Wednesday, March 17, 2010

Health-care reform: Navigating the tunnel's end

The health-care debate that’s on the verge of becoming American history has hundreds of thousands of personal stories that distill the nation’s perilous situation on health care for its citizens into something accessible. The lofty, procedural, partisan rhetoric of the issue comes down to everyday scenarios. Like the one for Natoma Canfield, a small-businesswoman recently diagnosed with leukemia, a woman whose story typifies the bureaucratic farrago facing those millions of Americans with pre-existing conditions.

Or Michael Brooks’ story. The 12-year-old Omaha boy, faced with a myofibroblastic tumor, a rare form of cancer that was unresponsive to chemotherapy, found that his family’s insurance wouldn’t cover an experimental procedure, according to KETV of Omaha. He faced a grim future until his community — from neighbors, friends and classmates to strangers wandering in off the street — rallied to gather the money for the experimental procedure. Health care by crowdsourcing: a sad sign of the times if there ever was.

It’s that kind of heart-wrenching financial improvisation that may be near an end in the United States. Sometime this week, maybe next at the very latest, President Obama expects to sign into law the most sweeping health-care legislation since Medicare, more than two generations ago, and the realization of an objective that has eluded this nation since Theodore Roosevelt first proposed it in 1912.

The caged death match Republicans have now with House Democrats hinges on so-called deeming resolutions, a procedure under which the yearlong saga of the health-care reform may finally be just about over. The resolution, shorthanded as “deem and pass,” was suggested by Rep. Louise Slaughter, chair of the House Rules Committee, and has been adopted and championed as a strategy by House Speaker Nancy Pelosi.



It's the latest skirmish in the health-care warfare between the House and the Senate, the bruising and confusing legislative choreography that all these months has looked like gridlock to the American people.

The intricacies of this entirely parliamentary procedure will provoke a headache you don’t need, but Jason Linkins of The Huffington Post, breaks it down nicely:
The House is stuck having to basically pass the Senate health care bill, because the bill cannot be reconciled in conference committee. Why? Because it will be filibustered. However, House members are averse to doing anything that looks like they approve of the various side-deals that were made in the Senate -- like the so-called "Cornhusker Kickback." The House intends to remove those unpopular features in budget reconciliation, but if they pursue budget reconciliation on a standard legislative timeline -- where they pass the Senate bill outright first and then go back to pass a reconciliation package of fixes -- they'd still appear to be endorsing the sketchy side deals, and then the GOP would jump up and down on their heads.

Enter deem and pass. Under this process, the House will simply skip to approving the reconciliation fixes, and "deem" the Senate bill to be passed. By doing it this way, the Democrats get the Senate bill passed while simultaneously coming out against the unpopular features of the same.

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The conservatives won’t roll over. In recent days, the National Republican Congressional Committee took out a new sky-is-falling ad, a countdown clock in ominous blacks, whites and red counting down the time before the expected vote.

And the conservative press is up in arms. The Wall Street Journal, mouthpiece of media buccaneer Rupert Murdoch, condemned “deem and pass” as an “amazing procedural ruse,” a “two-votes-in-one gambit” and “a brazen affront” to the Constitution. The Journal mentions in passing that the procedure has been used in the past, only going back to 1998 to put it in a shallow historical context.



Researching the issue, though, Ryan Grim of HuffPost found that the practice goes back a hell of a lot farther than that:
The first time that the chamber used what's known as a “deeming resolution” -- the mechanism Democrats are leaning toward using to pass the Senate health care bill through the House -- was March 16, 1933.

Then, as now, it involved a bill that had little support in the chamber among individual Democrats, but all of them knew they had to pass it. Very few Democrats want to vote for the Senate version of health care reform, but most are okay with it as long as it's amended through reconciliation.

Less than two weeks into FDR's first 100 days, Congress needed to raise its debt ceiling, a ritual vote that hasn't gotten any easier for the majority party in the intervening 77 years -- and is still political fodder for partisan opponents.

Instead of voting on the underlying Senate bill to raise the debt ceiling in 1933, the House voted on Resolution 63, which stated that "immediately upon the adoption of this resolution the bill H.R. 2820, with Senate amendments thereto, be, and the same hereby is, taken from the Speaker's table to the end that all Senate amendments be, and the same are hereby, agreed to. 
In other words, it was deemed passed and sent to the president for his signature. ...

“Republicans … have often made use of the deeming resolution themselves -- 36 times in 2005 and 2006, when they controlled the lower chamber. Democrats used deeming resolutions 49 times in 2007 and 2008.
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The bottom line: We may be approaching the light at the end of the long nightmare tunnel of the health-care debate, and this time there may be no oncoming train to deal with. The Republicans, themselves the beneficiaries of such legislative (and perfectly legal) slight-of-hand in the past (just like the Democrats), may be hoist on the same petard they’ve eagerly used before.



The stage is set for a vote this week. Some Democratic holdouts remain. Kucinich of Ohio, one of the staunchest Democratic opponents of the Obama plan, and a generally rock-solid progressive, was the object of pressure from the White House (as well as Natoma Canfield, who petitioned Kucinich to vote for the Democratic health-care plan with four poignant words: “Everything needs a start").

Citing sources, MSNBC’s Howard Fineman reported late Tuesday that Kucinich was likely to vote for the bill.

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The final count is expected to be close but Pelosi, DNC Chairman Tim Kaine, White House press secretary Robert Gibbs, senior White House adviser David Axelrod and the president himself have all forecasted a win. For health care. This time.

Some in the media think the vote happens on Friday or Saturday, a day or two before President Obama is set to leave for Asia.

The process of health-care reform can’t begin to change fast enough for middle-class Americans. A new report prepared for the Robert Wood Johnson Foundation by researchers at the University of Minnesota found that the U.S. middle class is losing health insurance more rapidly than any other income group.

The number of middle-income workers covered by employer health insurance declined by about 3 million between 2000 and 2008. The number of uninsured middle-income wage earners increased in that time from 10.5 million to 12.9 million -- more  than that experienced by any other income group.

This week, finally, President Obama drives to the basket on health-care reform. No shots from three-point land this time. In what may be the most pivotal vote of his presidency, and sure as hell the one with the deepest resonance for the people he governs, the president is doubling down for the need for change.

And change can’t get here fast enough for middle-class Americans. People like Natoma Canfield. People like Michael Brooks. People like anybody looking at you in the mirror.

Everything needs a start.

Image credits: Obama: Still from whitehouse.gov. Ad detail: National Republican Congressional Committee. Natoma Canfield: The Associated Press.

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