Democrats dig in for last stand

Democrats took heat over the “Louisiana Purchase,” and ultimately disavowed the “Cornhusker Kickback.” Now, they are racing to keep Republicans from defining the only legislative tool left to salvage the health care reform bill as yet another tactic hatched in a Democratic back room. During a year in which “deal” is a dirty word, Democratic congressional leaders are already waging a battle to defend reconciliation and beat back Republican charges that the fast-track rules are an abuse of power.

Democrats, including President Barack Obama, like to say Americans care more about the shape of a final bill than the way it was passed. But the Senate health care bill has suffered, in part, because of a voter backlash over the tactics Democrats employed to secure 60 votes in the Senate.

Republicans are craving a repeat. “I’ll tell you one thing, if Speaker Pelosi rams this bill through the House using a reconciliation process, they will lose their majority in Congress in November,” House Minority Whip Eric Cantor (R-Va.) said on NBC’s “Meet the Press.”

The battle lines crystallized over the past week. From Thursday’s White House health care summit to the Sunday talk shows, Republicans have blasted reconciliation as everything from “cataclysmic” to a “trick” to push the bill through Congress.

Democrats, in turn, argued Republicans have no grounds to criticize, accusing them of rank hypocrisy given their frequent embrace of the tactic during the past 30 years, when they passed several major bills using the threshold of a 51-vote Senate majority, not the usual 60.

In a rhetorical shift, Democrats have begun avoiding the word “reconciliation,” in favor of “simple majority.” “Health care reform has already passed both the House and the Senate with not only a majority in the Senate but a supermajority,” White House health care czar Nancy-Ann DeParle said on NBC’s “Meet the Press.” “And we’re not talking about changing any rules here. All the president’s talking about is: Do we need to address this problem, and does it make sense to have a simple, up-or-down vote on whether or not we want to fix these problems.”

Since 1980, Republican presidents have signed 14 of the 19 reconciliation bills into law, including two tax cuts in the George W. Bush administration that did not reduce the deficit, which the reconciliation rules explicitly require. And it was a Republican Congress that used reconciliation in 1996 to pass a sweeping overhaul of the welfare reform system, proposed by Democratic President Bill Clinton. “The criticism of us is absolutely duplicitous,” said Ron Pollack, executive director of Families USA, a leading proponent of health reform. “It is chutzpah. How can those who have championed the use of reconciliation, and far more frequently, how can they come and criticize us?”

There is truth in the Democratic and Republican arguments, said Marty Gold, an expert on Senate procedure who served three members, including former Majority Leader Bill Frist (R-Tenn.). “To a degree both sides are correct,” Gold said. Republicans have used the tool frequently and for far more than just minor fiscal adjustments. But Gold believes the reason Democrats will deploy the strategy is blatantly political — in “express defiance of an election outcome” — and would set a negative precedent in the Senate. If Democrats succeed, reconciliation will be used more often as a default mechanism to pass legislation, making the Senate more of a majority-rules body than it has traditionally been, Gold said. “This will come around again,” Gold said. “If it’s used in this case and gotten away with, the process will be revisited, and that will cause immense consternation on the other side when it is used in reverse.”

Reconciliation has never drawn quite as much scrutiny. In the 2001 tax cut debate, Democrats, including Sen. Kent Conrad (D-N.D.), objected to reconciliation as an “abuse of the process” that was “trampling on the minority’s rights.” But the tactic never appeared to generate as much buzz as it has with health care reform.

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Democrats will impose Obamacare no matter the cost

By: Hugh Hewitt

President Obama, House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid are embarked on a radical plan to fundamentally change American health care. The operative term is "radical," and the media should use that term in order to accurately convey the nature not just of the scope of the changes being pushed, or of the level of Medicare cuts on which those changes are premised, but also to accurately describe the process by which the radical Democrats propose to impose their vision.

The plan is to push Obamacare through the House on the promise of a subsequent "fix" that will use an arcane Senate procedure known as "reconciliation" to modify the health care legislation in order to bypass the Senate's 60-vote requirement for substantive legislation.

No matter what rhetoric the Democrats employ, this is indeed a radical -- there's that word again -- maneuver, one that will demolish forever the Senate's long-standing tradition of requiring a supermajority to enact sweeping legislation that fundamentally alters an area of complex law. Reconciliation has indeed been used for tax rate changes, which go up and down, and on two occasions for very focused initiatives on welfare reform and continuance of health care coverage.

But reconciliation is a recent and rare exception to the rule of supermajority, and its use here will forever spell the end of the 60-vote requirement for major legislation. If the vast changes contemplated by Obamacare can be pushed through reconciliation, then there is no limiting principle for the future.

Expect both conservatives and liberals to insist that, if the process could be made to fit for Obamacare in 2010, then it surely must be able to accommodate any other fervently hoped for piece of legislation. Thus in the space of 10 years the Senate Democrats will have re-engineered the supermajority tradition of the "Greatest Deliberative Body in the World" into one that is routinely applied to judicial nominees but waived for the most sweeping, most partisan legislative jam-downs.

With the exception of the bipartisan filibuster of President Johnson's ethically compromised pick of Abe Fortas as chief justice of the Supreme Court in 1968, judicial filibusters were unheard of before 2003. Though "blue slips" and "holds" did hobble many nominees in committee or on the floor, these procedures are distinct from the requirement of 60-plus votes to pass new laws. As rare as a judicial filibuster was in the last century, so, too, was the use of reconciliation to avoid the requirement of supermajority in law-making. Senate Democrats have trashed both traditions, and both were done in the service of ideology over basic traditions of governance.

Pelosi's tired talking point about "majority rule" asks the public to dismiss as irrelevant the jettisoning of a long-standing approach to governance that limited the speed with which Congress could act. This has been a virtue of the American republic since "The Federalist Papers" defended the Constitution's original design as one intended to keep factions from moving too quickly to dominate politics for short times of abrupt change.

We are not a majority rule system, and never have been. Government's ability to move quickly was cabined from the start and for the very good reason that sudden swings in law are not often to the advantage of freedom.

If Obamacare does indeed make it into law, the damage it will do to health care will be immense. But just as great a cost will be the injury done to the Senate and to the measured approach to legislation that has marked America as a deliberate and deliberating republic.

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The big bluff?

The Democrats in the Senate and Democrats in the House don't trust each other

President Obama's revised health-care plan is an ambitious attempt to bridge the divisions between two warring camps of Democrats who do not trust each other -- Democrats in the Senate and Democrats in the House. Both factions have passed versions of a health care plan, but neither believes the other can deliver what is necessary for a compromise to become law.

In the House, Speaker Nancy Pelosi only muscled through her more-liberal version -- which included a public-option insurance program -- by 220 to 215 votes last November. Since then, Rep. Robert Wexler of Florida has resigned, Rep. John Murtha of Pennsylvania has died, and Rep. Neil Abercrombie plans to resign next week to run for governor of Hawaii. In addition, Rep. Joseph Cao, the lone Republican to back the bill in November, has said he won't do so again.

That leaves Ms. Pelosi with 216 votes, shy of a majority. She will have to find new "yes" votes from some of the 39 Democrats who declined to support the bill last time as well as hold the votes of nervous Blue Dogs who voted with her and a dozen or so pro-life Democrats led by Rep. Bart Stupak, who demand tougher curbs on federal funding of abortion than President Obama or the Senate want.

Senators have yet to be convinced Ms. Pelosi can pull this off. Privately, Democratic members tell me she doesn't have anywhere near the votes yet. Rep. Heath Shuler, the North Carolina Democrat and former football star who heads the 54-member Blue Dog group, isn't optimistic. "I don't think a comprehensive bill can pass," he told reporters. "I hate to use a football analogy, but first downs are a lot better than throwing the bomb route or the Hail Mary."

In the Senate, Majority Leader Reid is close to lining up 50 Democrats who could join with Vice President Biden in ramming through a bill using parliamentary maneuvers that allow spending legislation to be passed with a simple majority. But those same maneuvers make it extremely difficult to craft a "health care" bill unless the Senate parliamentarian runs roughshod over every precedent. Republicans would also be able to drag out the process by offering hundreds of amendments.

The most likely explanation for what President Obama and his Democratic allies are up to by pressing forward with a bill is the following: 1) They are hoping his "bipartisan" summit meeting this Thursday will somehow be a game-changer and give health-care reform new momentum; 2) Democrats are trying to show unions and other allies that the Democratic leadership is making a maximum effort on health care before pivoting and blaming GOP obstructionism for its failure.

The best health-care analysts I know say Democrats have perhaps a 15% chance of threading the needle and getting a comprehensive bill signed into law. But even that success could be costly politically if voters came to believe Democrats had ignored the public's feelings and rammed through a bill anyway. The most recent surveys show that 61% of the American people want Democrats to put aside the existing bills and start over.

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An FDR lesson Obama missed

Barack Obama is trying to be the new FDR before the concrete settles around his image as the new Jimmy Carter. History will ultimately decide, but last week's celebrated health care summit made him look more like Mr. Jimmy than FDR.

The president was full of self-righteous talk, mostly about himself, and he twice felt it necessary to remind everyone that he's the president, recalling Richard Nixon's bizarre reassurance that he was not a crook. Some things are self-evident, and if they're not, such things are usually not true. We can stipulate that, like it or not, he's the president.

The Democrats relished the opportunity to portray the Republicans as the wrinkled party of "no," a crabby relic of the 20th century, devoid of anything that anybody could want, and Barack Obama's low-church eloquence would melt skepticism like butter on warm toast. But it didn't happen. Setting out the idea of a plain and simple alternative to Obamacare — smaller measures to reform, taken step by step — the Republicans sounded like the party of common sense, purveyors of the kind of kitchen-table solution that would work a lot better than an elaborate welfare-state scheme.

The health care summit was not the demolition derby the Democrats expected, instead it's a pothole the president and his party will have difficulty climbing out of. The first public-opinion polls this week will measure who won and who lost. But the prospect of a lot of changed minds in the wake of the talkfest is a small prospect.

The president was in his favorite role, the long-winded professor trying hard to be patient with half-bright students who hadn't done their homework. Like most liberals, he suffers from a severe occupational hazard. Anyone who disagrees with him must be dumb, unlettered and redneck crazy. If Lamar Alexander, John McCain and Eric Cantor had only gone to the right Ivy League university they could understand the prescription for what's good for them. It's a fatal mindset that afflicts the cult. Jonathan Chait of New Republic put it plainly in a revealing blog post: "President Obama is so much smarter and a better communicator than members of Congress in either party. The contrast, side by side, is almost ridiculous."

The contrast was so stark that he could only liken the professor's summit seminar to basketball, our least cerebral sport, where oversized men in gaudy underwear run up and down a court to stuff a ball down a hole. The president is "treating [Republicans] really nice, letting his teammates take shots and allowing the other team to try to score. 'Nice try, Timmy, you almost got it in.' But after a couple minutes I want him to just grab the ball and dunk on these clowns already."

No one would have confused FDR — or Harry Truman or Ronald Reagan — with somebody shooting hoops on a schoolyard. Nor would anyone have confused one of those presidents with a professor showing off his mastery of detail and trivia by presiding over a congressional seminar. Mr. Obama should remind himself that he's the president, not a professor.

The president who would be FDR has squandered much of his authority and mystique in pursuit of something the people clearly don't want. The more he pursues it the more the people don't want it. He has yet to understand any of the parts of "no." He is learning too late, if he is learning at all, that too much of a good thing is too much. The powerful hold a president can have on the public is weakened by too much visibility. "The public psychology," FDR once wrote to a friend, "cannot be attuned for long periods of time to a constant repetition of the highest note on the scale."

Mr. Obama's profligate use of the highest note on the scale follows the example of his immediate predecessors, and it may be that the presidential mystique, with its power to accomplish a president's aims, was gravely wounded by the invention of the jet airplane. Air Force One is not only an impressive presidential icon, it makes every congressional district convenient to visit, and presidents are tempted to use it ever more frequently. In his 15 years in the White House, FDR, who preferred trains and was the first president to fly, never got around to visiting all the states.

A visit by a president meant something. Now it's often a hindrance and a distraction. Last week, Mr. Obama should have stood in bed. That may be the ultimate lesson from his great health care summit.

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Health bill critics target Democrats

Advocacy groups that oppose the health care overhaul bill are taking aim at House Democrats who support President Obama's signature policy item, pouring money into television ads attacking vulnerable lawmakers in conservative-leaning districts.

While the bigger players keep their powder dry and await Wednesday's announcement by Mr. Obama on how to proceed, conservative groups such as the 60-Plus Association, an alternative to AARP, is attacking 18 Democrats in their home districts for writing "backroom deals" and is asking them to start over. "It's our job to remind the congressmen who they really serve - the people," said Bob Adams, executive director of the League of American Voters. "Americans believe in second chances. We're offering the congressmen that chance, but we're just getting started."

The League of American Voters is airing ads designed to counterbalance pressure rank-and-file Democrats are facing from their leaders on Capitol Hill. It has ads up in the districts of 11 lawmakers who voted for the bill and plans to hit 19 others.

Over the weekend, the White House and Democrats on Capitol Hill defended using reconciliation, a complicated procedural tool that circumvents the chance for a Republican filibuster, suggesting that's how they'll proceed. But House Speaker Nancy Pelosi said Monday that Mr. Obama's proposal will be "much smaller" than the legislation that previously passed the House and Senate, according to Fox News.

Major players in the previous ad war, including overhaul supporters such as the Pharmaceutical Research and Manufacturers of America (PhRMA) and AARP, are staying quiet for now. AARP pledged to reduce the political pressure on lawmakers with hopes that doing so would allow them to work together. "We promise to make no new statements, send no new letters, run no new ads about health reform, and we are urging all other interest groups to do the same," AARP Chief Executive Officer A. Barry Rand said ahead of last week's bipartisan health summit. "Let's turn down the volume on the outside noise so that our leaders might actually listen," he said. But of course, they won't stay quiet indefinitely. Mr. Rand stressed that failure isn't an option and that AARP will fight to pass health care reform.

Some groups are focusing more on lobbying now than televised campaigns. The National Right to Life Committee is talking with House members about the abortion language in the Senate's health bill. America's Health Insurance Plans is trying to get out its message that health costs are rising not because of insurers, but because of the underlying medical costs.

The Progressive Change Campaign Committee, which supports passing a public insurance plan favored by liberals, is aggressively searching for support of the plan. It has compiled a petition of 30 Democratic senators who support the public option and is airing online ads pressuring other Democrats to sign on.

Wednesday's announcement from Mr. Obama is expected to send the debate in a new direction. A spokesman for one group that has already spent millions on advertising on the reform issue said they're in "limbo" right now, awaiting the formal announcement of the Democrats' plans.

Meanwhile on Monday, billionaire investor Warren Buffett said on CNBC that the Democrats' health bills don't do enough to address rising costs that are hurting business and that he would start over on the effort, a call Republicans had made. "I would try to get a unified effort, say this is a national emergency to do something about this," said Mr. Buffett, who supported Mr. Obama's presidential campaign. "We need the Republicans, we need the Democrats. ... We're just going to focus on costs, and we're not going to dream up 2,000 pages of other things." He said he prefers the Senate bill to the House bill, but favors creating new legislation that does more to lower costs and generates more public support.

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The best and worst health care reform ideas

President Obama wants to work with Republicans on health care reform. "I am going to be starting from scratch," he says, "in the sense that I will be open to any ideas that help promote" controlling health care costs and making health insurance more widely available. As it happens, many of the worst ideas are in the legislation Obama supports. Republicans have embraced some of the best ideas, but also some of the worst.

Best Ideas

Tax reform: The president is right: the tax code inadvertently drives health care costs higher. But the solution is not to a new tax on health insurance that would hit union, older, female, and small-business workers hardest. The solution is to give those workers the largest effective tax cuts by changing the tax code so that workers control the money that employers now use to purchase health coverage – which averages $10,000 per family per year.

Tax credits for health insurance would give workers that $10,000, but only over the long term. That would leave many families in the lurch. Rep. Jeff Flake (R-Ariz.) has introduced legislation to create "large" health savings accounts, which would give workers that money immediately.

Medicare reform: Obama advisor Peter Orszag correctly argues that consumers will eliminate wasteful health care spending if they can keep the savings.

That's why, as Rep. Paul Ryan (R-Wis.) proposes, Congress should give each senior a fixed voucher to purchase their medical care. Poorer and sicker seniors would get larger vouchers. But the key is that seniors would keep whatever money they save. Only then can Congress reduce Medicare spending, as both Republicans and Democrats propose, while protecting seniors from government rationing.

Medicaid reform: President Obama should reform Medicaid the same way President Clinton reformed welfare: by providing each state with a fixed block grant, and the flexibility to target those funds to the truly needy.

Making regulators compete: Each state's health insurance regulators enjoy a monopoly over providing and enforcing consumer protections. Like all monopolies, that creates high-cost, low-quality consumer protections. Indeed, state regulations increase the cost of health insurance by an estimated 15 percent.

Letting individuals and employers purchase insurance regulated by other states would give them regulatory protections they need—and let them avoid unwanted and costly regulations.

Worst Ideas

Expanding Government Programs: The entitlement programs we have are bankrupting the government, crowding out private insurance, increasing costs, and reducing quality. Medicare is the main reason medical practice is dangerously uncoordinated, and why medical errors kill as many as 100,000 Americans each year.

Mandating Insurance Coverage: Forcing Americans to purchase coverage would effectively turn private markets into a government program. In addition to being unconstitutional, an individual mandate would reduce health insurance choices by outlawing economical health plans, just as the Massachusetts mandate has done.

Price controls: Obama advisor Larry Summers says, "Price and exchange controls inevitably create harmful economic distortions. Both the distortions and the economic damage get worse with time."

Democrats nevertheless want to use price controls to cover people with pre-existing conditions, which would perversely lead insurers to avoid and mistreat those patients. Obama advisor David Cutler finds they also reduce choice by eliminating comprehensive insurance plans. The reforms above would do a better job of reducing the problem of pre-existing conditions.

Democrats also want to use price controls to curb Medicare spending. That's merely a veiled form of government rationing.

Federal Med Mal Reform: Republicans want federal law to limit medical malpractice lawsuits. But the Constitution does not give Congress the power to do so.

Setting those rules is a state responsibility. Many states have enacted reforms, and other states are learning from those experiments. A one-size-fits-all federal law could harm patients, preventing them from filing legitimate claims.

If health care reform were simple, we would have done it already. Yet both Democrats and Republicans are making it unnecessarily difficult by pushing reforms that reduce choice and competition. That's not what the doctor ordered.

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