Health Care Reform: Too Big To Fail

The House health reform discussion draft (pre-cursor to the bill) is 852 pages. Senate bills will eventually be hundreds and hundreds of pages as well. Those are some big bills.

The seemingly endless pages of legislative language represent hundreds of different policy options the two chambers of Congress are considering as part of health care reform.

The number of bills kicking around in the House and Senate, their size and complexity, the high estimated costs (way over $1 trillion over 10 years) from the Congressional Budget Office, and the markup of Ted Kennedy's bill moving at a snail's pace all have contributed to one conclusion as the process hits the most sensitive phase to date: health care reform appears doomed to fail.

Here's the reality for Democrats: Health care reform is too big to fail.

The party--from the White House to elected officials in Congress--has made health reform the linchpin of its domestic policy agenda. The President and key committee chairmen on down have staked their political futures and credibility on health care reform.

That's why the troubling start--higher than expected costs, delays, controversy over key provisions--has triggered real panic among Democrats.

We're not going to minimize the problems health care reform faces in the present. But the big picture should not be lost.

First, for Democrats, it is imperative to have one bill done by the month-long August recess deadline imposed by Obama. We wrote about this in "The Pink Sheet" and The RPM Report. Here's an excerpt:

"Democratic leaders are trying to move quickly to meet a deadline imposed by the White House to have a bill passed before Congress leaves for its month-long August recess.

"We've got to kick that deadline down the road," said Alaska Republican Lisa Murkowski. Republicans repeatedly referred to the deadline as "arbitrary."

Democrats' fear is two-fold: First, lawmakers fear that the lag in itself will slow momentum for health care reform.

Significantly more important, however, is fear among party leaders that the recess would give Republicans a full month in their home states rallying support against Democratic proposals, as well as time for other opposition groups to conduct grass roots campaigns and public polling.

Moreover, if a clear-cut agreement isn't reached by the recess, Democrats themselves will be left to answer tough questions from their constituents on the fence about the legislation, or multiple pieces of pending legislation, without being able explain the reforms, benefits, cuts, or revenues contained in a final bill.

The approach recalls the 1993 health reform experience when many crucial Democratic elected officials struggled to communicate the complicated Clinton bill to voters in their districts and home states during the long delays in the legislative process, and thus, subsequently suffered politically from the fallout."

Second, the strategy by Republicans to delay progress of Democratic proposals in Senate committees should not cloud the fact that Democrats have historic advantages in both the House, Senate, and the White House.

The numbers to remember: 79, 59+1, and 60.

The first, 79, is the margin Democrats enjoy in the House. The second, 59+1, is the number of Democrats (we'll count independents who vote with Democrats) plus Al Franken, who could be seated as the junior Senator of Minnesota at anytime, in the Senate. The sum of the equation gives Democrats the filibuster-proof 60 votes they desperately need to move forward.

That's not the same "60" we mean by the last number. That 60 is Obama's approval rating; 60% of all Americans approve of the job he's doing, according to an average of polls from Real Clear Politics.

Now, there is the strong argument that Democrats themselves don't all agree on health care reform and certainly wouldn't vote in lockstep along party lines to pass sweeping legislation that impacts one-sixth of the economy. Presently, that's absolutely the case and was reinforced by comments on the Sunday morning talk shows.

However, we bet that health care reform--particularly universal coverage--is so important in defining the future of the Democratic Party that they will have no other choice than to come together. If they don't, Obama will make that case to them in the final stage of the legislative process.

And if those three numbers (79, 59+1, and 60) aren't enough, there's always a fourth number, 51. That's the simple majority it would take to pass reform as part of the budget reconciliation process in the Senate, with healthy margins assured in the House.

Democrats themselves point to 51 as a course of last resort. But the only way to get to 60 votes in the Senate may be to make sure you have 51--a threat of inevitability that would persuade conservative Democrats and moderate Republicans to sign on to a sweeping health reform bill.

We believe the 51-vote strategy is one of last resort, but one Democrats will resort to if necessary if the choice is between that and no health care reform. Put simply, Democrats have placed too much of the Party's future in the health reform basket to abandon it now.

Which one, two, or five Democratic Senator(s) wants to be known as the reason Obama's health care reform plan was torpedoed and likely delayed at least another four years if not another 15?

So while reform has hit some roadblocks, those roadblocks were predictable. For Democrats, health reform has become too big to fail.

Of course, that's what they said about Lehman Brothers.