Can Healthcare Go On?


None of the journalists who opposed health care reform quite want to say it's dead--at least, not any of the ones I've talked to.  On the one hand, Democrats are in full panic mode, and they no longer have a filibuster-proof majority.  On the other hand, Democrats have already pushed this far, far past where any of us thought they would be willing to take it.  Yesterday's results show what we all knew:  ramming through an unpopular health care bill on a party-line vote is very politically costly.  But until last night, the entire caucus somehow seemed to have convinced themselves otherwise.  So who wants to say they keep going with their current message to voters . . . which is to say, "Lalalalalalala I have my fingers in my ears!  I can't hear you!"

But still, I can't see any path to passage at this point.  The centrists began bolting so quickly that it's pretty clear they weren't gladly risking their careers for an unpopular bill they deeply wanted to pass--they were voting for it under heavy pressure from the leadership.  Now that the leadership is itself threatened, they can't keep the caucus in line.

Let's look at the three possible paths to a bill:

Rush through a compromise before Brown is seated  Not going to happen.  Brown's margin is too big to delay certification longer than 15 days, which means there is probably not enough time to get a full compromise scored by the CBO and then jump all the procedural hurdles.  Even if there were,Lieberman, Bayh and Webb have already signalled pretty strongly that they will not vote on anything until Brown has been seated; I can only assume that Nelson, Lincoln and Landrieu are even more reluctant.

Have the House pass the Senate bill unchanged  Er . . . maybe, but I don't see how.  Pelosi has already lost one of her votes, Robert Wexler, who quit to become president of a DC think tank.  It looks like at least Bart Stupak, and possibly more members of the pro-life caucus, will refuse to vote for it.  And Louisiana Republican Joseph Cao has already said he won't vote for it again.

That means that Pelosi has to find more votes.  It was widely believed that she had some in reserve, who she allowed to vote no last time.  But if they were allowed to vote no, that means that they needed to vote no.  It's hard to see many people becoming willing to switch now.  Democrats have been pushing the line that "you're already pregnant"--having voted for the thing once, the damage is done.  But for these representatives, that's not true--and the safest place to be seen right now is probably bucking their party. 

Even progressive Anthony Weiner was on television last night, saying this means they need to slow down.

Pass it through budget reconciliation  At this point, the most likely--but not likely.  The math in the Senate gets better--but if they lose just three more people, they can't even do reconciliation.  And I don't see that the math in the House improves, especially since so many vote-buying elements have to be stripped out in order to get the parliamentarian to approve it.

All in all, I think it's dead.  I think we'll get a Medicare expansion later in Obama's term.  But I've been back and forth on this so many times, that I don't know how confident I am in my prediction.

I do have one pretty powerful indicator, though.  The "anti" journalists are quoting represenatives saying no and running numbers.  The progressive journalists are floating theories of how it could happen, and lambasting their side for being panicky, spineless wimps.

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Megan McArdle is a columnist at Bloomberg View and a former senior editor at The Atlantic. Her new book is The Up Side of Down.

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