Healthcare Reform

Apparently, Sen. Dick Durbin, D-Ill., the Democratic whip whose comments Thursday about rallying lawmakers to vote against a public option, had had a change of heart. Aides told the progressives -- and reporters -- that Durbin would whip lawmakers for the public option, but only if the House included one in a reconciliation measure. The up-and-down path the public option has been on since last summer was heading up once more. The Huffington Post splashed Durbin's comments on its homepage; things were looking good.

But don't open the celebratory bottles of government-insurance-program funded medicine quite yet. There may be more cause for pessimism than optimism over the public option's fate, even though Durbin's office says he'll "whip aggressively" for the plan if it makes its way over from the House. Here are the top five reasons not to get too excited about the latest development:

1) Durbin didn't actually change his position. Aides say Durbin, who has been a vocal supporter of the public option all along, never meant to indicate it was dead Thursday, and the pressure he got since then didn't bring him around. "There is no change in his position; it's exactly what he meant yesterday," spokesman Joe Shoemaker told Salon. "In the simplest terms, Durbin will whip against any attempt to alter or amend the reconciliation bill sent over by the House -- if it includes a public option, Leadership will whip for it and against all amendments to strip it out; if not, they will whip against any amendments to alter the House bill." Which means Friday's "news" doesn't actually change where things stand -- the House still needs to put a public option in the reconciliation bill.

Why is it all up to the House? For a combination of reasons. One, the House doesn't trust the Senate much farther than House Speaker Nancy Pelosi could throw Senate Majority Leader Harry Reid right now. (Which is not that far, even if Reid isn't the biggest guy in Congress.) In order to finish the healthcare bill, the House will have to pass the Senate-passed version, which House members hate, and only then take up a reconciliation measure designed to "fix" the bill. The Senate has to promise the House that whatever comes over won't be changed; otherwise, the House might not have faith that the Senate will actually finish the job. Two, the reconciliation measure, because it would raise some taxes, must begin in the House anyway. And three, the Senate parliamentarian told Republicans there Thursday that the Senate can't take up the reconciliation measure until after the House has passed -- and Obama has signed -- the underlying healthcare bill. Otherwise, it's not reconciling an existing law.

All of that means Durbin had plenty of room Friday to pass the public option buck over to the House, and look justified in doing it. Conveniently, of course, that also means the Senate is slightly off the hook if the public option doesn't actually make it into the reconciliation plan.

2) The Senate still might not have the votes for the public option, anyway. The Progressive Change Campaign Committee and its allies have done impressive work building up support in the Senate for a public option from 0 lawmakers on record to 41. But 41 is still short of a majority. The holdouts who haven't signed on so far include Evan Bayh, Kay Hagan, Mary Landrieu, Blanche Lincoln, Mark Pryor and Ben Nelson -- not exactly fertile ground for the public option. But liberals like Jay Rockefeller, of West Virginia, have also come out against adding it through reconciliation.

Pelosi herself doesn't think they can get it done. "I'm quite sad that a public option isn't in there," she told reporters Friday. "But it isn't a case of it's not in there because the Senate is whipping against it. It's not in there because they don't have the votes to have it in there."

Could nine or 10 more votes for the public option be found, if the House includes it? Maybe, though it's hard to see exactly how. But will Democrats want to gamble on that if they aren't sure? Probably not. If a clear majority for adding the public option isn't there, chances are leadership won't put it in the reconciliation bill and risk seeing it defeated.

3) House progressives don't seem ready to go to the mat for the public option There was a time when liberals in the House said they wouldn't vote for a bill unless it had a public option in it. But that was months ago. Now that Nelson and Joe Lieberman have had their way with the legislative process, the White House has basically told progressives that the existing bill, with some additional changes via reconciliation, is about as good as it's going to get. "[President Obama] said the public option -- a well-known and long-standing progressive priority -- lacks enough Senate support to be included in the final package," Rep. Raúl Grijalva, D-Ariz., the co-chairman of the Congressional Progressive Caucus, said last week after a meeting at the White House. "However, he personally committed to pursue a public option after passage of the current bill."

That might wind up being enough to keep progressives from voting against the bill in the end; the argument that an imperfect bill is still better than the status quo is a pretty good one. (Remember, the bill would ban insurers from denying coverage to people with preexisting conditions or revoking coverage once patients get sick, as well as setting up a new exchange for people on the individual insurance market and establishing new subsidies to help people afford coverage.) So far, only Rep. Dennis Kucinich, D-Ohio, has said he'll vote against the bill -- and that's been met by ridicule by some liberal bloggers.

4) Does the House even have the votes for the public option? That's not entirely clear yet. Though the House-passed version of the legislation in November did include a public plan, some Blue Dogs have defected since then -- and for a bill that only passed with 220 votes, there's not much margin for error.

Democrats may have to make a trade to get the Senate bill through the House as it is. Rep. Bart Stupak, D-Mich., and other antiabortion lawmakers say they won't vote for the Senate version, because its restrictions on choice are less rigorous than the ones the House included. If the bill loses Stupak's block of about a dozen votes, there's no way House Democrats can afford to alienate any more conservative lawmakers by including the public option.

5) Why get excited about the public option, when the whole bill might still collapse? What is or isn't in the reconciliation measure is, for now, a theoretical question. The more pressing matter is figuring out whether Pelosi can wrangle the 216 votes she needs to get the House to pass the Senate's healthcare bill.

That's far from guaranteed right now. The White House has already announced that Obama will delay a trip to Indonesia next week, an admission that the deadline the administration had set for passing the healthcare bill -- March 18 -- won't be met. (But why should this deadline be any different from all the others that have been missed so far?) And no vote has been scheduled yet in the House, which is usually an indication that the votes aren't locked up yet.

In other words, there's still time for the whole thing to screech to a halt. Which means the public option wouldn't be the only policy that doesn't make it into law. No matter what Durbin says about it.

Caddell is in today's Washington Post with an op-ed he co-authored with Doug Schoen, Mark Penn's polling partner and another Fox News favorite. Their message to their fellow Democrats: Healthcare reform will destroy you this fall!

"If it fails, as appears possible, Democrats will face the brunt of the electorate's reaction," they write. "If it passes, however, Democrats will face a far greater calamitous reaction at the polls. Wishing, praying or pretending will not change these outcomes."

Mind you, they're only issuing this warning because they want to help the party they love: "At stake is the kind of mainstream, common-sense Democratic Party that we believe is crucial to the success of the American enterprise. "

And this isn't the only time Caddell has spoken out to defend the best interests of his party. Let's take  a moment to remember a few other instances from the last decade:

* Al Gore lacks character! (December 2000):  "We took [character] out of the equation in '92. The American people will never again take it out of the equation. Character matters. And in this kind of election, it matters a lot. And Bush has won that election"

* Going after Lieberman will destroy the party! (August 2006): "And this is my concern, is that if Joe Lieberman loses Tuesday -- and I hope... he doesn't, but I've felt badly about this ever since The New York Times went off the deep end and endorsed Lamont. But I'll tell you, I think if he loses you're going to empower what I call the real fringe of this party who are going to believe that they've been right all along and they are going to start setting litmus tests for everybody. A month ago, [there were] nine votes for pulling out (of Iraq) with a set timetable next year. You know the demand is going to be that position of the Democratic Party or else. That's what we're looking at here, this is kind of madness. The country's going to look at us and say, "What are you doing?"

* The Democrats can't win back Congress by criticizing the Iraq war! (September 2006): "Remember in '04, I kept saying to my party....'Get away from this National Guard thing. Stop doing this!' I'm telling you right now, the movement on the war on terror in Iraq have moved substantially, and I've just finished 40 hours of analysis on this. It's amazing. This is -- I don't think that's the issue the Democrats ought to be campaigning on, frankly. I don't care how many NIE reports come out."

* Leave George W. Bush alone! (October 2004): "Let me tell you something. I have said over and over...that this Michael Moorism, this hate stuff, this almost thuggery on the part of the sort of people that were brought into the [John Kerry] campaign, you know, sort of attacking Bush so personally was backfiring. I said this last week it was a mistake. It drives -- particularly when the president's personally popular as an individual but has problems. And they can't -- they've let themselves be dominated by that, because they think that's the next gimmick."

But, honestly, all Pat Caddell wants is what's best for the Democratic Party.....

The public option, of course, was public enemy No. 1 for Republicans last year. The GOP falsely blasted the healthcare reform bill as "a government takeover of the healthcare system," claiming any public insurance plan would inexorably lead to long waits, medicine shortages, crappy care -- in short, Canada, or at least Canada as portrayed in Republican propaganda. (As opposed to the real Canada, where a poll last fall found most Canadians are perfectly happy with their medical system and think it's "far superior" to what we're stuck with in the U.S.)

But it's worth remembering that the public option -- even the relatively limited one that was in the House-passed version of healthcare reform, which would have allowed providers to negotiate with the government-run insurance plan, rather than tying reimbursement rates to what Medicare pays -- was a compromise to begin with. What most progressives wanted all along, of course, was a government takeover of healthcare -- a single-payer system, with a public provider mostly taking the place of the private insurance companies that are now fighting tooth and nail against even this relatively mild reform bill. Given the angst the bill has caused, and the rabidity with which the GOP has proclaimed it to be a government power grab, might Democrats be wishing they'd gone for the real thing instead, and actually pushed some kind of single-payer plan all along?

There's a certain political logic to the idea. Medicare, after all, is incredibly popular; one way the GOP has fought the reform bill is by scaring seniors that if the government fixes healthcare for everyone else, their own socialized medicine gravy train will come to an end. For that matter, so is the public option, which polls show voters like more than the reform proposals Congress has actually passed. And if you're going to get attacked for letting government take over healthcare, why not actually get some of the policy benefits of universal socialized medicine in the process? Call it Medicare for All, as proponents urged the public option be renamed, and charge full steam ahead.

Like so much else about the healthcare debate, it comes down to math. "I would say that in the Senate, there are at most 10 votes for a single-payer plan," Sen. Bernie Sanders, I-Vt., a self-described democratic socialist, who isn't shy about his own preference for that kind of solution, told Salon this week. "In the House, I have no idea but it's a small minority ... It's absurd to say, 'Mr. President, go forward and make your bill single-payer,' when you've got 10 percent of the Congress supporting you."

There are any number of explanations for why there aren't any votes for a single-payer plan; the massive campaign contributions and lobbying expenditures by the insurance industry and other big healthcare players surely didn't help the cause. But as the public option looks like it may, once and for all, be ruled out of the bill, it's worth remembering that even the Democrats in Congress are a change-averse bunch when it comes to healthcare. (After all, it was Democrats, not Republicans, who insisted on knocking the public option out of the Senate bill.) The writing was on the wall for the public plan for a while, even though it did make it out of the House; President Obama told key progressive lawmakers last week that the votes just weren't there, but even before that, the White House was being so blasé about the idea that it was hard to see the administration fighting for it. Sanders will introduce an amendment for the public option in the Senate, but if Durbin is going to whip Democrats to vote against it in the name of smoothing the reconciliation bill's passage, it's likely to be defeated.

Still, rather than taking that as a sign that the healthcare reform bill is fatally flawed, it's possible to see the failure of single-payer or a public option as a reminder of how difficult passing any reforms was going to be. It may be obvious to progressives that a single-payer plan would be better than the bill Congress is contemplating, but the bill Congress is contemplating -- with its reforms of the insurance industry and its expansion of coverage -- is still better than the status quo. That might be about the best anyone can hope for at this point.

The Senate has been the focus, and the sticking point, for much of the debate over reform. Now that Democrats have finally settled on using reconciliation to avoid a filibuster in that chamber, however, the real action is in the House. In order to prevail there, Speaker Nancy Pelosi needs to pull together 216 votes, which constitutes a majority since there are currently four open seats in the House.

At first glance, it seems like that shouldn't be a problem -- the House's bill did get 220 votes last fall, after all. But two Democrats who voted for the bill, Reps. Neil Abercrombie and Robert Wexler, have resigned in the interim, and Rep. John Murtha, D-Pa., another "yea" vote, died. On top of that, the lone Republican to vote for the legislation the first time around, Louisiana Rep. Joseph Cao, now opposes it. That brings the total down to the bare minimum of 216 votes. Plus, Rep. Mike Arcuri, D-N.Y., who voted for the bill in the fall, now says he's going to vote against, meaning that knowing what we know right now, Pelosi doesn't have enough support to pass the bill.

There's still time for both sides to whip votes, though, and a fair amount of members are up for grabs. Opponents of the legislation are -- and should be -- cheered by the continued opposition coming from Rep. Bart Stupak, D-Mich., who says he has about a dozen votes that will move away from the bill if his amendment restricting funding for abortions isn't included in the bill. Other Democrats who voted "yea" last year are wavering, too.

On the plus side for Pelosi, the fact that President Obama's proposal involves essentially passing the more conservative Senate bill, with fixes that remove some of its more unpalatable provisions, means some moderates who were no votes the first time around can probably be swayed.

Republicans, meanwhile, have adopted a new strategy for fighting against the bill, one that could actually prove effective: They've all but started taunting House Democrats. Among other things, they're working hard to exploit the divide that already exists between Democrats in the House and the Senate, trying to convince members of the lower house that their Senate colleagues won't deliver on their promises to fix their bill through reconciliation. That would leave vulnerable Democrats in the position of having to explain to voters why they voted for a bad bill that included things like the "Cornhusker Kickback." They're also pressing hard on abortion, reminding members that reconciliation rules won't allow for a fix to the Senate's language on the issue.

We should know more about how all of this is going to go after today, when House Democrats are slated to meet and go over provisions of the final legislation. More importantly, the Congressional Budget Office is expected to release its scoring of the package; once that happens, the markup process will begin in committee and things will really shift into gear.

"[I]t's definitely a very Ralph Nader-esque approach, I think, to politics -- a very unrealistic and self-defeating approach," Moulitsas said.

"And I'm going to hold people, like Dennis Kucinich, responsible for the 40,000 Americans that die each year from a lack of health care. And I don't care if you're a Republican or you're a conservative Democrat or you're somebody like Dennis Kucinich. The fact is, this does a heck of a lot for a lot of people ... It's not the ideal solution. But we have our foot in the door, and if somebody like Kucinich wants to block that, I find that completely reprehensible."

Later, pressed by O'Donnell, Moulitsas said he'd support the idea of a primary challenge against Kucinich if the congressman continues his opposition to the legislation.

As Firedoglake's David Dayen pointed out, it's actually too late for someone to decide to challenge Kucinich in a primary this year. But all this -- and some back-and-forth Moulitsas engaged in on Twitter after the segment aired -- leads to a larger discussion: What, exactly, has Kucinich accomplished during his seven terms in Congress?

Moulitsas argues that the congressman hasn't accomplished anything at all, and -- though I know I'm going to get slammed for saying this -- I have to agree. Sure, it's good to see a politician standing up for his beliefs and fighting for a point of view that might not otherwise be represented. But there are ways to do that and simultaneously be an effective legislator. Kucinich simply isn't, and he's never really tried hard to be. (You could also argue -- I would -- that the way he goes about things makes him pretty ineffective as a spokesman for his ideals.)

Just look at this section from the biography on his congressional Web site:

In Congress, Kucinich has authored and co-sponsored legislation to create a national health care system, preserve Social Security, lower the costs of prescription drugs, provide economic development through infrastructure improvements, abolish the death penalty, provide universal prekindergarten to all 3, 4, and 5 year olds, create a Department of Peace, regulate genetically engineered foods, repeal the USA PATRIOT Act, and provide tax relief to working class families.

Notice that the bio never says whether any of that legislation actually passed. In fact, according to the Web site GovTrack, of the 97 bills Kucinich has sponsored since taking office in 1997, only three have become law. Ninety-three didn't even make it out of committee.

The three that were enacted are, in chronological order from first to last: A bill "to make available to the Ukranian Museum and Archives the USIA television program 'Window on America,'" a bill "to designate the facility of the United States Postal Service located at 14500 Lorain Avenue in Cleveland, Ohio as the 'John P. Gallagher Post Office Building" and a bill "proclaiming Casimir Pulaski to be an honorary citizen of the United States posthumously."