Slate invites readers to find a way to pass the health care reform bill.

How to fix health policy.
Jan. 22 2010 2:52 PM

Reader Contest: You Figure It Out!

Slate invites readers to find a way to pass the health care bill.

Update, Jan. 26: This contest is now closed. The results will be posted soon.

Click here for a guide to following the health care reform story online.

They say Washington can't come to any consensus about health care reform, but the capital is rapidly arriving at near-total agreement that the loss of a single Senate seat killed the bill after it passed both houses of Congress, that there's no plausible path to revive it, and that a stripped-down version would be unworkable. Here at Slate we try whenever possible to buck the conventional wisdom, but my best claim for originality here is that unconditional despair struck me a little earlier than many others.

Maybe you can help. If you can figure out a way to pass any significant health reform bill between now and November 2010, fill out the form below. You're limited to 500 words, you must give your entry a descriptive title, and you must submit it by Monday, Jan. 25, at 5 p.m. ET. I'll sort through the entries, judge their value and pragmatism, and publish the best. Warning: If you repeat a solution that I've seen outlined before, I'll automatically rule it out, because none of those will work. If they did, we wouldn't be holding this contest.

I will also rule out any submission that ignores the following seven parameters (you don't have to write about them; you just can't propose something that denies their existence):

1) With 59 Democrats, the Senate now lacks a filibuster-proof majority for health reform, which passed the Senate on Christmas Eve with 60 "aye" votes. (Sen. Ted Kennedy's temporary replacement, Paul Kirk, is the "aye" vote that's now been lost.)

2) Senate Majority Leader Harry Reid has ruled out ramming a House-Senate conference bill through the Senate before Kirk departs and Massachusetts Senator-elect Scott Brown, who opposes the bill, is seated. Doing so would at any rate appear to violate Senate precedent.

3) House Speaker Nancy Pelosi, D.-Calif., doesn't have the votes to pass the Senate bill with no changes at all. Press attention has focused on liberal opponents to the Senate bill's provisions imposing a 40 percent tax on "Cadillac" health plans valued in excess of $23,000, to its exclusion of illegal immigrants from the health insurance exchanges established under the bill (the House version merely excludes them from receiving government subsidies), and to an overall subsidy level that liberals judge inadequate to make health insurance affordable to those newly required to purchase it. It seems reasonably likely that these liberals would be persuaded to drop their opposition once they fully realized that the alternative was no health care bill at all.

But the press has lent scant attention to conservative opposition to the Senate bill by pro-life House members and other Blue Dog Democrats. This group has a much smaller stake in the bill's passage. Rep. Bart Stupak, D.-Mich., is especially intransigent on the abortion issue (neither he nor the U.S. Conference of Catholic Bishops will accept the Senate's compromise language on abortion coverage), and he appears to have enough votes to kill the bill. (The House bill, which includes Stupak's church-approved abortion ban, cleared the House by only a five-vote margin in November.)

4) House pro-lifers have no reason to agree to pass the Senate bill and then alter it via the reconciliation process, which requires only a 51-vote majority in the Senate. That's because reconciliation bills can handle only budget-related issues, and (despite what Stupak may say) the Stupak amendment doesn't involve the spending of federal dollars.

5) Swing-voting Republican Sen. Olympia Snowe of Maine has hardened her opposition to the bill.

6) The following provisions are widely judged interdependent: a ban against insurance companies refusing customers based on pre-existing conditions (most people—even Republicans!—consider this essential to health care reform), an "individual mandate" requiring everyone to purchase health insurance so there are no "free riders," and subsidies to make it possible for lower-income people subject to the individual mandate to afford coverage. This "three-legged stool" militates against passage of a "health care lite" bill. Some argue that the importance of the individual mandate has been overstated, but without it you need a lot more government intervention and subsidies. (Details and links here.)

7) Changing the Senate rules to eliminate the filibuster would require even more votes (67) than the number required to end a filibuster (60).

The texts of the House and Senate bills are available here, along with a variety of other informational links. May the best plan win.

E-mail Timothy Noah at



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