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Why I'm Hopeful On Health Care

Have you read Jonathan Not Me's latest take on where health care stands? If not, go read it right now and then come back.

Okay, so you've read it. Now let me chime in with a few thoughts of my own. Most of the coverage you've seen elsewhere -- this L.A. Times article offers a notable exception -- has offered a more dire take than the two Jonathans'. Here's why I think most of those prognoses are too grim.

First, as I've been saying, the fundamentals have not really changed since the Massachusetts election. Democrats have already paid whatever political price they'll pay, having voted through a bill in both houses. They've already done the hardest part by far, which is overcome a Senate filibuster. All that remains is getting 218 votes in the House to pass the Senate bill and 50 votes in the Senate to fix it, mostly with popular changes. The big picture view is that the Democrats have a massive incentive to get this done, and the procedural road to accomplish that has not gotten any more difficult. Generally, though not always, politicians can grasp their political self-interest.

Second, the news coverage has mostly been ignoring the fundamentals, and instead has revolved around ground-level reporting in Congress. This presents a pretty unhappy picture: The House and Senate distrust each other, everybody's freaked out, various members of Congress are spouting off. This is an important part of the picture. But it isn't the whole picture. Members of Congress have an incentive to hold out and express their skepticism -- it maximizes their bargaining leverage, and protects them in case of failure. Most of the news reports covering health care made this same mistake in the summer and early fall. Story after story emphasized disunity and obstacles, which was the ground-level picture, when the important dynamic was that the Senate Democrats came together in response to Republican obstructionism and decided to pass a bill.

Third, the biggest hurdle is the House of Representatives. The House is a majoritarian institution that tends to act like a parliamentary party. The House doesn't kill the agenda of a president of the same party. It's not just the lack of a filibuster -- House members are not like Senators. One thing that struck me about President Obama's appearance at the House GOP retreat was the way the Republicans treated him at the end, mobbing him for autographs. Senators don't act like that. Very few members of the House have the ego to stand up to serious pressure and tell their president they're going to kill the centerpiece of his agenda.

Again, I'm not making a guarantee or anything close. Among other things, my scenario presupposes an intense, engaged White House lobbying the House at the end of the process, and that level of engagement may not materialize. And multiple things could go wrong. Another negative political shock, not even as large as Massachusetts, would probably be fatal. Still, I wouldn't bet against a signing ceremony.

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