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Tuesday, December 15, 2009

What to do with Health Care Reform in the Senate ?

The post below was not at all constructive. I have a coulda woulda shoulda proposal which is probably too late and a still can proposal.

The still can proposal is to go for Nelson and Snowe. It is clear that Lieberman is not bargaining in good faith. There is every sign that Snowe is bargaining in good faith (she has worked hard on the issue and everyone agrees she cares about the policy). Her current stated position is to the left of Lieberman -- she supports a public option with a trigger -- he opposes even that. Nelson and Snowe oppose Medicare buy in, so it's probably dead. Nelson is making trouble about abortion but has hinted repeatedly that if he gets his way on the public option he will insist less on the rights of the innocent unborn.

OK that reminds me, Nelson isn't quite as clearly in bad faith and motivated by vanity as Lieberman and maybe 3 other people on the planet, but he is pretty bad.

Then the proposed 2011 budget can include Medicare buy in and the public option. There is no rule of the Senate which prevents this. There will be no rest of the bill to hold hostage. Both reduce the deficit and can be enacted with 50 senators plus Biden. Both are popular. Having a debate on those two issues next year would help the Democrats politically.

The only problem I see is the Senate finance committee. There is definitely possible trouble there. I wonder if Baucus would cede the bill to HELP ? Would Conrad accept the bills with opt out of both parts ? Can the caucus reshuffle the committee while it is throwing Lieberman out ? Say make Conrad chairman of Government oversight and get him off finance (problem with that was I was planning to suggest Snowe for government oversight).

The coulda woulda shoulda is, of course, splitting the bill in more equal parts and making the insurance regulatory reform and the exchanges a 60 vote non budget bill and the rest a 50 (plus Biden) vote budgetary bill. Note the individual mandate is part of the 50 vote bill. It is enforced by taxing people who don't get insurance. You can't get more budgetary than that. Schedule the 60 vote bill first. That bill is very super popular. Republicans will vote no and pay for it (if they later claim they are voting against the other bill they can be called on that lie).

Then AHIP is back where they were after Obama was elected. They don't want (maybe can't afford) regulatory reform without an individual mandate. The trick is to tell Democratic "centrists" that the two bills are really linked so they vote for cloture on the first bill. I don't think it is really to late for this approach. The 2010 budget has been passed, but most of the budgetary aspects of the bill phase in so they can be in the 2011 budget just as well. Some features start in 2010 so they have to be in the 60 vote bill (which with 60 votes can add to the deficit).

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