So, rather inevitably, the fate of health care reform now rests largely with a group of Blue Dog Democrats in the House. More specifically, the question is: Can Nancy Pelosi convince a small fraction of her caucus to endorse the Senate version of the bill, even though they initially rejected the House’s iteration? She’ll need to flip these members to her side because the abortion provisions in the Senate bill will necessarily cost her some votes.
The media chatter is all about these members' political calculus: How unpopular is health care reform in their districts? Would they be risking their careers with such a vote? But there’s another component of their decision that merits discussion—you know, the actual policy. The Senate bill, while sharing the same basic structure as the House bill, contains some pretty important differences. Would these members now have a substantive reason to switch into the affirmative column?
In fact, the Senate bill, even after the president’s proposed modifications, addresses almost all of the major concerns that the Blue Dogs have raised. As a matter of policy, the Senate bill is a moderate Democrat's dream. House moderates have to ask themselves, apart from political considerations, how can they now vote against a bill that senators Lincoln, Lieberman, Landrieu and Bayh have all voted for?
Let’s go issue by issue. The Blue Dogs opposed the public plan that featured so prominently in the House bill. Well, the Senate scrapped that a long time ago. Blue Dogs wanted more cost-containment policies. Well, the Senate bill is not just stronger, but substantially so. It features a robust Independent Payment Advisory Board with authority to lower Medicare payment rates. The House bill doesn’t even have such a commission. The Senate bill also has stronger provisions to push payment reform through a new “innovation center” that will reward quality of care, rather than the volume of care that doctors provide. These are important moves away from the fee-for-service system.
Some House moderates criticized the House bill for taxing the rich. Lucky for them, that’s barely in the Senate bill. While the House bill used the millionaire’s tax to raise $460 billion in revenues, the Senate bill has a Medicare tax that raises only $87 billion from high-income folks.
What about deficit reduction? Both the House and Senate bills would reduce the deficit by upwards of $100 billion over the next decade, but the Congressional Budget Office gives the Senate bill better marks over the next decade on longer-term savings. The CBO says the Senate bill “would reduce federal budget deficits over the decade after 2019 relative to those projected under current law—with a total effect during that decade that is in a broad range between one-quarter percent and one-half percent of GDP.” Furthermore, they should be suffering from significantly less sticker shock. The Senate bill costs nearly $200 billion less over ten years. Not a trivial difference.
In short, as a moderate House Democrat said to me in December after she voted against the House bill, “I like where the Senate bill is going and I would vote for that.” Of course, that was before Massachusetts. But the Senate bill did not change. And neither should her intentions.
Now, most of these provisions that should appeal to Blue Dogs are a source of agitation for liberals. But liberals seem to have made the following calculation: In order to get a bill that covers 30 million Americans, with insurance reforms that protect consumers, they will swallow hard and accept several provisions that anger them. It’s called compromise—and, in some quarters, it’s also known as governing. Liberals shouldn’t be the only ones who bear the responsibility to govern. That falls to the whole Democratic Party—its right, left, and center.