President Obama pushed health care reform throughout his campaign and early in his Presidency. The public option was an idea that he endorsed as a means of cost containment, though it was hardly the only idea President Obama raised. President Obama's big deal on health care was to reassure Americans that if you liked what you, you could keep it. Nonetheless, after he was elected, President Obama spoke frequently in support of the public option through the summer.
Problem 1: All, But One Republican, Votes "No" On Everything.
The problem is that Republicans simply want to bring down the President at all costs, thus they will do anything to kill any health care reform for political reasons. Thus, you lose about 39 votes in the Senate right out of the gate.
Problem 2: About nine Senators (1 Republican, 1 Independent, and 7 Democrats) Are Conservative
You have about nine votes who are somewhat indifferent to health care reform or hostile to many proposals such as a public option. Ben Nelson, Joe Lieberman, Olympia Snowe, Mary Landrieu, Max Baucus, Evan Bayh, Kent Conrad, Blanche Lincoln, and Jim Webb. Thus, you potentially lose another nine votes, but still hold a 52-48 advantage. Unfortunately, this is not sufficient to overcome a filibuster.
Problem 3: Reconciliation is not a panacea.
http://www.salon.com/news/politics/war_room/2009/11/24/reconciliation/print.html
The problem is that budget reconciliation isn't really supposed to be used to make policy. Instead, as the Congressional Research Service's Robert Keith said in a 2008 report, reconciliation "is a procedure ... by which Congress implements budget resolution policies affecting mainly permanent spending and revenue programs." In the procedure's early years, however, it was used to circumvent the filibuster on provisions unrelated to that purpose. So in the 1980s, then-Minority Leader Robert Byrd led the Senate in a crackdown. What resulted was the Byrd Rule, which prohibits the Senate "from considering extraneous matter as part of a reconciliation bill."
The definition of "extraneous matter" is fairly broad, and subject to interpretation -- during the Bush administration, Republicans passed tax cuts using reconciliation -- but it generally includes any provision that fails one of these six criteria, as listed in Keith's CRS report:
* it does not produce a change in outlays or revenues;
* it produces an outlay increase or revenue decrease when the instructed committee is not in compliance with its instructions;
* it is outside of the jurisdiction of the committee that submitted the title or provision for inclusion in the reconciliation measure;
* it produces a change in outlays or revenues which is merely incidental to the non-budgetary components of the provision;
* it would increase the deficit for a fiscal year beyond the "budget window" covered by the reconciliation measure; and
* it recommends changes in Social Security
Even if a provision violates one of these rules, it won't automatically be stricken from a bill. In order for that to happen, a senator has to take action, generally by raising a point of order. Then, the chair (the majority leader or a designee) rules on whether to sustain that point of order and remove the offending part of the bill. That may seem like an easy victory in the making -- Reid rules that the public option passes the Byrd Rule's tests, and that's that -- but that's not necessarily the case.
In other words, Alan Frumin could be placed in a position of writing or rejecting major points of the bill. The bottom line is that no one really knows what kind of bill we would end up with through reconciliation. I have yet to see a credible description of the type of bill that has the votes to be passed through reconciliation. In other words, even assuming you cobble a bill together that passes the reconciliation test, would we actually want it? The bar against denial based on pre-existing conditions is frequently mentioned as a casualty of the reconciliation process. What else would need to be jettisoned, and would it all pencil out in the end?
Dilemma: Should the President try to overcome a filibuster by trying to cobble together 60 votes, which means trying to get Senators on board, who may actually oppose large portions of the bill. Or, try to pass health care reform through reconciliation, which also means jettisoning portions of the bill in order to satisfy the Senate parliamentarian who could stymie the entire process with a few unfortunate procedural calls?
Now, health care reform is not the only reform issue that Congress will need to consider. There is cap and trade, as well as financial regulations. Unfortunately, Republicans have proven willing to try to shut down all legislation in order to inflict political damage to the President, which narrows the window that the President has to work with.
The other option, of course, is to throw one's hands up in the air in frustration, and declare that passing health care reform with the current Congress is impossible, which may actually put the health care reform movement in an even worse position, since the spinmeisters will point to a liberally controlled Congress that wasn't.
Conclusion: I think the President is making the right choice to get the best health care reform bill he can get passed through Congress for two reasons. First, doing so will establish that IT IS POSSIBLE to pass a health care reform bill. Second, once the main elements are adopted, it is easier to tweak the bill. Case in point is Medicare, which is constantly being tweaked.
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