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The Coming Conservative Health Care Freakout

Ever since Scott Brown beat Martha Coakley, conservatives, with very few exceptions, have been convinced that health care reform is dead. Friday's Charles Krauthammer column offers a good example of the prevailing sentiment: "Barack Obama's two signature initiatives -- cap-and-trade and health-care reform -- lie in ruins."

Some of us realized all along that there was no rational reason that the Massachusetts election had to kill health care reform. Fundamentally, the main barrier -- getting sixty votes in the Senate -- had already been crossed. The remaining obstacles are puny. All the Democrats needed to do was have the House pass the Senate bill. If they insisted on changes, most of those could easily be made through reconciliation, which only requires a majority vote in the Senate. Most conservatives paid no attention to this basic reality, though they did indulge in some gloating mockery of those of us who pointed it out. (I've "gone off the deep end." "It is all rather pathetic." Etc.)

But the mustache-twirling bonhomie has started to give way to the realization that the legislative door to health care reform is wide open, and Democrats simply need to walk through it. By no means is it clear that they'll succeed. But I've been waiting for conservatives, filled with hubris at having swept liberalism into the dustbin of history, to wake up to the fact that health care reform is very far from dead, and start to freak out.

Friday's New York Times report that Obama plans to propose a bill on Monday signaled the start of the freakout. Former Bush administration aide Yuval Levin writes:

The apparent decision to push Obamacare through reconciliation gives new meaning to the term political suicide. It will almost certainly fail, for one thing. And it will persuade rank and file Democrats in Congress that their leaders have lost their minds, and so will badly divide the Democratic caucus and make for a very difficult year to come for them.

Brian Darling at Red State speculates that the Democrats will fire or overrule the parliamentarian in order to pass their plan through reconciliation. Republicans actually did fire the parliamentarian in 2001, after he complicated their plans to push tax cuts through reconciliation, but this caused virtually no outcry. But Democrats aren't going to need to do so. The paranoia stems in part from a failure to understand the technicalities of what's going on here -- liberal policy wonks have been following this closely for the last month, but hardly anybody else has. There was some discussion last year of using reconciliation to pass the entire health care bill and avoid the filibuster. This ran into technical difficulties -- reconciliation can only be used for measures that principally effect revenues or outlays. So instead the Democrats passed a health care bill through the Senate using regular order.

Now, of course, the problem is that they can't mesh the Senate bill with the House bill using regular order, because Republicans will filibuster it. But most of the points of negotiation between House and Senate concern taxes and spending -- exactly the kinds of things that reconciliation is designed for. So it's fairly easy to just have the House pass the Senate bill, then use reconciliation to eliminate the Nebraska Medicaid subsidy and change the mix of taxes that pay for new coverage. Indeed, this process is probably easier than getting another 60 votes in the Senate would have been even if Martha Coakley had won.

You can imagine how this feels to conservatives. They've already run off the field, sprayed themselves with champagne and taunted the losing team's fans. And now the other team is saying the game is still on and they have a good chance to win. There may be nothing wrong at all with the process, but it's certainly going to feel like some kind of crime to the right-wing. The Democrats may not win, but I'm pretty sure they're going to try. The conservative freakout is going to be something to behold.