Obama's end game for passing health care reform.

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March 2 2010 8:34 PM

Health Care Rising

Obama's end game for passing health care reform.

Barack Obama. Click image to expand.
Barack Obama

If Barack Obama has his way, health care reform will be completed by Easter. That's fitting for a bill that was born on Christmas Eve, died, and that the president hopes will rise again. It's also a story that, like the resurrection of Jesus, calls on its adherents to take a leap of faith into the unseen. In Obama's case, he is selling the not-so-Biblical proposition that people will like health care reform that they don't appear to like right now.

John Dickerson John Dickerson

John Dickerson is Slate's chief political correspondent and author of On Her Trail. Read his series on the presidency and on risk.

On Wednesday, the president is scheduled to make an afternoon statement about how to move forward with health care, but today he made his intention clear in a letter to Congressional leaders. He's moving ahead. He's not starting over as Republicans would like.

The president did outline several Republican ideas he would like to consider. These include a search for alternatives to resolve medical malpractice disputes, plus efforts to cut down on waste and fraud in federal health programs, to set Medicaid fees so as to keep good doctors in the system, and to rejigger the insurance system in a way that might allow for health care savings accounts.

Republican leaders weren't buying any of it. Senate Republican leader Mitch McConnell called the president's offerings an effort to "simply paper a few of these commonsense proposals over an unsalvageable bill."

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With these expected dance steps out of the way, Obama's plan ends up back in the laps of Democrats in Congress. The first question that needs to be resolved is about timing and who goes first. The most likely scenario is that around mid-March, the House will vote on the Senate health care bill that passed by a supermajority in that chamber last Christmas. The president will sign that bill. Then, the House members will take up a second bill, full of fixes to the Senate bill they just passed. That bill will have to pass the Senate via reconciliation. (They'll schedule the bill for just before the Easter recess, so that Republicans will eat into their vacation time if they delay with excessive amendments. Though reconciliation limits the number of hours of debate, it does not remove all opportunities for procedural mischief-making.)

The problem is that the House doesn't want to go first. Its members worry about voting for the existing Senate bill, with its flaws, from their point of view, based on promises of future fixes the Senate might make in a second, reconciliation bill.

Nonetheless, White House Chief of Staff Rahm Emanuel has been pressuring Speaker Pelosi to go forward. But she is looking for some kind of assurance from the Senate that it will keep its promise. There has been a rumor going around about a letter that 50 Senate Democrats would sign and that would promise to do just that. But this won't do the trick. The problem is not whether Democratic senators will act in good faith but whether they can. What if the Republicans propose so many amendments that the process gets out of hand and Senate Leader Harry Reid has to shut it down?

Or, as another senior House aide put it, what if a Republican senator comes up with an amendment that acts as a poison pill? Such an amendment would have to be so universally appealing—probably related to funds for Medicare—that no senator could vote against it. And yet by passing the amendment, the Senate would put in motion a policy that would have a catastrophic affect on the whole reform package.