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Racing Against Time

For most of the last year, time has been health care reform's enemy. Could it now be reform's friend? That's the gamble reform's proponents in the administration and Congress are making now.

For most of the last year, the Obama administration and its chief allies in Congress have been trying to pass health care reform as quickly as possible. And, as we all know, they haven't been terribly successful. Deadlines slipped, negotiations stalled, and the public grew increasingly disenchanted.

When the Senate passed its health care bill on Christmas Eve, none of this seemed to matter. Some sort of agreement between the two houses seemed inevitable. But those negotiations also dragged on until, well, you know the rest of the story: Scott Brown beat Martha Coakley, Senate Democrats lost the ability to break unified Republican filibusters, and health care reform went from near-certainty to the longest of long shots.

After a few days of ambivalence and indecision, Obama and congressional leaders have announced they intend to push ahead with reform. But they've made clear that they're no longer in a rush. The White House and Congress are talking about the budget and the economy. Chief of Staff Rahm Emanuel suggested health care could wait until after a jobs bill and financial regulation. Democrats have talked about "letting the dust settle" and having a "cooling off" period.

Some of the people making these statements clearly don't want to be talking about health care reform, period. To them, delay is just a way of easing reform into death. But others say they have a specific plan in mind:

Use the coming days, or maybe weeks, to improve the Democrats' political standing by focusing on jobs and banking regulation; allow congressional members time to digest the political shock of Massachusetts and figure out that their best political interest lies in passing a blll; give Congressional negotiators the time and space to work out a new House-Senate compromise.

Yesterday brought some evidence that the strategy might actually be working. It came in the form of new poll numbers, which show Obama's popularity has risen in the last few days--a product, apparently, of the State of the Union address. It's pretty clear voters don't want to be talking about health care reform any more than members of Congress do. Seeing the president talk jobs and, more generally, dealing with the country's economic crisis is undoubtedly helpful.

And there are signs that the Congress, too, is starting to come around. I reported on some of this over the weekend. But I wasn't the first to notice the change. A week ago, in a dispatch for the Nation, Christopher Hayes reported

For the first time since the Massachusetts debacle, I'm cautiously optimistic about the fate of health care reform. Here's why: In the wake of Scott Brown's election, what was most dispiriting was the total leadership vacuum and chaotic, every-man-for-himself atmosphere among congressional Democrats. There didn't seem to be any hard consensus on what to do next. Some said: break it up into smaller pieces, radically pare down the bill, go back and find Republican support (ha!) or let the thing die. Every one of these options would actually spell the death of health care reform, and one of the most stunning legislative failures in recent memory. To even consider such a move seemed insane, and yet those of us paid to observe Congress have spent the last two weeks watching, with mouth agape, as congressional Democrats slowly raised a loaded gun to their collective mouths and volubly considered pulling the trigger.

But sanity has, tentatively, provisionally prevailed. After spending much of yesterday talking to folks on capitol hill, it's clear there is increasingly consensus on a path forward. ... The House has to come up with a list of changes to the Senate bill that will get them to 218 votes (and will also pass muster with the procedural constraints of "reconciliation". ... They then send those changes to the Senate leadership, which can pass them through reconciliation, a process that requires a simple majority. Once that process has moved forward or (better!) is completed, the House can then pass in quick succession the Senate bill, and the amended fix.

I still think ti would have been better to push ahead with reform immediately after the Massachusetts election, riding the momentum of the House-Senate negotiations that were just coming to a close. But once a day or two passed, that momentum was gone anyway. And now that the original momentum is gone, the smart play may very well be to take some time, build up political support, and attempt to reframe the debate before pushing legislation one last time.

But only to a point. The more time members of Congress spend away from health care, the less enthusiastic they will be about taking it up again. It's one thing to see a grueling debate through to the end when you're in the middle of it. It's quite another to restart that debate once it's stopped.

So there are basically two competing forces here. More time means more opportunities to craft a deal and build up political support. But it also means more time for Congress to lose interest. Even if waiting helps reform's prospects right now, that may not be true for long.

P.S. This weekend, at the annual "Health Action" conference sponsored by FamiliesUSA, I had a chance to talk about the timing issue, among others, on a panel with FamiliesUSA President Ron Pollack, Health Affairs editor Susan Denzer, and my friend Ezra Klein. Click here for the video.

Update: I should clarify something that I assumed would be implicit in the above. The only way to make sure a temporary pause in the health care debate doesn't become a permanent one is for advocates to apply pressure. Phone calls and e-mails to members of Congress, rallies, and the like are absolutely essential. The message can be encouraging or threatening; I'm rather fond of Ezra's suggestion that people tell their representatives they won't vote for them if health care reform dies. But one way or another, the advocates for reform have to let Congress know they care about it.