On the Path to Health Care Reform

So. Where does health care reform go from here?

(For those reading at some future date, the context — Martha Coakley lost a special election in Massachusetts, depriving Democrats of the 60 vote majority they had in the Senate).

As strange as this sounds, I think that health care reform is in a better position today than it was last week. In spite of losing a filibuster-proof majority, the Democrats still hold the cards. They have their destiny in their hands.

The reason for this quixotic belief? It’s quite simple, really. The Senate has passed a bill.

It’s not a perfect bill by any means. But it has passed the Senate. All the House of Representatives needs to do is to take up the bill, pass it, and send it to the President for his signature.

I’ll be frank. I was not sanguine about the chances of a conference committee bill in the Senate, because a conference bill gives the Joe Liebermans of the world another chance to preen before the camera on the Sunday morning talk shows and talk about how awful this bill is. Sending a revised bill back to the Senate would have been playing with fire.

No, the House is not happy with the Senate bill. I am not happy with the Senate bill. It’s not progressive enough. It’s too corporatist. (As Andrew Sullivan has pointed out repeatedly, it’s a Republican bill; it’s roughly what Bob Dole was offering as an alternative to Clinton’s health care reform proposals in 1993 and 1994.)

But there is a way forward on that.

Budget reconciliation.

Jeff Davis of The New Republic explains the way forward on that. Essentially, things like the public option or a Medicare for all program can be passed through the budgetary process, which would provide progressive Democrats in the House with a program they can support, and it would not be subject to the filibuster in the Senate.

If the House Democrats don’t pass the Senate bill?

I think we can guarantee that November will be bloody. Josh Marshall of Talking Points Memo makes that argument well. It could make 1994 look like a minor flesh wound.

Health care is the issue that has generated the most press, and if the Democrats walk away from it with the perception that they can’t do anything, they they are setting themselves up for failure at the ballot box.

There comes a time for idealism, and there comes a time for pragmatism. This is a time to be pragmatic for Democrats. There is a path to victory, and it will mean that some House Democrats will vote on and a pass a bill they find unpalatable. But the consequences of not being pragmatic are far worse, both for the country and their own electoral prospects.

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