Thursday, September 10, 2009

Rumors of the Death of National Health Reform are Greatly Exaggerated

By Tom Bunnell

Director, Institute for Health, Law & Ethics at Franklin Pierce Law Center

After a tumultuous August, there are a number of reasons why national health reform is still very much alive, prognostications of doom to the contrary.

Legislatively, health reform’s prospects are further along than ever before – four of five committees of jurisdiction in Congress already have approved comprehensive health reform bills. And the remaining policy differences (posturing to the contrary) are relatively narrow and far from irreconcilable.

But the most straightforward (albeit trouble-causing) explanation is purely political.  Failure is not an option for Democrats who want to stay in power.  Indeed, the shared fate of the Obama presidency and of the Democrats’ majority status in the US House and Senate appears increasingly likely to depend on the passage of health reform that works.

With political stakes so high, it’s little wonder that the August recess featured no small share of partisanship and fear-mongering, misinformation about health reform that metastasized in the news media, and select Republican leaders professing a goal that health care be Obama’s “Waterloo”.  .  .  .  Politics, after all, is not for sissies.

As the House and Senate now return to business, on Wednesday evening, the President will be addressing a joint session of Congress on health reform. 

Obama’s remarks will be tailored to a public, besieged by propaganda, that yearns for clarity, strength of leadership, and reassuring calm.  But the President’s other target audience is of equally vital importance: Congressional Democrats across the spectrum; and at least one Republican in the US Senate that steadfastly refuses to abandon policy for partisanship (Olympia Snowe of Maine). 

For reform to succeed, of course, Obama has to have the votes (a special challenge in the US Senate).

A “Cloture Vote”

While much has been made of the need for a 60 vote supermajority in the US Senate to pass health reform, the 60 vote requirement in Senate rules is rarely explained and oft-misunderstood. 

60 votes are not required in the Senate to actually pass a bill, but to overcome a real or threatened filibuster in order to allow a vote on the substance of the bill.  In other words, a so-called “cloture vote” is merely procedural and not substantive.

60 or more votes in favor of cloture allow a bill to go to the floor of the Senate for a vote on the bill’s substance. And critically, that subsequent vote on a bill’s substance requires only a simple majority (51 of 100 Senators) for actual passage of the bill.

Routinely and for a variety of reasons, there are Senators who do and will choose to vote in favor of cloture on a bill – in order to allow the measure to proceed to the floor for a vote on its substance – and then vote against the substantive bill on the floor.

Prevailing Strategy

At this juncture, one prevailing strategy is to have 60 Senators agree to vote in favor of cloture on national health reform legislation, even if some small number of them may end up opposing the measure and voting against it when it comes to the floor.  In that case, a 57-43 vote on the substance of health reform is still an impressive majority that assures passage of the bill.

Credible sources under DC’s golden dome believe that the Obama White House has – and will exercise – the ability to unify the 59 US Senators who caucus with the Democrats (with Sen. Edward M. Kennedy’s seat now open), and to bring Sen. Olympia Snowe along as the 60^th supporter, on a cloture vote. 

Resolution

The truth is that partisan hay-making and legislative sausage-making have obscured a deeper consensus in the policy world and the public realm.  Irrespective of party politics, a sizable majority in Congress wants to get health reform done, and most Americans support the outlines of what they’re trying to do. 

For all the passionate arguments over a few particulars (including a public option), Congressional Democrats across the spectrum – and at least one lone Senator from Maine – want to pass a bill, not kick it down the road or try to make the issue go away. 

As we await the President’s address to Congress – and even while the White House, Congressional Democrats, and Senator Snowe have yet to seal the deal – comprehensive health reform is still very much alive. 

Down the home stretch, if supporters can keep their heads while others don’t, and if the President continues to focus the debate on what’s really at stake for families, businesses, and our nation’s economy, we can look for a meaningful version of health reform to cross the finish line this year.

Tags: Citizens Health Initiative, national health Reform Obama

This entry was posted on Thursday, September 10th, 2009 at 9:05 am and is filed under Health Reform. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.