Here's the bottom line: For health reform to become law, the 2,700-page Senate bill somehow has to get through the House.
The trickery that Speaker Pelosi is concocting to get that done almost defies belief. It's aptly called the "Slaughter Strategy," after Rep. Louise Slaughter, D-NY, who cooked it up.
Here's how it would work: The House would "deem" the main Senate bill to have passed without directly voting on it as long as the House approves a companion bill of amendments to the Senate bill.
Got it? The original bill and the bill of fixes would be tied together on final passage. Enough House members hate provisions in the Senate bill that Pelosi can't round up 216 votes to pass the Senate bill alone.
The Slaughter Strategy (more likely describing what would happen to House members in November if they try this) would allow House members to say they never voted for the Senate bill, just the amendments to fix it.
Former Speaker Newt Gingrich had the best line: Last year, the House was passing bills without reading them. This year, they're passing bills without voting on them.
How is this possibly even remotely constitutional?!
Five alarm: I attended a meeting in the Capitol on Tuesday with the top Republican leaders from the House and Senate in which Congressman Mike Pence said, "This is a five-alarm fire! Think about the biggest battle you have ever fought and double your effort. This is the most important fight of our time!"
Trust us! There is one simple fact behind all of these bizarre contortions of the legislative process: The House simply doesn't trust the Senate.
The only way that the legislative process can move forward right now is for the House to pass the Senate bill. Then they have to trust that the Senate will wage and win an incredibly difficult battle to pass a totally separate second health reform bill to fix the things in the bill the House hates.
The operable term here is "Trust us."
"The House has a right to be skeptical," Sen. Richard Durbin (D-IL) told reporters. The House has passed almost 300 bills that are "somewhere lost in the Senate," he said. That includes such things as Cap and Trade legislation that the Senate apparently has no intention of bringing to a vote.
The House will have to believe that the Senate will come through for them and pass a second health care bill to amend problems with the first one.
This reminds me of a line from one of my favorite country and western songs: "Just give me one more last chance."
So the House wants a guarantee that the Senate will vote on a second health reform bill that removes the Cornhusker Kickback, the Louisiana Purchase, Gator Aid, and the dozens of other sweetheart deals in the Senate bill.
But the Senate Parliamentarian told congressional leaders that the Senate can't consider a second bill to amend ObamaCare until the original bill is passed and signed into law.
But what happens if the House "deems" the Senate bill to be passed because it was piggy-backed onto the package of associated amendments?
Under normal procedures, if the House passes the Senate bill, the president will sign it, and ObamaCare will be the law of the land.
In fact, AP reported yesterday: "White House spokesman Robert Gibbs said that if the Senate bill is cleared by the House and reaches Obama's desk, he'll sign it."
The operable question of the day is whether the president could sign a bill the House "deemed" to have passed before the Senate votes on the actual bill of amendments it was attached to.
Senate strategy: And another thing: There is no "reconciliation package." That would assume some normalcy to the legislative process — like a conference committee you learned about in civics. They aren't doing that.
The Senate plans to use the process designed for budget reconciliation to get past normal Senate rules that require 60 votes. This ultra-partisan process would be used to consider this totally separate bill that no one has seen yet to amend its own bill to suit the House.
What possible incentive does the Senate have to carry through with this incredibly difficult maneuver once its own bill has been signed into law?
And the battle will be difficult: Senate Republicans have signed a pledge that they are going to hold the leadership to a very strict interpretation of what will be allowed to pass the Senate through the narrow budget reconciliation pipeline. Republicans don't have enough votes to impact the 51-vote threshold for passing the measure or amendments, but they can make sure that any provisions are thrown out unless they strictly adhere to the rules.
Abortion language won't clear the hurdle, and it became clear yesterday that the House is not even going to try to fix the liberal abortion language in the Senate bill. That means Rep. Bart Stupak (D-MI) and other strong pro-life House Democrats will have a very, very difficult time voting for the Senate bill because it clearly allows abortion coverage in federally funded health plans. Jim Capretta has an excellent post today explaining this on National Review.
If the Senate doesn't pass a second health reform bill, that means House members will be on the hook, likely forever, to defend their votes for all the special deals in the Senate bill that have repulsed the American people.
Senate Majority Leader Harry Reid is trying to explain this, clearly saying that passing the Senate bill through the House is the main event: "[T]he reconciliation bill now under consideration would not be the vehicle for comprehensive reform — that bill already passed outside of reconciliation with 60 votes," Reid wrote on Thursday in a letter to Senate Republican Leader Mitch McConnell. That is, 60 votes before Sen. Scott Brown came along.
Reconciliation is the process through which the Senate may — or may not — pass a totally separate, second piece of health reform legislation that would attempt to address some, but surely not all, of the House's problems with the Senate bill.
It would be a long and painful debate in the Senate.
But trust me! They'll do it. If only the House votes first. To pass the Senate bill.
Want to buy a bridge, anyone?
CLIP OF THE WEEK
Grace-Marie Turner on reconciliation
The health reform debate has been buzzing this week with talk of the House of Representatives using the reconciliation process to pass the Senate's bill. As Grace-Marie Turner explains in an original Galen Institute video, if the House and Senate pass identical bills, Obamacare will become law, and neither the House nor the Senate will be required to make fixes through additional legislation.
More video and audio clips are available on the Health Reform Hub >>
GALEN IN THE NEWS
Will the House Be Tagged Out on Reconciliation?
John S. Hoff, Galen Institute
The Examiner, 03/08/10
The reconciliation scheme to pass health reform is a hidden-ball trick, Hoff writes. The danger is that Americans may focus on the planned reconciliation package (which still does not exist), while the Senate-passed bill is snuck th
rough the House and enacted as law while they are looking elsewhere. The critical question is whether reluctant members of the House will be seduced into approving the Senate bill on the promise of changes that may or may not actually be enacted — but which in either case would not avoid the serious harm that the legislation would do. Read More »
Obama's Misleading Assault on the Insurance Industry
John E. Calfee, American Enterprise Institute
The Wall Street Journal, 03/12/10
The president's populist foray against health insurers is a reckless diversion from the broader debate over how to deal with both the insured and the uninsured, including those with significant pre-existing medical conditions, Calfee writes. He and his reform allies should explain to the public the real dilemma. Health insurers operate in a market in which party one (the patient) is told by party two (the doctor) what products and services to consume, while party three (the insurance firm) pays the bill, and more often than not, party four (the employer) bears the financial risk of cost overruns. That's a tough business environment in which to make money without offending someone. Read More »
Numbers that Border on "Udder" Nonsense But Are Milked for All They Are Worth
Tom Miller, American Enterprise Institute
National Journal Expert Blogs: Health Care, 03/12/10
Perhaps the only thing that is more inflated than recent insurance premiums is the distorted depiction of administrative costs and profits for private insurers, Miller writes. Insurers could do a better job of trying to control low-value health care expenses and streamlining administrative hassles, instead of largely passing through rising health care costs to payers and blaming everyone else. But providers also could do a better job in delivering better coordinated and more evidence-based, higher-value care. And health care consumers could do a better job of seeking out and using the limited and imperfect information that does exist regarding better treatment choices, as well as improving their health behavior and lifestyle practices. Politicians could pause from blaming everyone else, too, and reflect instead on reducing and correcting the host of misincentives, regulatory excesses, and price distortions that they have previously created (before adding even more). Read More »
Health Bill Gives Bigger Subsidies to Newly Covered Health Exchange Users Than to People Who Get Insurance at Work
Stephen J. Entin
Institute for Research on the Economics of Taxation, 03/10/10
Proposed subsidies for people eligible to buy health insurance policies through the new exchanges would be much larger than the tax subsidies currently available to people with employer-provided health insurance, Entin writes. For example, under the House bill, a family of four earning $42,000 would receive a total subsidy of $17,400, or 85% of the cost for getting the health exchange policy. The family getting its policy through its employer has a total subsidy of $3,921 or 19.1%. That's a difference of $13,479. Read More »
The Congressional Budget Office has probably understated the cost of health care reform measures before the Congress by omitting the rather obvious effect of the higher subsidies on people's demand for health care and on the unit costs of providing it, Entin writes in a separate paper. CBO asserts that the Senate health bill's effect on health care spending and on premiums would likely be small by 2016, but unit costs in the health care area have risen dramatically, in part due to the expansion of insurance and health care demand over the past 50 years. Costs likely will be driven higher by 2016, and rise further thereafter as more people learn to make use of the new insurance. Read More »
Obama's Proposed Medicaid Expansion: Lessons from TennCare
The Heritage Foundation, 03/03/10
Tennessee's experience with TennCare demonstrates that the free lunch now promised by President Obama of increased coverage with reduced costs is likely a pipe dream, Blase writes. Enacted in 1994, Tenncare was Tennessee's attempt to reduce the number of uninsured individuals through a major expansion in Medicaid. Although the rate of uninsured individuals dropped substantially, costs exploded. While inflation-adjusted per capita Medicaid spending across the rest of the states increased an average of 71% between 1994 and 2004, the corresponding increase in spending on TennCare was 146%. Further, instead of improving health care quality, mortality data indicates that TennCare may have resulted in a decline in the quality of care for Tennesseans. In the four years following TennCare, the average decline in mortality rates in the surrounding states was 5.2% compared to a 2.1% decline in Tennessee. Read More »
INTERNATIONAL HEALTH SYSTEMS
Labour Hid Ugly Truth about National Health Service (NHS)
The Sunday Times, 03/07/10
Damning reports on the state of Britain's National Health Service (NHS), suppressed by the government, reveal how patients' needs have been neglected, The Sunday Times reports. The first report, by the Massachusetts-based Institute for Healthcare Improvements, identified the neglect of patients as a serious obstacle to improving the NHS. One heading in the report says: "The patient doesn't seem to be in the picture." It adds: "We were struck by the virtual absence of mention of patients and families…whether we were discussing aims and ambition for improvement, measurement of progress or any other topic relevant to quality." It has emerged that the recommendation of the reports, intended to help the NHS improve, have not even been circulated. Read More »
Intelligent Health: Exploring the value of innovation in health care
Galen Institute Conference
Thursday, March 25, 2010
8:30am – 1:00pm
Grace-Marie Turner speaking on the Vital Signs show
KFTK-FM Radio Broadcast
Saturday, March 13, 2010
St. Louis, MO
Grace-Marie Turner speaking on the David Gold show
KSFO-AM Radio Broadcast
Saturday, March 13, 2010
San Francisco, CA
Is Wyden-Gregg the First Step to Fundamental Tax Reform?
The Heritage Foundation Event
Tuesday, March 16, 2010
Taking Control of the Health Care Debate: Avoiding the Mistakes of the 1990's
The Heritage Foundation Event
Thursday, March 18, 2010
10:00am – 11:00am
ObamaCare: What the House Should Know about the Senate Bill
Cato Institute Capitol Hill Briefing
Monday, March 22, 2010
Would Universal Coverage Improve Health?
Cato Institute Policy Forum
Thursday, March 25, 2010
Compensating Bone Marrow Donors: Patients versus the Department of Justice
American Enterprise Institute Event
Friday, March 26, 2010
10:00am – 12:00pm