Ping pong, anyone? The House must pass the Senate bill to save health care reform

By Lindsay Beyerstein

Martha Coakley's loss in Massachusetts will end the Democrats' 60-vote majority in the Senate. This is a major setback for health care reform, but let's not hang crepe yet. Remember, the Senate already passed its bill. If the House were to "ping pong" the bill by passing the identical legislation, the bill wouldn't have to go back to the Senate for final approval. So, no 60-vote majority required.

The alternative would be to fast-track the conference report and put it to a vote before Scott Brown is sworn in. This seems procedurally viable, and would probably result in a more progressive bill, but Sen. Jim Webb (D-Va) has already made it clear that he doesn't want a Senate health care vote before Brown is sworn in. If Webb won't cooperate, the fast-track approach is dead.

So, the choice is between ping pong and abject defeat. It had better be ping pong. For all its faults, the Senate bill is still better than nothing.

Comments

[Ugh]

No. Fnck this bullsh!t, this is the time the Democrats need to finally go procedural postal (or Republican, if you will) in the Senate. Ram everything through in reconciliation, HCR, additional stimulus, financial industry re-regulation, tax increase/reform, etc. Just do it all on 51 votes and let the chips fall where they may in November. Fnck Lieberman, Nelson, Blue Dogs, etc., 51 votes means the bill passes, like a regular democracy. And the fncking nonsense senate "holds" on confirmations should go too.

[Brett Bellmore]

I understand there's a faction in the Republican establishment that share's your view: Better that the Democrats destroy themselves passing this atrocity, than stop short of destruction, and do something that's actually, you know, popular.

The problem is, this bill IS worse than nothing, unless all you care about are the prospects of the GOP in the next election.

[Ben Alpers]

At this point, I'm pretty convinced that there aren't fifty votes for real reform in the Senate.

Politically, the Democrats have to pass the Senate bill. Whether they do or not, the Republicans will run against it in the fall. If they don't pass it, the Republicans will simply be able to add to their appeal by claiming victory in defeating it.

From a public policy perspective, I'm less sold. The Senate Bill is very, very bad. Then again, so's the status quo.

What do I think will happen? The Senate bill we be attacked by both sides in the House. It won't pass. HCR will die for another two decades. Republicans will feast on its carcass in November

America's gonna party like it's 1994.

[ChrisJ]

Or actually force them to filibuster for days and days. Lately the mere threat of filibuster is enough to stop anything. It isn't.

[Ben Alpers]

Read Barney Frank's take on these things.

Bottom line: the Senate Bill is dead and Democrats (Frank included) seem bent on committing political suicide.

Perhaps we should just get out of the way and consider it euthanasia.

[Roger Moore]

Ram everything through in reconciliation, HCR, additional stimulus, financial industry re-regulation, tax increase/reform, etc.

Unfortunately, there are limits on the reconciliation process. It's supposed to apply only to budgetary bills, and it can't increase the deficit beyond 10 years. IOW, it puts considerable constraints on the kinds of bills you can pass. I agree that the Democrats need to be willing to push things through on a 51 vote majority (or even 50 plus Biden), but I think a better approach is to end- or at least substantially reform- the filibuster.

[hairshirthedonist]

Or actually force them to filibuster for days and days.

Where's Gary Farber when you need him to explain why it's harder on the party being filibustered (if that's a valid phrasing) than the party doing the filibustering? It's like forcing someone to stand on your shoulders for a long time. It's worse for you.

[Ben Alpers]

ChrisJ,

There is no longer the possibility of forcing someone to "really" filibuster....and there hasn't been since Senate rules were changed in the 1970s.

Before then, you needed a 2/3 vote of Senators present in the Chamber to end debate.

Since then, you need a 3/5 vote of all Senators, so you can't make people stay in the chamber to keep a filibuster going.

In addition, before the Seventies, the Senate could only conduct one piece of business at a time. But thanks to a rule change by supposed Constitutional supergenius Robert Byrd, the Senate can now engage in "dual tracking," meaning that it can conduct other business while a bill is awaiting a cloture vote. In the past, a filibuster ground the Senate to a halt. Now it can't.

The Mr. Smith style filibuster is a thing of the past, due to the unintended consequences of a reform effort that made a bad institution, the filibuster, even worse.

[Sebastian]

"Where's Gary Farber when you need him to explain why it's harder on the party being filibustered (if that's a valid phrasing) than the party doing the filibustering?"

It doesn't matter who it is worse for, if you let filibustering become routine because you never say no to it, it is worse for you.

The question is not: which party is it harder on for the three days it takes to break a filibuster?

The question is: which party is it harder on if you let the other side get away with filibustering everything?

Also, I'm not convinced that it will ultimately be so hard on the Democrats if they do it. We haven't had a filibuster in the time of potential you-tube videos showing the senator reading from the dictionary.

[Ben Alpers]

Where's Gary Farber when you need him...

Where are the Hilzoys of yesteryear...

[Brien Jackson]

I think it would help tremendously to stop calling a failure to win a cloture vote a filibuster. The conflation seems to confuse a lot of people.

[Brien Jackson]

"There is no longer the possibility of forcing someone to "really" filibuster....and there hasn't been since Senate rules were changed in the 1970s."

To be really accurate, there never really was a way at anytime. If you don't have the votes to end debate, you don't have the votes to end debate.

[Jesurgislac]

Can someone explain how a bill that appears to primarily serve the health insurance industry, rather than the millions of uninsured and the millions more with US-standard crappy "insurance", is actually better than nothing?

[Brien Jackson]

"The question is not: which party is it harder on for the three days it takes to break a filibuster?

The question is: which party is it harder on if you let the other side get away with filibustering everything?

Also, I'm not convinced that it will ultimately be so hard on the Democrats if they do it. We haven't had a filibuster in the time of potential you-tube videos showing the senator reading from the dictionary. "

Except, you know, there's no way to do it. None. Anyone saying "make them talk" doesn't have any idea how the procedural rules of the Senate work.

[Sebastian]

You make them vote to continue debate. And if they vote to continue debate, they have to actually continue the debate.

[Turbulence]

Can someone explain how a bill that appears to primarily serve the health insurance industry, rather than the millions of uninsured and the millions more with US-standard crappy "insurance", is actually better than nothing?

I think that moving the US much closer to the medical system used in the Netherlands would be a huge win. I think spending a hundred billions of dollars a year on buying health insurance for low income people is a huge win. I think opening lots of community health centers around the country to help underserved populations is a great thing. And I think that trying every reasonable proposal for cost control is vitally important. That's all in the bill. And it all represents a huge improvement over the status quo.

Does the mandate suck? By itself, yes. But I don't see how you can get ban pre-existing condition limitations without a mandate. Unless you want premiums to triple overnight. If you have any ideas for solving that little problem without mandates, let me know.

[hairshirthedonist]

The question is not: which party is it harder on for the three days it takes to break a filibuster?

I'm unaware of the "the three days it takes to break a filibuster." Where does that come from? If three days does it, then I agree. Suck it up if it's that important.

[Ben Alpers]

Can someone explain how a bill that appears to primarily serve the health insurance industry, rather than the millions of uninsured and the millions more with US-standard crappy "insurance", is actually better than nothing?

I keep going back and forth on the stark question of whether the Senate bill is better than nothing, Jesurgislac.

I don't disagree with you that its primary purpose is to line the pockets of the insurance industry. And it's funded through an unnecessarily regressive excise tax that in particular punishes union households. These are serious marks against it.

But on the margins, it does provide access to insurance for millions of people who don't currently have access. And it provides several billion dollars for urgent care facilities. And therein lies the case that it is better than the status quo (that it otherwise very closely resembles).

As I say above, however, from a purely political perspective, the Democrats would be crazy not to ping-pong this. But they clearly don't see things that way.

[Brien Jackson]

"You make them vote to continue debate. And if they vote to continue debate, they have to actually continue the debate. "

It just doesn't work like that.

[Turbulence]

You make them vote to continue debate. And if they vote to continue debate, they have to actually continue the debate.

No, not really. They can sit there and read constituent letters or reports from think tanks till the cows come home. There will be no political price for reading constituent letters whatsoever. No one will criticize them for that. Which means that they can do it indefinitely. If a few college educated young urban professionals on the coasts find it funny watching Jim Demint read utter stupidity from his constituents, then won't much matter for Jim Demint since those folks were never going to vote for him anyway.

[Brien Jackson]

"No, not really. They can sit there and read constituent letters or reports from think tanks till the cows come home. There will be no political price for reading constituent letters whatsoever."

No, you just don't do anything. Open question is the Senate defult. You have to have an affirmative motion pass to proceed to a vote.

[Scott P.]

They don't even have to debate. Whenever there is not a bill being voting on, the Senate is considered to be debating, whether or not anyone is actually saying anything on the floor.

I propose we call this procedural roadblocking billiflustering to distinguish it from the well-known read-from-the-phonebook strategy.

[Hogan]

Funny that the health insurance industry seems so determined to leave all that government money on the table.

[Sebastian]

"If a few college educated young urban professionals on the coasts find it funny watching Jim Demint read utter stupidity from his constituents, then won't much matter for Jim Demint since those folks were never going to vote for him anyway."

You don't know that will be the result, because no one has tried. I find it incredibly annoying that everyone just assumes what the public's reaction will be. In 2007, the general thought process of Democrats before the primaries was that the US wouldn't elect a black president yet. Yet, hello, when given the opportunity, they did. And by quite a bit.

Yes, you're right that if Democrats do everything really poorly and Republicans do everything right, Democrats probably can't profit from trying to break the routine filibuster.

But if you're assuming that, Democrats never had a chance at doing anything anyway.

But if THAT is the case, WTF, why not just try it anyway on the off off off off chance that it can work.

Do you think that trying to break the filibuster is an actively LOSING position for them? Or are they just too lazy to do it?

"I'm unaware of the "the three days it takes to break a filibuster." Where does that come from? If three days does it, then I agree. Suck it up if it's that important."

Under the modern rules each senator only gets to speak twice unless other members yield their time. Unless every single Republican is willing to talk until they actually drop (and frankly most of them won't even actively participate at all) three days is about as much as it is likely to work before they run out of participants/people to yield time (unless Democrats are yielding speaking opportunities to Repbulicans, which seems unlikely). I'm sure there is arcana more complicated than that, but basically 3 days or so is about as long as you can keep up an active filibuster. As opposed to threats which can last forever.

[wj]

Why, exactly, is the choice between the Senate bill and nothing? Granted, nothing resembling the house or Senate bills is going to get passed. But there is no obvious reason why a less ambitious bill could not get done.

Sure, it wouldn't be the massive world-changing piece of legislation that some liberals were demanding. (Of course, the current bills were opposed by some on the left as too limited.) But it would be a step forward. And the only reason to oppose it from the left would be an inability to accept that they can't have everything they want the instant that they want it. Or else a burning desire to lose the next election big time.

[Brien Jackson]

"I'm sure there is arcana more complicated than that, but basically 3 days or so is about as long as you can keep up an active filibuster. As opposed to threats which can last forever"

Except we're not talking about filibusters or threats, we're talking about motions to proceed/end debate.

You're wasting a lot of time thinking and typing about stuff that's just totally detached from the way Senate procedure has worked since the very first Congress.

[Eric Martin]

Why, exactly, is the choice between the Senate bill and nothing? Granted, nothing resembling the house or Senate bills is going to get passed. But there is no obvious reason why a less ambitious bill could not get done.

Well, couldn't they pass the senate bill as it stands if the House approves?

[Nate]

I'll give them a few days to regroup, but the entire Democratic leadership seems to be hell-bent on making themselves look at useless and cowardly as possible, on top of the dithering for the past too many months about it.

Seriously, this is @$!#ing embarrassing, nobody knows how to act like they have a spine, and handed the MA senate seat to the Republicans, and seem dead set on handing many more seats to the Republicans in the next elections, by being both useless and cowardly.

If they flip out, panic, let health care reform die, let the Republicans' craziness win, and then let the Republicans win in 2010, I fear we're headed even further into the craziness than we were over the Bush years. Which could get REALLY ugly. Especially the next time the Republican's policies cause disaster, and the only people benefiting are the wealthy.

[Nate]

wj: If this bill dies, there will be no smaller bill. There will be nothing. The useless @$!#ing Democrats will be useless cowards and not put anything forward, the Republicans will be gloating and not allow any policy to be made, since that worked for them, and absolutely nothing will happen. For at least a decade, probably longer, during which time, hundreds of thousands at least will die for preventable reasons, millions more will lose their health insurance, and the current status quo will degrade into something worse and worse until it breaks. Probably before anything gets done to fix it. And probably after the Republicans gut Medicare and Social Security to give huge tax cuts to the top 1%.

[Ben Alpers]

Funny that the health insurance industry seems so determined to leave all that government money on the table.

Just as the insurance industry understands that buying two political parties is more efficient than buying one, they also understand that they are more likely to get favorable results by both writing the healthcare "reform" legislation and opposing it. Of course they like the status quo and are willing to fight for it (since winning that battle also discourages future, real reform efforts). But they've made sure that if they "lose," they still win.

And this process is helped by a White House gameplan that Obama borrowed from Clinton: trying to coopt the insurance and pharmaceutical industries by tossing them huge concessions from the start.

The result is all win for these industries. The concessions make the bills less popular and easier to defeat (e.g. drug reimportation, killed by the White House at the behest of PhRMA was very popular as well as good policy). And they make the bills less damaging to the industries if they pass. Yet, the industries are under no obligation to support the proposals as the White House concessions come with no real strings attached. They can truly have their cake and eat it too. And that's what's happening even as we blog.

Bottom line: the only way to get real healthcare reform is to run a populist campaign against these industries that presents them as the enemies of the American people. This has the added benefit of being largely true. And its political costs are much less than DC insiders would suppose because, at the end of the day, these industries will fight tooth and nail against any reform, even one that is more or less explicitly written with their interests in mind.

[Ben Alpers]

Well, couldn't they pass the senate bill as it stands if the House approves?

They could, but they won't. The party's left objects to its structure; the right objects to its insufficient concern for life misogyny. Perhaps most importantly, organized labor has indicated that the Senate bill is unacceptable (indeed, they've indicated that all along).

The problem with constructing a bill to please two Senators--one who represents a small red state and another who represents only his own enormous ego--is that you end up with a bill that pleases none of your core constituencies. The Senate is insulated enough from the voters (and political reality) that they can get away with that in the short run (though it has already helped to cost the Democrats a seat). The House? Not so much.

[Turbulence]

(e.g. drug reimportation, killed by the White House at the behest of PhRMA was very popular as well as good policy).

Um, do you have a cite explaining why drug reimportation would be good policy? That seems absurd on its face to me, but I'd be happy to review some expert opinions.

The party's left objects to its structure;

Eh? Can you explain? That party's left voted for something very similar in the House already. At least in terms of structure.

The difference between the House and the Senate bills is really quite small. I suppose it is possible that this small difference is a bridge too far for the left most members in the House, but frankly, I have trouble believing it. My guess is that they're going to scream that in order to push the Senate to pass an amended version that's a little closer to what they've got now on the theory that if they agree to just pass the Senate bill, they won't get most of the concessions they seek.

[wj]

If this bill dies, there will be no smaller bill. There will be nothing.

But why, Nate? Other than the fact that it would be less than you like.

Granted that there are flaws in the way the Democrats decided what they were going to do, not to mention their execution. (Although I suspect we would have different takes on what some of those flaws are.) Granted also that the Republican leadership, and probably a majority of their members, are interested only in game playing, not in contributing to governing the nation.

But are you saying that there is no possibility of passing something which, although less (probably far less) than you would like, would be a step in the right direction? Something that at least some Republicans would consider they had to support, if they want to get re-elected. Or just that you don't even want to consider such a possibility, because you want everything that you want, and no compromise can be considered?

I really don't understand, and hope you will enlighten me. Thank you.

[Bernard Yomtov]

Can someone explain how a bill that appears to primarily serve the health insurance industry, rather than the millions of uninsured and the millions more with US-standard crappy "insurance", is actually better than nothing?

Turbulence did a good job.

Or ask yourself how you like the current situation compared with the bill when you lose your job, in your 50's say, with somewhat below average health, and have to shop for a policy?

[Tony P.]

wj,

Consider the possibility that nobody will want to revisit the healthcare battle after a minimal bill passes, just as nobody will want to revisit it if nothing passes. The temptation to declare "Mission Accomplished" may be just as strong today, as it was six years ago.

Ed Rendell just told Rachel Maddow the thing I've been thinking since last night. Offer a bill that does only two things: 1)requires insurers to issue policies regardless of pre-existing conditions, and 2)forbids them to drop coverage after people get sick. Dare Republicans to oppose it. When they fail to, wait for the insurance companies to chase after them for a more-comprehensive bill.

--TP

[Bernard Yomtov]

Tony,

Offer a bill that does only two things: 1)requires insurers to issue policies regardless of pre-existing conditions, and 2)forbids them to drop coverage after people get sick.

Sounds great, except that if you do that without mandates you end up with justifiably very high premiums.

So if you want guaranteed coverage without regard for pre-existing conditions you need mandates. And when you have mandates you need to subsidize some people.

If you or Ed Rendell have any ideas as to how to square that circle, I'm listening.

[Warren Terra]

Offer a bill that does only two things: 1)requires insurers to issue policies regardless of pre-existing conditions, and 2)forbids them to drop coverage after people get sick. Sounds great, except that if you do that without mandates you end up with justifiably very high premiums.

And, of course, that's basically what the Senate bill is - insurance company regulation (guaranteed issue, community rating, no rescission), mandates, and some other stuff, i.e. subsidies, odious restrictions on access to abortion, and a tentative first step towards taxing health benefits.

So we come full circle: the existing Senate bill, which the House could pass tomorrow, isn't great - but it does the basic things, and it's the best chance we've had in about seventy years. Furthermore, anyone who's really troubled by the financial issues should be aware that these could be fixed in the Senate with fifty votes, by Reconciliation.

Yeah, the aforementioned odious abortion restrictions suck. But it looks like we can't pass a bill without some such thing in any case, and we've been waiting since FDR to get this far. If the Dems manage to drop this ball, then the Republican's nihilist strategy will be a complete success, and if that happens I don't know what kind of future America's experiment with representative democracy will have. It might work out OK for the country in a parliamentary system, where the opposition is largely moot until the election, but in a system like we've got, where the minority has so much veto power, if nihilism becomes a formula for success our goose is pretty much cooked.

[Warren Terra]

Sorry for the messed-up blockquote. I'm out of practice with posting here.

[Tony P.]

Bernie,

The point is to let the insurance companies, or their GOP/conservadem mouthpieces, go ahead and make the case that insurance rates would go up if insurance companies had to meet those two simple conditions. I can hear the insurers'argument now: "We're keeping your rates 'low' by refusing to insure sick people, and by dropping customers when they get sick."

You and I both know that healthcare financing is a triangle: guaranteed coverage, mandates, and subsidies have to go together. "Reasonable" Republicans know it too. The political trick is to get them to admit it.

--TP

[Jesurgislac]

Bernard: Or ask yourself how you like the current situation compared with the bill when you lose your job, in your 50's say, with somewhat below average health, and have to shop for a policy?

What difference does that make? I don't ever have to "shop for a policy", in work or out of work, regardless of my state of health, because I always have high-quality healthcare free at point of access, without any quibbles or arguments about bills: I love the NHS.

Oh, you mean if I were American? I have no idea. The current situation with regard to healthcare in the US is obviouslly appalling: you have a system that fails to provide an acceptable level of healthcare and which is hellishly expensive. The new system looks to be even more hellishly expensive because it prioritises profitability for insurance companies over healthcare, and it was unclear to me what benefits it was going to provide in exchange for making the most-expensive healthcare system on Earth even more costly.

Turbulence did explain that, yes.

[Bernard Yomtov]

Oh, you mean if I were American?

Well yes, jes. I took your question as referring to the American system, not the British one, and answered on that assumption. I do understand, more or less, about the NHS, and did not imagine that changing the American system would affect it.

[Hartmut]

Iirc the senate bill still allows the insurance companies to charge some people (i.e. those that before were handled as 'preexisting conditions') THREE TIMES the amount of premiums of the 'normal' customers.
And I know of no provisions that stop the current premium hikes. From that I would conclude that the 'undesirables' will be simply 'priced out' instead of thrown out.
I am also extremly sceptic that even the Ed Rendell idea would work because GOPsters seem to be able to vote with impunity however inhumane their choices are.