide, but passing one using legislative maneuvers designed solely to get around Scott Brown wouldn't be?

Furthermore, reconciliation would take weeks and weeks to pull of, and Judd Gregg in an interview has already stated that the Republicans will do whatever they can to make it proceed at a glacial pace. That will really work wonders for the bill.

Posted by: Bob65 | January 22, 2010 5:36 PM | Report abuse

2009 dems had all the power to pass whatever they wanted but because of special interests could not get anything done. 2010 - they still have a chance to get something done if they can keep special interests at bay and concentrate on parts of bill that will help people.

This is a good opportunity for house members to clean up the special deals in senate bill, let go controvertial issues and pass the bill.

Posted by: alpha7 | January 22, 2010 5:45 PM | Report abuse

To build on joe potosky's comments, the problem is that in 15 years if health care continues to go up at twice the rate of inflation, health care (i.e. Medicaid/Medicare) will consume absolutely EVERY tax dollar we collect. That means no social security, no Army/Navy/Air Force/Marines, no education funding, no unemployment benefits, no National Park system, no regulatory agency funding, etc. I happen to be for all these things, so I want to see health care spending be brought under control so we CAN have all these things.

Posted by: fltacks | January 22, 2010 5:47 PM | Report abuse

"So, basically, Dionne posts a very interesting piece of news - a story about possible steps the congressional leadership is taking to get a health care bill passed.

Washington Post readers commenting so far:

1) Right winger who hates health care reform

2) Right winger who thinks health care reform is unconstitutional

3) Holier-than-thou left winger who thinks the bill is "not true health care reform"

4) Somebody who hates the filibuster.

Good job, guys! Way to stay on point."

Hey, you forget to add:

5)Pompous, holier-than-thou know it all(that would be you).

Posted by: Bob65 | January 22, 2010 5:47 PM | Report abuse

There was a good reason why Obama pressed for early action (ie a signed bill prior to the end of 2009). Unfortunately, the Democrats lacked (and still lack) the sort of discipline that the Republicans in Congress have demonstrated. So we get a VERY messy process and a seriously flawed bill from both houses of Congress. Voters (even in MA) watched the 'process' with increasing revulsion and demonstrated their ire in all of the elections (November 2009 and January 2010).

So no, I don't expect a Health Care bill to pass (and pass and reconcile won't work since both bills are so seriously flawed that the voters would punish the Democrats big time in November).

The thing is, notwithstanding the words from some Republicans about the need for health care reform, given the success of their current tactics (just vote no), there will be nothing passed.

A good point was made earlier, with health care costing 1/6 of our current GDP and rising quickly, while fixing health care insurance is really important, addressing the overall cost of the health care 'system' in this country is an even higher priority, and quite frankly, the bills passed by the Senate and the House really do not do anything about that at all.

If there is no effort to control costs (and the Republicans are REALLY against efforts to reduce the revenue for any business), then any health care bill that gets passed would be DOA anyway.

I'd love to see a good health care bill, but watching the Senate and House make the messes they have really turned me off.

Posted by: Barry8 | January 22, 2010 6:00 PM | Report abuse

Maybe the Democrats should solve the health-care problem by involving republicans in the process and focusing on solutions to Americans health care problems, instead of "THEIR" health care problems, as outlined in the above article.

Submit a bill to congress opening up the "exchanges" to all Americans, then submit a seperate bill mandating Insurance for all Americans, and etc... Let our elected officials vote on single portions of the solution...instead of this "take-it-or-leave-it" crap they've been pulling.

Maybe then Americans can have some real relief from high Insurance prices, and all of us can stop calling each other names on a Washingtonpost chatboard.

BTW, the bill that the Senate passed was worthless and it was nothing but a tax on ALL Americans to redistribute wealth to Insurance, Pharmacueticals, and the AMA...Team Obama bought them off just like he bought off Louisiana, Nebraska, and the Unions...using various penalties and procedural tricks. If you don't believe me then look up what Howard Dean has to say about this bill.

Posted by: wlpuck | January 22, 2010 6:11 PM | Report abuse

This is clearly a balloon - question is just at whose behest. (I think it's a pretty good one, and hope it works.)

Posted by: mahmad1 | January 22, 2010 6:14 PM | Report abuse

There was some effort to involve Republicans in the process in the Senate -- seems that only made things worse. Heck, with Nelson and Lieberman in the process there already were a couple of Republicans.

I guess my sense is that 'bipartisan' support only seems to be an argument when there is a Republican president and a Democratic Congress.

It really seems that with the current Congress, given that Republicans are very well disciplined to just vote no (even when they have 'Republicanized' legislation in committee), involving Republicans is likely a non starter.

That being said, I agree that the bills that were passed required such mangling that even though they provided to extend health care coverage to the majority of folks currently without coverage (and no, going to the emergency room is not coverage), the payoffs to insurance companies, big Pharma, wealthy unions and state specific interests, without doing anything to deal with the cost side of the equation, made those bills quite bad indeed.

Posted by: Barry8 | January 22, 2010 6:47 PM | Report abuse

Somebody put a hallucinogen in the WaPo water, King, Pearlstein and now Dionne are delusional.

A Republican won Ted Kennedy's seat largely as a result of his opposition to this health care reform legislation.

Just let that sink in. Most of the members of Congress must face the voters in November. They have no stomach to ram something through now. In fact, most of them wish the entire issue would go away.

It's dead. It's really, really dead.

Posted by: edbyronadams | January 22, 2010 7:21 PM | Report abuse

Democrats are cowards. This health bill the Senate passed was end-all-be-all. The world would go up like the Hindenburg if the bill didn't get passed and signed by the President. All the House has to do is sign it and send it to the President. Get on with it.

But no, sitting House Democrats want to keep their seats. Their perks, their privilege. And the heck with their electorate that sent them up there to deal with health care. If I WAS a Democrat, if I DID want health care reform, I'd be very disturbed that House Democrats refuse to send this thing through after two years wasted wrangling over the issue. Democrats are abject cowards, corrupt mutts. Dogs, no better. The surrender over this freak, Scott Brown being elected to Ted's seat in the Senate is reprehensible. And, again, the House Democrats wear it. San Fran Nan is the leading coward. They make me want to vomit. Have a nice plane ride home to San Fran, Nann. You miserable corrupt cow.

Posted by: JamesChristian | January 22, 2010 7:36 PM | Report abuse

Speaker Pelosi: CRE Loans will end the unemployment problem within 2 months....Glass mfg, electricians, truckers, STEEL, Aluminum, plumbers, office equipment, architects, construction workers, concrete industry--will all be working immediately....in Los Angeles alone there are 140 entitled CRE jobs with 70 or more units.....Credibility will be restored and responsible Health Care Reform will be accepted with honesty and transparency. (The Banks are now unfettered to make Prudent Loans & there are thousands of pristine Projects out there Nancy.)

Posted by: MSFT-PELOSI | January 22, 2010 7:54 PM | Report abuse

It's a great idea, and I am sick and tired of hearing loud-mouthed losers opine that "the American public doesn't want healthcare reform." They are wrong. What Americans want is to see the Democrats grow a spine and kick some butt while passing the legislation that the country needs. Stop pussyfooting around, Democrats in Congress, and do what the majority elected you to do: fix the country that your Republican colleagues broke.

Posted by: bertram2 | January 22, 2010 7:57 PM | Report abuse

EJ,
Please drop all the pretense and quit referring to "the Democrats" as some distant group. Please refer to them as "us" or "we" since you have, long ago, ceased being objective.

Example, instead of writing "How the Democrats may solve their health-care problem" you should have your headline writer "How we can solve our health-care problem".

Get the point?

Posted by: mcguirebj | January 22, 2010 8:11 PM | Report abuse

"whether in addition to "life, liberty and the pursuit of happiness" man's inalienable rights as expressed in the Constitution include a right to the goods and services of others (i.e. health care)."

Okay, I'm gonna go easy on you, but you are aware that forty-five thousand Americans *die* *every single year* directly due to a lack of health insurance?

That's pretty much life right there (and, as Republicans are so fond of reminding us during terrorism debates, you can't have liberty or pursue happiness if you don't have life).

I'm astounded at how many Republicans seem willing to let tens of thousands of Americans die. Every single year. Because that's what opposing health insurance reform boils down to.

Posted by: gregM2 | January 22, 2010 8:53 PM | Report abuse

Go ahead Dionne and the Dems! Ram through health care using a parliamentary trick.

Then see how many of those same Dems hold their seat after the November election

Face it, the majority of Americans, including rabid liberals from MA, don't want this corrupt, pork laden, stinking mess.

Posted by: krankyman | January 22, 2010 9:10 PM | Report abuse

Reply to comment by fitacks:

"This will force us health care consumers to shop around for services and bring a market mechinism to health care delivery."

Nonsense.

You don't shop around for health care when you're having a heart attack. And you don't shop around for health care when a cervical disc suddenly ruptures and compresses your spinal cord, as happened to me in 2008. One day after my disc ruptured, a neurosurgeon had to do an emergency operation to relieve the pressure on my spinal cord. Believe me, I was in no condition to "shop around" for health care services.

You may not remember it, but HMOs and Managed Care were introduced as market mechanisms to control health care costs.

The result? Health care costs increased at an even higher rate.

The most cost-effective deliverer of health care services and the system with the lowest yearly cost increases, is Medicare. Following your logic, Medicare should then be extended to all - and we'll all save money.

Posted by: posterchild90 | January 22, 2010 9:10 PM | Report abuse

Here's a plan that will work.

1. Military coup. Send Congress home -- all of them. Close the courts. Keep Obama as figurehead President -- a ceremonial rubber stamp for the ruling junta.

2. All unemployed persons must join military or be executed. Result: zero unemployment.

3. VA absorbs the entire health care system over a decade or so, by the end of which well over half of the population will be veterans.

Posted by: mnjam | January 22, 2010 9:10 PM | Report abuse

This guy is like an obnoxious used car salesman who won't take no for an answer. Give it up, EJ; no one wants this hopeless clunker.

Posted by: liam358 | January 22, 2010 9:33 PM | Report abuse

Look, all we want is lower health care costs.

The best and possibly ONLY way to accomplish that is to have a public option.

Anything else is not true reform. Sure, some of the stuff in the House and Senate bills are nice, and better than nothing on their own, but they are not worth the price with the way they are currently packaged.

The "people" (and by people I mean those who voted in Mass on Tuesday, which is a TINY part of the American public) said, according to polls, they want MORE in the health reform bill, NOT less! The worst thing Dems could do now is to NOT listed to these voters. DO NOT GIVE UP.

That said, special interests (i.e. lobbyists for Cigna, Aetna, etc.) will not allow a public option. Ever.

And Republicans will not allow Dems to pass a bill that would give them any glory, even if blocking the bill leaves millions without health care. That's just politics baby. Dems would probably act the same way towards Repubs.

Let's just get used to it and try to get some of the good parts from the bills passed separately on their own through reconciliation.

The best part about Tuesday's election --(other than proving Fox News WRONG yet again when they said a Brown victory would be good for the stock market... unless you consider a 500 point drop since Tuesday night "good")-- is that health reform can no longer be held hostage by the likes of Lieberman, Nelson, Snow, etc.

Posted by: jgarrisn | January 22, 2010 9:56 PM | Report abuse

Shouldnt have tried to pass a bill with mandates and no public option and national exchange. the key centerpiece of the bill is bad policy and when combined with the subsidies its bad fiscally as well (mandates and subsidies without cost control is fiscal suicide).

they should just pass a bill without mandates or subsidies. good policy can overcome bad politics. good politics cannot overcome bad policy.

Posted by: PindarPushkin | January 22, 2010 10:04 PM | Report abuse

It would seem that the dems can ask the republican leadership to submit its basic points for health care reform. Then the dems submit their basic plan. NOT A 2000 PAGE document, but the basic points,i.e. portablity,no preexisting limitations,etc. Then post both online and ask for comments from voters.This should clear the air of B.S. When our republic was established, there were very limited communications. Not so today. The president can set out in simple terms his plan so folks will understand. Problem with Washington, too damn many lobbists cooking legislation for too many incompetent pols.

Posted by: tlrasnic | January 22, 2010 10:05 PM | Report abuse

EJ, you spend all your time on spin and cheer leading. I suspect that a couple bright grad students could write a computer program to produce you analysis based upon WaPo headlines from the prior day. For all I know they already have. Try writing something informative or humorous.

Posted by: ericnestor | January 22, 2010 10:13 PM | Report abuse

I may be the only commenter old enough to remember George McGovern. EJ Dionne is old enough to remember. But does he?

The main thing about McGovern and his acolytes was that purity was everything. Losing was not a problem but a badge of honor as long as you had refused to compromise. McGovern was not a half-a-loaf kind of guy.

More and more Dionne and Ezra Klein and the lineup at MSNBC remind me of the McGovernites. There is the same ostentatious sense of moral superiority. There is the same passionate disdain for those who don't agree with them. There is the same frisson of self-satisfaction as they drive eagerly off the cliff.

None of the tactics that Dionne describes here can work. The ignorance about the "reconciliation" option -- how it works and what can be done with it -- is embarrassing. But none of this really matters to the purists. They are a little like Joan of Arc in this. It's being seen in the holy armor, not winning the battle, that counts.

Posted by: miglefitz | January 22, 2010 10:27 PM | Report abuse

The Democrats should do what they should have done in the first place.....pass a robust public option while taking away the monopoly...errr..."antitrust" powers of the private insurance companies.

If the Republicans had 59 votes, and wanted a piece of legislation passed, they would. Heck, they DID!.

This is all about re-electing Democratic Party do nothing Senators , not helping the public.

So why should I contribute to these guys who couldn't extinguish a match with a fire hose?

Posted by: busdrivermike | January 22, 2010 10:30 PM | Report abuse

At the end of your article you said you are for health care reformj. So am I. But, after the reform I don't want the government running it. The government should promote free enterprise and restict it when the government can attain a majority consensus.

Posted by: aradki | January 22, 2010 10:31 PM | Report abuse

Dionne, as do many others, seems more concerned about the political fortunes of the Democratic Party...than he does about health care reform that meets the needs of the people.

Posted by: Independ | January 22, 2010 10:49 PM | Report abuse


There are also some House Democrats from moderate-to-conservative districts who are wary, after Massachusetts, of voting for a health-care bill, period.

Any member of congress who thinks his own job security is more important than 40,000 American lives a year... doesn't deserve his job.

To quote SNL in a different context: "Grow a pair. And if you can't, I'll lend you mind."

Posted by: wendynyc1 | January 22, 2010 11:14 PM | Report abuse

Dionne, like most Progressives, is so emotionally engaged with Health Care Reform, that he is not thinking clearly. The House vote just barely passed the first time. A good number of Democratic moderates from conservative-leaning districts are going to run for the hills in the next vote (whether YOU like it or not - that's politics). A successful vote in the House is impossible this year.

But Pelosi won't tell you that. Her constituency is the Progressive Caucus. She has to do everything she can to push their Progressive cause even though this effort will ultimately go down in flames. She knows this. But she is doing this to retain their support for her Speakership in the next Congress. Now, she is simply campaigning for herself, nothing more.

Posted by: Terry21 | January 22, 2010 11:56 PM | Report abuse

Wow! The psyops in the comments section is in full bore. I bet Woodward is just laughing his butt off at how effective this stuff is.

Posted by: weekendclimber | January 23, 2010 1:05 AM | Report abuse

I love reading all the comments about how this plan would be a "government takeover" or lead to "government control." On what planet? Unlike the supremely popular and successful Medicare program, which for the record is a single payer system, this bill would do little more than regulate and expand the private market. That's not even remotely close to a takeover. Will the doctors work fort he government? No. The hospitals? No. The pharmacies? No. The labs and technicians? No. Big Pharma? No. How can you take something over, or more to the point socialize it, if you don't take over the means of produciton? Quite obviously you cannot.

And please don't start talking to me about the "size" of the bill. Over the next ten years this bill would cost roughly $90 billion per year. In that same time the nation will spend roughly $2 trillion per year on health care. The sums involved in the bill thus represent less than 5% of the total amount spent by tthe coutnry on health care. How can anyone possibly think that 5% of a total is a "takeover?"

As for socialized medicine, I cannot help but wonder why the right wing doesn't demand the dismantling of the VHA and TRICARE. That's truly socialized medicine - the docs are even on the government payroll! I mean - the horror! To be a solider and treated by a doctor who, like you, works for the government?!? Its as if the US Army has become a Communist front! When will the madness end?

Finally, as for the Tea Party people and their incessant talk of the will of the majority. The majority of people in this country voted for Obama in 2008. The voted to hand Democrats a majority in both houses of Congress. By their own logic, this means that the Democrats should be able to enact their agenda, and that the Tea Partiers should be focusing their anger on the ways the minority party are obstructing them. Elections have consequences, right? Or do they only count when the ratify your personal positions?

Posted by: awhalen71 | January 23, 2010 1:41 AM | Report abuse

Mr. Dionne, you need a vacation.
There has clearly been a failure of leadership in developing legislation that can achieve consensus, even among Democrats. This is because these are poorly-drafted bills that do not address the real problems, nor present viable solutions that the majority of Americans will accept.
The contorted procedures you propose sound like embezzlement schemes worthy of Bernie Madoff.
If the bills were good, none of this would be required.
Good legislation would find consensus and support from the American people. These bills do not.
Passing "health care reform" that is not "health care reform" for the sake of being able to say that you passed "health care reform," is downright stupid.
It's time to throw in the towel.

Posted by: parkbench | January 23, 2010 2:32 AM | Report abuse

"Nonetheless, for those (and I’m one of them) who believe in health-care reform -- and who think the Democrats would be committing suicide if they gave up on health care now -- it’s heartening to hear that serious people are making serious efforts to get a health bill through."

This is everything that is wrong with our media, our politics, and our system as a whole.

Some of us don't care about the Democratic Party as much as we do about the American people. Some of us don't believe putting a 'mission accomplished' banner up is worth forcing us all to pay huge subsidies to the very same corporations that have helped put us in this situation to begin with. The same corporations who, I'm sure, would love to put all that extra money into lobbying and giving money to senators now that the supreme court has decided coporations are people, in its infinite idiocy.

I'm an independent (non-affiliated) voter who generally leans left, but I will not vote for the hypocrites in the Democratic Party.

Posted by: privacy3 | January 23, 2010 3:10 AM | Report abuse

Mr. Dionne: You are truly frightening. Written and apparently "thought-out" by you, implies that you have no respect for the American people. Just like the Dems who passed their separate versions of Health-Care/Taxpayer Disasters with a House bill, then a Senate bill, both of which are monstrosities of rapacious behavior by zealots in Congress with "D" next to their names. And you want the House Dems to basically "give the finger" to the people and pass the pathetically frightening Senate bill? It would absolutely destroy the insurance companies. You know that, right? How could they survive with having to insure everyone who pays the small penalty until a major illness ensues, then the insurance has to accept them when they need expensive coverage, and the govt will mandate that the insurance cos cannot raise their rates to make-up for the ridiculous adverse selection that will ensue. You agree with that EJ? That the federal govt CAN do that to our companies? Crush them by fiat? You are truly a Marxist, if you believe that. At least 53% of Mass voters are awake to the damaging war that the Dems in Congress in DC are waging against us. Yes, that's right EJ. And apparently you are still on the wrong side of history. Why don't you just move to Cuba?

Posted by: sbourg55 | January 23, 2010 4:04 AM | Report abuse

E.J. What is interesting about your post is that it affords the liberals in the democratic caucus to get precisely what they want!

The House drafts a reconciliation bill that allows for a public option, medicare buy-in for those 50-65, etc. and passes it. The Senate takes it up and passes it with a simple 51 vote majority, and then the House passes the Senate Bill and sends both Bills to Obama's desk.

This is promising. As you say though, it's contingent on Obama making the case more forcefully. I get the sense that Obama has sort of washed his hands of HCR and is focusing on populist issues to strengthen the democratic brand before the mid-terms. The next several days will tell us all we need to know.

Posted by: ChrisNBama | January 23, 2010 7:06 AM | Report abuse

Theere is a bill that has passed the house and the senate. Conference can pare it down to what they think is passable. If democrats throw away the most significant legislation in fifty years at the five yard line just because they got a bloody nose in Massachusetts the spineless cowards deserve to lose every seat they have. It's called leadership morons. If we get this thing passed it will be the republicans who whine for the next twenty years about how they really are not against health care the same way they whine now about how they are not really against social security and medicare even though they fought it every bit as bitterly as they now fight healtth care.

Posted by: orange3 | January 23, 2010 8:33 AM | Report abuse

EJ, clueless as usual. See if he'd be so "tough" with his own job. Feckless, partisan hack = EJ DIonne

Posted by: subframer | January 23, 2010 9:37 AM | Report abuse

Mr. Dionne:

You can't be serious. Use parliamentary tricks to pass sham health care reform? Do really think we are so stupid as to not be able to tell the difference between real reform and these stupid monstrosities that the bought-and-paid-for hacks in the House and Senate have delivered. You STILL don't get it.

Posted by: pmaguire1 | January 23, 2010 9:58 AM | Report abuse

pmaguire1:
You can't be serious. Use parliamentary tricks to pass sham health care reform?
-----------------------------------------------------------------

What is a fillibuster if not a parliamentary trick to block health care reform?

The Democrats have a solid majority in both houses. We have a representative democracy, it is time for our Democratic representatives to use every tool at their disposal to do what they believe is best for the country.

Posted by: HuckFinn | January 23, 2010 10:25 AM | Report abuse

I give up. It's back to dog-eat-dog and I've got mine, the heck with you. No point expecting a sense of community and shared interest or even compassion from my countrymen. Sick people will lose their jobs because they can't work, lose their insurance and their homes, and then fall into abject poverty and die. In a few years we'll be opening paupers' graveyards and there will be the same posters here declaring that there is no constituional right to a free burial plot. No Congress and no president can govern a people who have lost compassion for the sick.

Posted by: cavecraw | January 23, 2010 10:58 AM | Report abuse

This republican ruling will hand over the Govrment to Foreign corporations....How will Americans feel when the govrment is controled by the appointees of the Saudi's and the Iranians corporations? Shameless fools all those Scotus guys!

Posted by: jetlone | January 23, 2010 11:28 AM | Report abuse

A brilliant tactic! Do it, Dems... Fast!

==========================================
The House would pass a version of the reconciliation bill containing the various amendments and send it to the Senate. The Senate would change it slightly (in ways that the House agreed to), which would require the House to vote on it again. Only after it got the revised reconciliation bill would the House take up the Senate bill.
==========================================

Posted by: Jimdotz | January 23, 2010 11:34 AM | Report abuse

EJ,

The Democrats should vow to give every man, woman, and child in America a single aspirin, call it Health Care Reform, and then...for G*d's sake, move on.

If they spend all spring and summer debating this losing issue, they can only expect to receive the mother of all electoral punishments this coming November.

On the other hand, the Republicans are probably cheering at the prospects of a lengthy and robust series of Health Care debates in the coming months.

Posted by: pgould1 | January 23, 2010 11:40 AM | Report abuse

I'm weighing in late, but I cannot believe the philosophy behind this idea. The House and Senate are to pass a reconciliation bill vitiating the current Senate Bill and then the House is to pass the Senate bill which has already been gutted. A Democrat in Iowa (I assume such exist) is to go before his constituants next fall and say, "Yes, I voted that Nebraska get a sweetheart deal on Medicare that we don't have here in Iowa, but before that vote, I voted that that deal would not happen. It's true that I voted that it would happen after I voted that it wouldn't happen, but, hey, that's Washington. Vote for me! I'm an Iowa square-shooter!"
I don't think so.

Posted by: JSDickey | January 23, 2010 11:54 AM | Report abuse

Your idea to pass health care sound like Jimmy's effort to rescue the embassy hostages in Iran;
so convoluted that a disaster is virtually written into the plan.
Just listen to the voters and included the peoples ideas like tort reform and access across state lines.

Posted by: patrickjd1 | January 23, 2010 12:01 PM | Report abuse

Speaker Pelosi: You have an opportunity NOW to end the Recession by encouraging the Banks to make prudent CRE Loans. The Banks are now unfettered to make Prudent Loans; which in Major Cities there are thousands of Major Projects with Entitlements. CRE produces the greatest number of jobs than any other segment of the Economy. Glass mfg, Steel Industry, truckers, architects, brokers, agents, construction workers, electricians, plumbers, office furniture manufacturers....WE COULD HAVE 6% UNEMPLOYMENT WITHIN 4 MONTHS....THERE ARE 140 SHOVEL READY, ENTITLED, PROJECTS OF 70 OR MORE UNITS ALONE, READY TO GO IN LOS ANGELES. By January 2012, the recession will be over and tenants will FLOOD TO ULTRA-MODERN "green" BUILDINGS.

Posted by: MSFT-PELOSI | January 23, 2010 1:42 PM | Report abuse

The GOP is saying something along the lines of "But that will look like they are forcing healthcare upon an unwilling electorate"

- This argument is ridiculous. All of these lawmakers are elected by popular vote. Passing a HCR though reconciliation would require a majority in both houses of congresses. If a few "independents" or conservative "democrats" don't want to support it in the Senate, that still leaves at least a majority. Screw the opposition and give us what I voted for.

Posted by: jboogie1 | January 23, 2010 4:53 PM | Report abuse

Yeah! Ram the medical monstrosity down their throats. Those ignorant bumpkins don't know what's good for them.

This is bizarro world politics.

Liberals are out of control.

It's getting really, really scary.

Abort the ObamaNation! Now!

Posted by: battleground51 | January 23, 2010 5:44 PM | Report abuse

Get out of the Washington box, please! The whole country is appalled and angry at this Democratic left wing health care bill mess. Obama and the Democratic congress have been arrogant thinking they know whats best for us. This disgusting, expensive, bribery ridden bill has nothing to do with reducing costs, covering people or addressing the worst problems like malpractice insurance. Medicare was huge, it took time and it was bipartisan. That is what the American public expects.

Posted by: katie6 | January 23, 2010 5:57 PM | Report abuse

E.J. is ignoring the gorilla in the room, and still pretending near-universal health care should pass. Why are some pundits so bent on getting anything through? How does one explain the mood of the citizenry and still believe propping this corpse is in anyone's interest?
Here's the simple truth: If congress were to tackle cost-containment as the primary issue, not universal coverage, they would pass a bill with lots of bipartisan support. But that means abandoning universal coverage as the main goal. Most of us think health care reform's centerpiece is cost-control and view any link to universality as a huge stretch.
One may agree with that take or not, but I assure you if the congress continues to embalm this rotting cadaver November will bring change you'll have to see to believe in.

Posted by: slatt321 | January 23, 2010 6:43 PM | Report abuse

I agree with slatt321 . . . What will it take for the left to get the message? It's not reform that Americans are against it is what kind of reform! Obama doesn't get it either! He thinks we don't really understand what the dems are doing . . . it's not just reform in this bill its the ruin of our economy and a ruse of the constitution!

With Obama and the gang it's give away the farm time! For the last time what universal system of health care is working whether it be in Europe or Massachusetts? Health care goes down costs go way up!!

If health care is a citizen's right then I say home ownership and college degrees are as well. The numbers don't work!

Posted by: reddog19621 | January 23, 2010 7:40 PM | Report abuse

How tone deaf can somebody be? Incredible.

Posted by: tkelso1 | January 24, 2010 9:27 AM | Report abuse

This is an interesting theory, but probably too cumbersome to actually work given that it requires several votes in both houses.
Additionally, is it possible to use the Senate reconciliation process, which is supposed to be used to consider budget matters, to pass a budget bill related to a program that does not even exist yet? According to Dionne's theory at least one reconiliation bill would have to pass the Senate before the House would vote on the Senate's HC bill?

Posted by: AmericanCentrist2010 | January 24, 2010 9:46 AM | Report abuse

Brilliant strategy, E.J.! The Democrats have already lost one state to the health care boondoggle, might as well go for the other 49 in November.

Guess you haven't figured out yet that the health care bill was never really about health care -- it's simply the vehicle for what Obama actually wants to accomplish, the "redistributive change/spread the wealth around/economic justice" crap he learned in college.

See, Obama imagines himself to be a transformational historical figure. He couldn't care less how many Democrat Congressmen he takes over the political cliff with him, because he's more ideologue than politician.

Alas, E.J. naively clings to the notion that health care is really the issue ... and he cluelessly encourages Democrats to grab the president's hand and take the "Thelma and Louise" plunge!

By the way, spare me the "45,000 people die every single year for lack of health insurance" silliness. Let's see ... on one hand, this is the most dire emergency since the earth cooled, but on the other hand, the health care bill wouldn't kick in until 2013.

Gosh, that means either the Democrats are inventing another bogus "crisis" for political gain ... or part of their health care strategy involves sacrificing another 135,000 Americans between now and 2013!

Posted by: UponFurtherReview | January 24, 2010 9:58 AM | Report abuse

Universal health care is dead. Perhaps for another generation. Some of the causes are the Dems' refusal to honestly fund it and their refusal to take a bipartisan approach. There were honest ways to get it done. There are two GOP senators who were obviously receptive (Snowe and Collins), plus another five who are cosponsors of Wyden-Bennett (a proposal that would insure far more people than either the House or Senate bills). But the Dems were so bogged down in doctrine that they destroyed the opportunity. I'm not saying that I have any hope of the coming GOP majority doing any better, but the Dems had a golden opportunity and screwed us.

Posted by: Steve851 | January 24, 2010 9:59 AM | Report abuse

This is for Kingfish247:

"Low information voters"? Is that the current replacement description for calling us ignorant, teabagging conservatives?
Earth to Democrats: You cannot continue to insult the American electorate and expect to win....it won't work. This is one of the biggest reasons why Democrats will lose in November no matter what they do now.
It must just drive you folks crazy that the "unwashed masses" can even vote at all. How long will it be before the elite Democratic leadership determines they need a solution to that problem?

Posted by: dobrien60 | January 24, 2010 9:59 AM | Report abuse

Any bill, like this health care bill, that can be totally upended by just ONE election of just ONE Republican in just ONE state, isn't very good to begin with.

If the health care bill truly had broad appeal, then some Republicans, especially Olympia Snowe, would be hard-pressed to oppose it.

At no time did the liberals in Congress, or Obama, ever try to take into account any of the GOP's concerns. They figured they didn't need to. So they put together a doctrinaire liberal bill that couldn't garner a single Republican vote.

Snowe tried to work with Harry Reid until he shafted her by insisting on a public option, something she couldn't support. So she walked out--but the Blue Dog Dems killed the public option anyway.

Obama should make a final, dramatic appeal for bipartisan support. Towards this end, he should demand strong tort reform and some other reforms that the GOP wants.

Posted by: sinz52 | January 24, 2010 10:05 AM | Report abuse

Rebuplicans/Conservative do NOT oppose healthcare reform. They oppose the Democratic reform which would have government takeover the entire sector, tax the crap out of every American, provide little to no cost reduction and expand the debt beyond belief.....all being achieved by buying the votes of, and making deals with, Insurance, Pharma and Unions. So stop mis-characterizing the issue.

Posted by: dobrien60 | January 24, 2010 10:15 AM | Report abuse

"Problem solved, health-care passes, and we move on" .... to total defeat in November.

Posted by: kbishop1 | January 24, 2010 10:32 AM | Report abuse

Mr. Dionne, your summary states that the whole thing rests on Obamas leadership, which he hasn't shown any yet, on anything. Thats his problem, too busy preening on TV , hasn't authored one sentence , left the heavy lifting for Pelosi and Reid. Why does anyone even call this "Obamacare". He has positioned himself to take credit for passage, and point fingers for failure. Is that leadership?

Posted by: TampaSooner | January 24, 2010 10:43 AM | Report abuse

"Problem solved, health-care passes, and we move on" ... to total defeat in November.

Posted by: kbishop1 | January 24, 2010 11:01 AM | Report abuse

This approach brings to mind a question. How can amendments be passed for a bill that doesn't even exist?

It is great news that all the liberals, the White House, and the Congress can only see in one direction. This is like having blinders on carriage horses. They can only see straight ahead. The problem with that is hazards coming from the side are unseen.

Posted by: 5280sail | January 24, 2010 11:07 AM | Report abuse

The very first thing to do to solve the Democrats' health care problem is to stop listening to the delusional pundits on the left like E. J. Dionne.

Posted by: YanceyWard | January 24, 2010 11:27 AM | Report abuse

I love reading all the comments about how this plan would be a "government takeover" or lead to "government control." On what planet? Unlike the supremely popular and successful Medicare program, which for the record is a single payer system, this bill would do little more than regulate and expand the private market. That's not even remotely close to a takeover. Will the doctors work fort he government? No. The hospitals? No. The pharmacies? No. The labs and technicians? No. Big Pharma? No. How can you take something over, or more to the point socialize it, if you don't take over the means of produciton? Quite obviously you cannot.

And please don't start talking to me about the "size" of the bill. Over the next ten years this bill would cost roughly $90 billion per year. In that same time the nation will spend roughly $2 trillion per year on health care. The sums involved in the bill thus represent less than 5% of the total amount spent by tthe coutnry on health care. How can anyone possibly think that 5% of a total is a "takeover?"

As for socialized medicine, I cannot help but wonder why the right wing doesn't demand the dismantling of the VHA and TRICARE. That's truly socialized medicine - the docs are even on the government payroll! I mean - the horror! To be a solider and treated by a doctor who, like you, works for the government?!? Its as if the US Army has become a Communist front! When will the madness end?

Finally, as for the Tea Party people and their incessant talk of the will of the majority. The majority of people in this country voted for Obama in 2008. The voted to hand Democrats a majority in both houses of Congress. By their own logic, this means that the Democrats should be able to enact their agenda, and that the Tea Partiers should be focusing their anger on the ways the minority party are obstructing them. Elections have consequences, right? Or do they only count when the ratify your personal positions?

Posted by: awhalen71 | January 23, 2010 1:41 AM | Report abuse

Posted by: mnjam | January 24, 2010 11:55 AM | Report abuse

Ya still don't get it. I hope healthcare is the main topic for the next 10 months and O will have successfully (his first two years in office) pissed everyone off and will be a one termer as well he should

Posted by: pinnacle1 | January 24, 2010 12:25 PM | Report abuse

The biggest delusion here is not on he House side, but on the Senate side.

To think that there are 50 senators on the Dem side who are willing to pass this bill now, having seen what happened in Mass., is silly.

The ONLY way to roundup 50 votes is to simply accept a likely loss of the Senate majority in 2010, and allow Senators to retire or otherwise sacrifice themselves by going through this process.

They may do that. They may line up enough nice post-Senate job options or ambassadorships to satisfy 10-15 Senators that retiring or losing their next election isn't the end of the world. And those Senators may allow themselves to be sacrificed at the alter of Health Care Reform.

But I wouldn't bet on it.

Posted by: shipwreckedcrew | January 24, 2010 1:04 PM | Report abuse

Unbelievable ARROGANCE! After MA the Democrats are really working behind closed doors to pass the trillions in corrupt spending? The Lousiana Purchase? The Cornhusker Kickback? The $60 billion union payoff? And E.J. Dionne thinks that would be a good thing. Is there no end to the contempt the Democrats have for American voters? The Democrats realy can't be trusted with power! There really is no other option, but to kick them all out in Nov!!!!

Posted by: valwayne | January 24, 2010 1:26 PM | Report abuse

Super majority in both the House and the Senate, and could agree enough to pass a health care bill. First it was Bush's fault, then the republicans, and now it will be Brown and Mass. voters. Bad liberal governing always seeks to blame someone, anyone, but those liberals who have been in total control. I wonder how long they will be out of office, before they grow up enough to say, "it was our fault".
Dream on E.J., the choice is their's, as they can lose 100-130 by passing some form of health care, or 50-65 by doing nothing.

Posted by: poppy11 | January 24, 2010 1:30 PM | Report abuse

"enacting the Senate bill into law without changes is far preferable to passing nothing"

Progressives keep framing this false choice. Much better for the country would be to pass the half dozen reforms that neither side can safely oppose, and would go a long way to satisfying what us "uneducated morons" most want. You know the list: Protect our insurance when we get sick, give us the same tax breaks that companies enjoy, let us buy insurance from all insurance companies in all states, limit lawsuit abuse, let us own the policies we get through our employers, let individuals join risk pools, and so on. Incremental reform is a better choice than either the monstrosity before congress or no reform at all.

Posted by: rmfischer117 | January 24, 2010 1:33 PM | Report abuse

Wow!
After reading the article and many of the posts, I had to check the corresponding dates.
They're all AFTER the Mass. election.
Is tone deafness the new Ballroom dancing and will it be in the next Olympics?

Posted by: Guamly | January 24, 2010 2:24 PM | Report abuse

Bad advice that may be invaluable to the Republicans if the Democrats take it. E.J. wrote an entire piece of the political scenario for health care legislating without mentioning that it's opposed by the majority of Americans. He and the other extremists on the leftt are willing for the Democrats to take heavy losses so long as they deliver some kind of health reform bill, however flawed.

Posted by: grohlik | January 24, 2010 2:42 PM | Report abuse

This guy seems to think that the problem is that the Dims can't find their way through the procedural requirements to keep those mean old Republicans that have so much power from thwarting the will of the people. Let me try to make it a little less complex for you, E.J., about half of the Dims now realize that if they pass any more of Obama/Pelosi/Reid's left wing agenda, they're going to get their asses handed to them in November. That simple enough for you?

Posted by: Dimslie | January 24, 2010 3:14 PM | Report abuse

The 45,000 American deaths a year due to lack of insurance is BS. And whats worse you know it. Any bill passed by Congress that is 2,000+ pages long is worthy of the distain of the people.

Posted by: devildogdon | January 24, 2010 3:58 PM | Report abuse

Poor EJ, the eternal optimist. He apparently thinks there are readers who still care what he believes in.

Posted by: redmanrt | January 24, 2010 4:05 PM | Report abuse

Ej is delusional. and apprently much farther to the right than even I imagined. siding with house dems over the senate dems? at a certain point people who act like socialists need to stop taking umberage at being pegged as such.

and this cadillac tax was a john mccain idea. it IS the bipartisan compromise and house dems arent even willing to consider it. senate republicans would support it in substantial numbers, if only the democrats made a couple other compromises like tort reform and cutting down the cost of the bill to $500 billion.

I cant imaguine being much more generous with tax-payer funds at a time of declining government revenues.

Posted by: dummypants | January 24, 2010 6:17 PM | Report abuse

Dionne:
You are on the Moon. People want healthcare reform, BUT NOT THIS ONE. The Senators have read the tea leaves (polls, VA race, NJ race, MA race) and there are not 51 votes for Reconciilliation. The only way Democrats can get out of this mess and pass any type of health care reform is walk away from this monstrosity and admit that it is DOA. They should start again, with Republicans and address the following:
1. Tort reform
2. Insurance companies allowed to sell accross state lines.
3. Eliminate tax deduction for ALL health plans (including the union plans) but issue a tax credit for the full amount of the plan. The insurance companies can issue a 1099 for the value of the plan as well as a year end statement indicating that the taxpayer was insured and what they paid for the plan.
4. Anyone who does not want to buy insurance will be required to pay a tax equal to the price of the average plan to compensate for the uninsured. Medicaid will pay for the poor.
5. All health insurance plans should reward healthy behavior. Premiums should be higher for those who smoke, drink too much, use drugs or have a poor diet as well as for those who fail to get annual exams.
6. Eliminate pre-existing condition.
These change will not cost a Trillion $ and they do not create new huge government programs.

Posted by: acahorvath | January 24, 2010 6:44 PM | Report abuse

EJ Dionne...

You certainly "well represent" the Democratic Party. You are a far leftist, you are out of touch with the people, and you simply don't "care" what the people want.

Your arrogance will be your downfall. You say that you are heartened that a few "serious" people are still trying to push healthcare - you ignore and deprecate the many, many, more "serious" people that are greatly opposed to healthcare.

Your blind arrogance, elitism, and disregard for your fellow man is inexcusable - history will push you to the side.

Posted by: wilsan | January 24, 2010 7:24 PM | Report abuse


Obama has NO leadership. The guy is a community organizer from Chicago with ZERO executive experience... that's why this FAILED. You elected "change" when you should have elected a president.

Posted by: dboc_991 | January 25, 2010 12:51 AM | Report abuse

Some interesting comments here, and some typically intemperate and imperious ones.

First, put me with those who think EJ Dionne is completely oblivious as usual. If you see the world through liberal eyes, it may seem like smart politics to twist the Senate bill through the House then rewrite it to the extent possible in reconciliation with a bill that starts in the House and then goes to the Senate but once there they just make changes that the House directs them to make and then it comes back to the House and then the House can have the president sign a Senate bill that not even the Senate could still pass and that the House never liked but the changes are already made in the reconciliation bill but not everything because reconcliation is reserved for tax increases and cuts and spending increases and cuts but only if the increases don't increase the deficit over 5 years or any 10 year period for 50 years or 35 years or I forget which but yeah let's do this and right NOW!

Except any Democrat who's not a blinded true believer in a completely safe district knows that Americans don't want any version of Obamacare. They don't trust that it's simply a removal of pre-existing coverage exclusions, lifting of coverage limits, extension of health insurance for free (or heavily subsidized) to people making up to 3X or 4X the poverty level, guarantee of service-rich, comprehensive care, and prevention of termination of policies when people get sick. Because it *isn't* simply that.

It's a top-heavy, bureaucratic, anti-market monstrosity that does nothing of any substance to address the ONE problem we'd all like addressed: the high and fast-rising cost of healthcare. Mind you, we can all reject the advances in medicine that cost so much. Falling ill and dying remains an option for all those convinced healthcare is just too darned expensive. But at some point, the autocrats and charlatans who drafted these bills need to get a little humility and register this: start over. If you have the courage of action and belief in what you were doing, it shouldn't be too hard to find some palatable measures to pass. My suspicion? They won't do it. Because it was never about incremental fixes to the market distortions in healthcare today. It was about setting the system on a path to government control.

Posted by: Imperfections | January 25, 2010 1:28 AM | Report abuse

Democrats have a history of self-destruction. Now that they have the best opportunity ever to secure the necessary votes to carry out health care reform, they become arrogant and implode. Pelosi and Reid just cannot be trusted to run Congress. Go, for God's sake, go, and let others with the commitment and the ability to carry these reforms through take the lead.

Posted by: mapleleaf3 | January 25, 2010 2:40 AM | Report abuse

Passing the Senate bill may help them not look weak but it will make them look especially craven and tone deaf. We aren't stupid. We know what's in the bill and we don't like it. Mandates without a public option (broken campaign promise) anger independents. The excise tax (broken campaign promise) angers labor (guess who won the labor vote in Mass). Special favors for Nebraska and PhRMA angers everyone. Subsidies without cost controls angers independents. And now there's talk about eliminating one of the only universally popular provisions (pre existing conditions).

Face it, this isnt a problem of optics it's a problem of policy. No matter how sympathetic i might be to the 60 vote difficulty I cannot give them credit for that if they pass a bad bill. What's the campaign slogan, "hey we had to sell you out in order to get 60 votes in the senate and broke our campaign promises in doing that but we did put some money it for consultants to study the problem."

Posted by: PindarPushkin | January 25, 2010 12:37 PM | Report abuse

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