Wednesday, February 3, 2010

Pass Then Patch

Last week, I pushed the idea that the House should act first on health care reform, by passing the Senate bill and the reconciliation patch even if the Senate had not agreed to act -- because, I argued, unlike the usual cases in which the House felt betrayed by Senate inaction, in this situation the House could be in a good bargaining position by making health care reform law and then sending over a patch.  I also argued that liberal bloggers and activists were siding with the House in their claims that it was the Senate that needed to go first because liberals assume (based on lots of evidence) that it's always the Senate that's the problem.

And last week, I thought momentum was building for my position.  But none of the reporting or comments on Nancy Pelosi's interview yesterday that I've seen have challenged her assertion that the Senate has to act first.  Here's Pelosi:
[I]t won’t happen by the House simply taking up the Senate bill. “Our members will not support the Senate bill,” Pelosi said. “Take that as a fact.”
And apparently everyone does take it as a fact -- Greg SargentNick Baumann, Steve Benen, Jonathan Cohn.  Here's how Matt Yglesias puts it:
If the Senate gets its act together and passes a “sidecar” bill of modifications under reconciliation order, then the House will pass the sidecar and pass the original Senate bill and everyone will look like geniuses. If the Senate doesn’t get its act together, then everyone will look like idiots.
But...why?  That is, why let the House off the hook? 

Once again: If the House goes first, passing both the Senate bill and reconciliation, the Senate is then presented with a health care law and some proposed fixes -- fixes such as the repeal of the Nelson deal, switching to taxes for rich people instead of the excise tax, eliminating lifetime caps, all of which should be fairly popular.  But the real key is that Senators would no longer be making a choice between health care reform vs. no health care reform; they would be making a choice between health care reform with Nelson, and health care reform without Nelson.  Democrats should flock to such a bill; Republicans will presumably oppose it anyway, but even that is good: the debate will no longer be over such things as the individual mandate or the exchanges, but over a much less complicated bill filled with goodies.   Not to mention that Republicans will be, should they oppose that bill, actually supporting the continuation of the Nelson deal. 

Now, I don't know what Members of the House are telling Pelosi, but if it's true that they are telling her that they will vote for pass and patch, but only if the Senate acts first, then they are making a real mistake.  Sure, voting for the Senate bill is ugly; they're going to have to bite the bullet and vote for the Nelson deal, and the Cadillac tax, and various other things they don't like.  But the truth is that sooner or later, one way or another, they are going to have to vote for that bill if health care is to become law -- including pass and patch with the Senate acting first. 

The danger, I suppose, is that the Senate lets them down again, even if they send the Senate a very appealing bill.  Is that really so bad? After all, they will be able to brag about the good things in the bill they passed, and also brag about voting for the patch bill -- and they can blame the Senate for not passing it.  Moreover, if the Senate can't pass the patch once the House turns the tables on them by making the Senate bill into law, then it's highly unlikely the Senate would ever have acted without that incentive.  So pass then patch gives Democrats in the House their best shot at health care, and their best shot at the best health care bill they can get.  Most likely the Senate will realize that the patch they are being sent is actually, as a stand-alone bill (which is what it would be at that point), a clear winner.

And then they can start planning the push for a public option through reconciliation if their majority survives the 2010 elections. 


  1. How about a commitment strategy? -- Obama publicly pledges to veto the Senate bill if the Senate doesn't pass the House patch. Hrm. That might make it worse.

    After today's Q and A performance I really think the centrist Dems would rather fail and be in the minority (or fail and be lobbyists). The 50th vote in the DW-NOMINATE rankings is smack in the unreliable Landrieu/Bayh/McCaskill belt.

  2. Jonathan has made his case and yet House Democrats just aren't accepting the logic of his position.

    How do we know? Because enough time has passed and Pelosi has not put the bill up for a vote. That action Pelosi backs up her contention that the Senate Bill alone cannot be passed, and I accept that Pelosi knows where the votes are. So House Dems are the problem.

    So what is the hitch? I suspect that enough House Dems have made their peace with the prospect of Dem health care failure. They are dug in and won't make the first move. It has gotten emotional.

    Time is not on the Democrat's side. A little time was needed for legislators to absorb the MA election blow, but not much. The bigger dynamic is that the public at large is impatient with how long health care has taken, and public HCR support continues to drop (check We seem to be at a now or never moment, and the House Dems are choosing never.

    Jonatahn's analysis says they are being stupid, and I cannot fault his logic. This won't be the first time people are stupid. It sucks, because the Dem lack of strategic intelligence contrasts rather poorly with the rather brilliant success of the Republican 'tease and delay and then all vote no' strategy.

  3. I actually wonder if the problem isn't Stupak. Recall that the house bill passed very very narrowly. It may well be the case that (as Pelosi says) there simply are not enough House votes for the Senate bill, patch or not.

    It's also a mistake to assume the house can easily get its way via reconciliation. There may not be, for instance, 50 senators in favor of cutting the excise tax (since they would need to raise the money somewhere else).

  4. Anon 10:08,

    If the problem is Stupak, patch or not, then the problem is the House, and that's where reform supporters should be looking.

    I don't know that the Senate would just roll over and pass whatever the House sends them in a reconciliation patch, but I do think that the House is (at least) no worse off if it passes the main bill first. After passage, the Senate has to act somehow, or else the Nelson deal remains the law of the land; right now, the Senate retains the option of not acting.

    So I think both your points are fair ones, but still don't shake the logic that reforms supporters should focus on getting the House to pass the bill first.


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