Health Care End Game

Spoiler alert: How it will end

Carl Leubsdorf, former Washington Bureau Chief for The Dallas Morning News, predicts that last weekend's statements by President Obama and Secretary of Health and Human Services Kathleen Sebelius mark the beginning of the end game for health care reform. Obama said a "public option" was just a "sliver" of health care reform. Sebelius said it wasn't the "essential" part of health care reform. Leubsdorf said he saw such compromises on substantive parts of health care reform coming three months ago.

Compromise is one way to see the end game playing out. But Leubsdorf's playbook suffers from the fact that Republicans, so far, show no interest in compromise, even if Obama does. Key GOP players were quick to reject even the insurance cooperatives that have been offered as an alternative to a public option. And I can't imagine any GOP softening later. The anger that those Tea Party protestors have been barraging Democrats with would be redirected in an instant at any GOP Congressman or Senator who broke ranks with the party of "no."

There's another ending to this game that is more likely. Without GOP support, the Democrats are going to have to pass this bill themselves. To put that in the best possible light, they'll need to be able to say they really tried to compromise but the Republicans would have none of it. The Obama administration's coordinated hints at compromise are the bait. If, against all odds, the GOP bites, Obama gets his bipartisan bill. If, as is much more likely, the GOP refuses to bite, Obama gets to say he tried to compromise but the GOP said "no." Either way, he wins, as the Democrats have enough votes to pass health care reform without any Republicans on board, even if takes the obscure budget reconciliation process to do it. So, expect the public option to be included in the final bill and pass by the skin of its teeth.

The final vote will be really close, by design. The final bill will be crafted to get maximum reform with just enough votes to pass both the House and Senate. Some Democrats facing particularly difficult re-election fights if they vote for health care reform will be allowed to vote no, but not so many as to send the bill down to defeat. Whose arms get twisted to stay on board and who are allowed to desert, that's where the end game negotiating will play out, among Democrats. But ultimate passage of the bill is assured, just like it's always been.

One risk with using the budget reconciliation process is that some provisions of the bill having only an incidental impact on the budget might get stripped out of the bill during the reconciliation process. How that plays out may not be possible to predict or control. So, Democrats are reluctant to use this route. But they will if Republicans (and just a single Democrat) force them to. Expect Republicans to do just that. And, Democrats being Democrats, expect at least one Democrat to do that, too. So, budget reconciliation it shall be.

P.S. Texas' representatives and senators are not players in this game. Their "no" votes are cast in stone. Texas is irrelevant. And likely will remain so as long as the likes of Kay Bailey Hutchison, John Cornyn and Pete Sessions represent us in Congress.