Slate readers find ways to pass health care reform.

Slate readers find ways to pass health care reform.

Slate readers find ways to pass health care reform.

How to fix health policy.
Jan. 26 2010 5:43 PM

You Figure It Out: The Results

Slate readers find ways to pass health reform.

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

Nancy Pelosi, Harry Reid, and Barack Obama.
Nancy Pelosi, Harry Reid, and Barack Obama

Last week, in a fit of despair, I invited Slate readers to figure out a way to get the health care reform bill across the finish line. Five hundred and seventy of you replied. I still don't feel that we've licked this problem, but many of your responses were witty or wise. The top winner (by Eric Jaffe of Mill Valley, Calif.) managed to be both—and was a stroke of political genius besides.

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One group of readers deserves an apology. After I posted the column inviting submissions, I turned my attention to boning up on the filibuster, about which I was scheduled to yak on MSNBC's Rachel Maddow Show that evening. I quickly realized that one of the parameters I'd set for the contest was incomplete: "Changing the Senate rules to eliminate the filibuster would require even more votes (67) than the number required to end a filibuster (60)." True enough, but what I'd neglected to point out was that the "nuclear option" that Senate Republicans had contemplated to change the filibuster rules back in 2005 (when the GOP was in the majority) required only a simple-majority vote. My segment on Maddow ended up focusing on this intriguing point to the exclusion of all others, and afterward I decided to write about it. This had the unintended effect of rendering moot many excellent entries on the nuclear option.

Reading the submissions Monday night and Tuesday, I gained much insight into what's on the collective mind of Slate readers. A lot of you said the Democrats should force a real old-fashioned filibuster, requiring opponents to hold the floor by speechifying round the clock. A lot of you said it was more possible than I thought to prohibit health insurers from refusing customers based on pre-existing conditions, and that Congress should just do that and then call it a day—because once the insurers started bleeding losses or jacking up premiums sky-high, it would become a lot easier to pass a follow-up bill laying down the "individual mandate" that everybody get coverage. And a lot of you said the budget-reconciliation process could be made to work provided the Senate also passed a separate bill codifying Rep. Bart Stupak's anti-abortion amendment. The best versions of these responses appear below.

A lot of you said let's just institute single-payer and be done with it. A lot of you said we should take health care coverage away from members of Congress until they fix this problem. A lot of you had other health reform proposals of your own that differed from the one currently before Congress. Some of you questioned whether the exercise of figuring out how to pass health reform was really worthwhile, and one of you challenged me to balance this contest out with another one soliciting the most creative strategies to block health reform. (Too easy. Ask Scott Brown!) The most depressing entry read as follows:

There is very little point in participating in what once was the democratic process at this point. Majorities are useless, so why bother? The simple fact is that we have become ungovernable, and what will pass for governance will be what our corporate masters want to happen. Just never mind.

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I have moments like that, too, but they pass.

And now, the winners:

Eighth runner-up: Bruce Miller, Grand Ledge, Mich.:
Invent a time machine. Go back to 1974 and tell Ted Kennedy to take the health reform deal Nixon offered. Inventing the time machine is the hard part, but it is likely easier than getting this bill passed. I mourn for the millions of folks who stood to get help under this bill and am ashamed of our country for kicking them to the curb.
 
Seventh runner-up: George W. Bush, Crawford, Texas (as imagined by Michael W. Price):
Declare that the U.S. is at war with the forces of Death and Disease. Seek a joint resolution stating the same. Scare up support by telling voters they're all going to die. Have the office of legal counsel draft a memo declaring that the president has the inherent and unfettered authority to protect the nation against the evil "Duo of Demise." Implement the preferred version of health care reform through a secret executive order and pay for it with the 2010 war supplemental. Repeat as needed.

Sixth runner-up: Ben Swainbank, Portsmouth, N.H.:
All right, pop quiz. You're president of the United States. You've almost passed health care reform. You're past the House. You're past the Senate. You're almost there. You can taste it.

But you've got problems.

You've got two bills. They're about the same. They do what they need to do. But all you hear about are the flaws. Everybody is yelling and screaming. You need everyone to agree on everything or you're screwed. And Joe Lieberman might just screw you for the sake of screwing you.

You've a special election in Massachusetts coming up. And you've got your big State of the Union speech coming right at you. Like a bus.

Got that, hotshot? What do you do?

Throw the special election. Take the Senate out of the equation. Have the [Democratic] candidate insult the Red Sox. They won't be able to drag her across the finish line …

After you throw the election, you watch everyone panic. Act like big reform is impossible now. What happens then? All the lefties that have been blasting you coming running to the rescue.

That Senate bill starts to look pretty darn good when the alternative is complete failure. [Andrew] Sullivan, [Joe] Klein, [Paul] Krugman, DailyKos, the single-payers, the public opters, the Medicare expanders, the bloggers, and the papers. Everyone is singing the same tune. The Senate bill will cover the uninsured. The Senate bill will cut costs. The Senate bill will sort out the insurance companies. The Senate bill is what we need. Everyone is on your side and singing the praises of your health care plan.

Just in time for your big speech ...

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Fifth runner-up: Joshua Griisser, Cumming, Ga.:
President Obama and Vice President Biden should call a meeting late at night (say, 3 a.m.) in the Oval Office. The 51 most liberal Democratic senators would be invited to this meeting—Lieberman and the Blue Dogs would be excluded, as would all Republicans. This would not be publicized ahead of time.

When all 51 senators are present, along with Obama and Biden, then Biden would act in his constitutional role ("The Vice President of the United States shall be President of the Senate") and call a session of the Senate right then and there. Since Article I stipulates that "A Majority of each [house of Congress] shall constitute a Quorum to do Business," this impromptu meeting would fulfill the constitutional requirements. The Senators would mark up the House bill. Then they would hold an up-or-down vote on it immediately afterward. Only a majority of the quorum would be required to pass the legislation; the Republicans and Blue Dogs would be completely irrelevant. In order to safeguard against future challenges, each senator should be made to sign a notarized affidavit certifying his or her presence and vote. Also, the meeting would have to be transcribed ("Each House shall keep a Journal of its Proceedings, and from time to time publish the same").

After this, the House would pass the adjusted bill, which would be far more progressive than the Senate's previous effort. Subsequently, having passed both houses of Congress as required by Article I, it would be signed into law by President Obama.

Fourth runner-up: Al Brown, Oak Park, Ill.:
Appealing to patriotism hasn't helped. Appealing to compassion hasn't helped. Appealing to economic reality hasn't helped. So, let's try relying on the laziness, self-regard, and unwillingness to endure discomfort of United States Senators. Here's the plan:

1.) Avoid a formal conference committee by working out the compromise bill in informal House-Senate negotiations, denying the opposition an opportunity for procedural delays in setting up the conference.

2.) Introduce the bill simultaneously in both houses, with whatever safeguards are available to prevent amendments.

3.) Refuse the Senate Republicans a "procedural" filibuster: If they want one, make them sustain one the old-fashioned way, with cots in the cloakrooms, big urns of coffee, no shaves, no showers, and all the other trappings.

4.) Wait them out: The side that loses is the side that gives up first. Be ready to go for a vote as soon as they flag or falter. No recesses and no adjournments until there is a vote.

While the filibuster is on, the administration will have one more chance to wage the PR offensive at which it has so far failed so glaringly, to educate the country on what the bill will do, why so much the opposition is saying is untrue, why we need reform now, and what doing nothing will cost. Let's hope they get the do-over right.

If the administration can turn the debate in the country, and portray the opposition as a minority willing to bring public business to a halt indefinitely to keep people uninsured, this thing can still be won.

As will certainly be pointed out, the danger of an appeal to senatorial laziness, self-regard, and unwillingness to endure discomfort is that these qualities are shared equally by both Democratic senators and Republican ones. This is true. We can hope that the Democrats will hold out, though, because they have more to lose. The credibility of a Democratic administration is at stake, they've sat on a filibuster-proof majority for a year, and they've failed to advance the administration's No. 1 domestic objective. Either they win now, or prove to the country that they're incapable of governing and shouldn't be trusted with the responsibility for a few more years yet.

Under this plan, a lot of senators are going to lose a lot of sleep. Let that serve as a reminder to them of how much they blew it by slow-walking the process for a year, instead of using their majority for the public good when they had the chance.

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Third runner-up: Monty Hindman, Minneapolis, Minn.:
Insurance reform: Forbid exclusions based on pre-existing conditions and move the system as close to community-rating as politically possible. Regarding the latter, adjust the rules pragmatically to acquire the needed 60 votes.

Low-income support: sliding scale to assist low-income families in purchasing health insurance. Again, take a pragmatic approach: Provide as much assistance as possible, subject to the requirement of getting 60 votes. Don't let the perfect be the enemy of the good. Social programs, if run well, can be expanded over time. Social Security, for example, started out with meager benefits; now it's both generous and politically secure.

Individual mandate: Forget it for now.

Once these popular provisions are enacted, insurance companies will be in a huge bind. The system will be unsustainable, but it won't collapse immediately. There will be plenty of time over the next few years to add [an individual mandate], the third leg of the stool—with insurance companies being a powerful advocate for change. At the same time, progressives might also be able to demand further concessions down the path of community-rating.

Regarding other issues, such as abortion coverage, progressives should make whatever sacrifices are needed to get 60 votes. Policy details can be adjusted later. The main goal should be to get two of the three pillars of a better system in place. In subsequent legislative sessions, it will then be easier to make incremental improvements.

Second runner-up: Daniel Singal, Rochester, N.Y.:
The only way to get a comprehensive bill passed is for the House to pass the Senate version. There should be two other bills passed before that happens—or simultaneously. The first supplementary bill should contain all the provisions agreed upon by the House-Senate conferees that can qualify for the reconciliation process. That would include, among other things, higher subsidies, the tax on higher-end health care plans that the unions agreed to, and scrubbing out the special Medicaid provision for Nebraska (or perhaps extending it to other states if the cost permits). In effect, this first supplementary bill would amend the main health care bill even before the main bill passes. As someone who is pro-choice, I hate to say this, but there should be a second supplementary bill to pass the Stupak amendment. That would rely on a combination of GOP votes, Blue Dog Democrats, and the requisite number of liberals who are willing to hold their noses in order to get health care reform enacted (i.e., putting first things first).

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There will be some changes to the Senate bill that the House conferees and the White House would have liked to make had they not lost the 60th Democratic vote in the Senate, but the reality is that that seat is lost (at least until 2012), so perfection is no longer possible. Still, through the process I have just outlined the Democrats can come extremely close to the bill they would have passed had Coakley won. What they can't do now is give up. Failure to pass a bill after all the effort they have put in will deal a major blow to Obama, perhaps putting his entire presidency in jeopardy, and if he goes down, the Democratic Party is will go down with him for another generation.

So they need to do three things—have the House pass the Senate bill, amend it instantly with a bill that can pass the Senate with 51 votes through reconciliation, and enact another bill that will provide the language Stupak and his supporters are demanding. They have the votes. Now they need the will to do it.

And the winner is … Eric Jaffe, Mill Valley, Calif.!
[The president] bestows a plum appointment to [Iowa Republican] Sen. Chuck Grassley (ambassadorship, U.S. Trade Rep, Secretary of Agriculture, etc.). Grassley avoids what's seeming more and more like a tough re-election fight against Bob Krause. Iowa Gov. Chet Culver appoints the 60th vote. Done.

(This is a totally brilliant solution. I just hope Grassley doesn't hold out for John Paul Stevens' seat on the Supreme Court.)

E-mail Timothy Noah at chatterbox@slate.com.