Health Care Sausage

I am amazed at the number of people objecting to seeing sausage made. No, I don’t mean pork or beef, I mean the US legislative process in regard to the health care bill.

The simple fact is that the bill will upset the status quo. That gets everyone riled up to include a number who really prefer the status quo – either because they have it good or they fear the change. At the same time you’ve got opportunists and egotists all involved in putting their imprint and pet projects into the bill.

Take a deep breath. Calm down. Remember that the careers of some people pretty critical to the process are involved here. (Reid’s re-election is looking to turn on whether he can get this bill through, just to consider one.) Let’s look at the outline of what’s left, ok?

The bill has to meet cloture. That means 60 people have to vote to say “enough”. Now, people have been disliking this for a long time but at the same time they don’t want to destroy the brakes they might need when the other party becomes the majority. Still, this is a Big Issue and Big Issues cause other changes.

If Harry Reid can’t get 60 votes it’s POSSIBLE he’ll make a move to reduce the rule. About 8 years ago this was contemplated and discussed ad nauseum so I’ll just make the magic reference: “Nuclear Option.” Kill the 60 vote rule in simple passing and watch chaos erupt – but the bill goes on to conference. Frankly, I think a number of people on the edge of this vote – people like Nelson and Snowe – know this is in play and might be willing to vote cloture just to keep the filibuster available. In other words I think we’ll see cloture. Don’t forget failing cloture once does not mean failing cloture forever. It means (nominally) “We still want to work on this bill.”

Eventually the bill will pass cloture. At that point you’ll see a number of motions and dances by Republicans trying to derail the process. They’ll get a lot of press, but they’re sideshows. The Big Deal is the actual vote. That only needs 51 in favor and that’s pretty much locked.

At that point we get rid of the kabuki sausage making and get to the real deal: the conference committee. Actually this isn’t kabuki either. It’s very, very hard to bring something in that wasn’t in either of the bills being resolved. But back to the committee, what happens here is that some people are selected from both the Senate and the House. They mix and match between the two bills and get one more-or-less compromise. This happens, by the way, behind closed doors.

Oh and take that bit about limits to the changes with a huge grain of salt. It is possible that to resolve something that a third idea has to be introduced and agreed upon. Still, the purpose is to get something that’ll get majority vote in both houses as “well, I guess”.

A bit of digression here: the committee is not a pure majority vote. In other words, if Reid sent three people (more likely to be ten but I digress) and Pelosi decided to send 250 people, it wouldn’t really matter. The Senate voters must majority approve, the House voters must majority approve, and both must do so for the report to come out of committee. If 2 of the 3 Senators of our example say “no” it doesn’t matter of all 250 house members said yes.

Anyway, eventually the report (as the compromise bill is called) comes out. At that point on a fast track. Over in the house, it doesn’t need a rule (doesn’t need a prelimary vote to put it on the agenda), it’s there, and needs 50%+1 to pass. In the Senate it’s going to need two votes. Again, it’s going to need the magic 60 to end a filibuster – which may get brought up over and over and over. (I mentioned before that Reid could end the filibuster rule here. The other thing he could do is end the two-track rule that says if something is hung up awaiting cloture other business may proceed. He can say, “nope” and request the objectors raise their points of debate. It’s theater if he does so, but it could catch the opponents flat-footed and do great things for his election chances.

Oh, I need to point out that the report is not amendable. The filibuster cannot be to add or remove various points (though the points can be mentioned). It is possible to send it BACK to the committee with these mentioned but there’s no guarantee they’ll happen — and no guarantee of 51 votes to send it back, either.

Once (yes, I’m saying it’ll happen) the cloture is done it’s off to final vote. A few days after that the president signs it. Lots and lots of sausage making.

Now I’m going to make a hard left turn here and address in general the complaints I’m seeing from many on the left in regard to the bill. There are problems with the bill. Many pet items have gone – single payer, the ‘compromise’ public option, medicare at 55, etc. I want to make two points.

point one and most important – the Senate bill is not the Conference report. Smell the sausage.

point two – the bill has some major impact on the industry. Yeah, I’ve seen some comments from insurance lobbyists who say, “We’ve won.” I’ve got a simple question for folk here – do you really think that was an uncontrolled tweet? Do you really think it was about the whole bill? Here’s something buried in both versions – just for example – that is going to cause a lot of complaining from the industry: 80 to 90% of premiums must be spent on the plan, not on administration. In other words on the doctors and nurses and tests and drugs, not on sales and administrators and, well, you get the idea. There are also a LOT of pilot programs meant to see what works in controlling the costs. Medicaid bumps to at least being for 133% of FPL nationwide pretty much immediately in both versions – and that is NOT a small deal.

Is it the bill I wanted? No, I really don’t think so. Is it what we need? No, not at this point. However, I can pretty much guarantee you something about it. If it passes, it’ll never go away. Further it’ll get refined and expanded just as Social Security and Civil Rights and Medicare and Medicaid and CHIP and, well, just about every piece of Major legislation meant to “promote the general welfare.” You know, from the constitution – and the preamble is as much a part of law of the land as any of the subsequent articles.

Pass it. Pass it so our children can get something closer to what they really need instead of having to fight (again, still) to get to first base.


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