Obama's end game for passing health care reform.

Obama's end game for passing health care reform.

Obama's end game for passing health care reform.

Who's winning, who's losing, and why.
March 2 2010 8:34 PM

Health Care Rising

Obama's end game for passing health care reform.

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Assuming the Democrats can solve their who-goes-first difficulty, the next question is whether they have the votes in the House of Representatives. The conversations I've had with people in the administration and on the Hill are all bullish. They talk about Pelosi's talent for hitting the right number the way people used to talk about Barack Obama's speaking prowess.

At a more practical level, faith in Pelosi is based on an assumption that the number of House members who previously voted yes for health care reform last year but who will now vote no (because they think the legislation does not sufficiently limit abortion rights) will be small enough to overcome. Democratic leaders hope to find new yes votes among the retiring Democrats who previously voted no and in the crop of members who voted no last time but who would have flipped to yes if Pelosi really needed them at the last minute.

Here are the main arguments the White House and Congressional leaders are making to win votes, in order from most high minded to most political: First, with this vote, you'll be insuring 30 million people and giving people health security because they'll know their coverage won't be dropped. Second, once people see the benefits—closing the donut hole and holding on to their medical care—they'll warm to the bill. Third, if you vote no, you'll dispirit our base, which wants us to do something. Fourth, you already voted for health care last year—you can't erase that political downside by voting no now. Fifth, you don't want to hand your Democratic president a defeat on his signature domestic policy proposal. Or hand a win to Republicans who have obstructed us every inch of the way.

Of course, this endgame strategy all relies on the Senate using reconciliation, even though that's a word White House aides and Democrats would like never to hear again. It's a technical term, open to misinterpretation and hyperbole, and remote from the problems people face with health care every day. It's an even more potent possible distraction than last summer's debate over the public option.


For all of these reasons, Republicans would like to shout the word to each voter every morning. Along with repeating words like jam and ram to characterize the measure. With the public opposed to the legislation, such framing makes the president's efforts to pass the bill not just wrong but sinister.

Right now, Democrats are fighting back by explaining that reconciliation is being used in a limited way (not for the whole bill). They also point out that Republicans have used it more than Democrats, so those who now oppose its use are disingenuous. They are also trying to erase the word from the conversation. "We're talking about a process where we use a simple majority to pass the legislation. So without any fancy names, a simple majority," said Nancy Pelosi.

The best course may be to do what the president did at his health care summit last week: ignore the reconciliation debate and when asked about it quickly return to saying that Americans will have less health care coverage and higher premiums if no legislation is passed. "When asked about reconciliation the response is Anthem," said one senior House leadership aide citing the president's favorite recent example of insurance company excess.

Of course, the country hasn't bought those arguments over the last many months. White House officials and other Democratic strategists argue that popular support will follow once the legislation is passed and people see that the world didn't end. It's a lot to ask. If the president pulls it off, you might call it a miracle.

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