Whatever it takes



What are the odds that today's health care reform summit will end with President Obama and the Republicans locking arms and singing "Kumbaya?" I'd sooner take odds that Lady Gaga will morph into Greta Garbo and become a recluse.

A bipartisan miracle will occur only if the Republicans say, "Hey, guess what, folks. We want to shelve all our philosophical objections to the Democratic plan, and we also think it'd be a great idea to hand the Democrats a political victory that will inspire their liberal base to turn out en masse in the November congressional elections." And the miracle will occur only if Obama and the Democrats say, "We won in 2008, decisively so, after campaigning for health care reform - but so what? We're now prepared to betray our voters and accept Republican ideas that will leave most uninsured Americans out in the cold. We want our voters to stay home in November."

But the summit - or, to be more precise, the "summit" - is not really designed to yield anything fruitful. Obama isn't really trying to find common ground with the Republicans. At this point, why bother? No, Obama's prime task is to stiffen the spines of the tremulous congressional Democrats whose support is essential if health care reform is to be shoved into the end zone on fourth and goal.

Indeed, the Democrats have floated a possible game plan to score on health reform without any Republican assistance at all, a plan that would circumvent the usual Republican roadblocks. (Obama clearly hopes to use today's event to put the Republican naysaying on national display.) The key feature of this plan is the Senate parliamentary tactic known as "reconciliation," which, if employed successfully, would allow the Democrats to do an end run around the usual Republican filibuster threat, and pass a final House-Senate health reform bill with only 51 Senate votes.

Reconciliation can be used to pass bills that have a budgetary impact. Health reform has a budgetary impact. Democrats have already passed health reform bills in both chambers; reconciliation can be used to resolve the differences, which are mainly fiscal in nature. In a reconciliation showdown vote, Senate Democrats can lose as many as nine of their caucus members, and still get the magic 51 if Joe Biden is called upon to cast the tie-breaker.

The reconciliation tactic has long been available, of course, but Senate Democratic leaders have been averse to using it - in part because, being typical Democrats, they were afraid that if they did use it, somebody somewhere might get mad. With the clock running out on health reform, however, they now seem to understand that there are times when it's important to do whatever it takes to win. (This is a credo that Republicans implicitly understand. More on that in a moment.) So we now have people like Evan Bayh, the lame-duck Indiana Democratic senator, grudgingly conceding that reconciliation at this point is the only way to go; in his words this week, "Obviously, if the minority is just frustrating the process, that argues for taking steps to get the public's business done."

What's priceless, of course, are the Republican complaints about how this "unprecedented" reconciliation strategy would destroy the Senate forever and ever. Former Bush speechwriter Michael Gerson calls the potential Democratic game plan an "insult," and warns that "the minority would not only be defeated on health reform, but its rights would be permanently diminished." Senator Lindsey Graham says that using reconciliation to pass health reform would trigger "the end of the minority rights in the Senate as we know it...the loss of the United States Senate as a real viable institution." Senator Lamar Alexander calls reconciliation "the ultimate trick," and he claimed at the summit this morning that if reconciliation was used to pass health care reform ("jamming it through in a partisan way"), that would constitute "the tyranny of the majority."

OK, I'm just wondering: How come the Republicans consider this tactic to be such an outrage when Democrats contemplate using it...yet they thought this tactic was just dandy in the past when they used it? In fact, they used it repeatedly when they controlled the Senate. On all kinds of major legislation. Including health care.

On 22 occasions since 1974 (when the Senate tactic was first used), reconciliation bills have passed the chamber. Senate GOP majorities authored 16 of them. That puts the Republican slugging percentage at .727. They used reconciliation to pass George W. Bush's tax cuts, for instance. Senator Charles Grassley defended that move as necessary, given Democratic opposition in the chamber; in his words, the reconciliation tactic was "the way it will have to be done in order to get it done at all." That's also how the Senate Republicans passed Ronald Reagan's tax cuts in 1981. The ruling Senate Republicans also used the tactic to pass welfare reform in 1996. They tried using the tactic in 2003, when they sought to open the Alaskan Wildlife Refuge to oil drilling (failing only because they couldn't muster the necessary 51 votes for passage.)

But, most germane to the current debate, the Republicans used the tactic during the '80s to open Medicare to the HMOs. They used it to create the COBRA program, which allows laid-off Americans to keep their health coverage. They used it to overhaul the doctor payment system for Medicare, and to increase the oversight of nursing homes that take Medicare and Medicaid patients.

That's just a sampling. All told, as Washington health policy expert Sara Rosenbaum told NPR the other day, "the way in which virtually all of health reform, with very, very limited exceptions, has happened over the past 30 years has been the reconciliation process...We've changed access to health care all across the United States all as a result of reconciliation." She should know, because she helped write some of those health provisions.

So why are the Republicans whining now? Because they know the tactic is legit, and they know that it works. They just don't like having it used against them. If the Democrats can use reconciliation to actually help most of the roughly 40 million uninsured, that messes with the GOP game plan.

But Republicans need not necessarily despair. There's no guarantee that swing-district House Democratic congressmen will cast final Yes votes in that chamber, nor that the Senate Democrats will muster even the bare majority. And at the summit this morning, we had Senate Democratic leader Harry Reid saying this: "No one has talked about reconciliation." Huh? What?

Bottom line: I think I speak for most Americans when I say that, at this point, after a long year of speeches and summits and confabs and hearings and votes on health care reform, regardless of which side wins or loses...Just. Wrap. It. Up.


Al Haig is still dead, but if you want my short version, here it is.