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Time to Enact Health Care With 51 Votes

Tuesday, 23 February 2010 10:30
Portrait, Robert Reich, 08/16/09. (photo: Perian Flaherty)

Portrait, Robert Reich, 08/16/09. (photo: Perian Flaherty)

his week the President is hosting a bipartisan gab-fest at the White House to try to tease out some Republican votes for health care. It's a total waste of time. If Obama thinks he's going to get a single Republican vote at this stage of the game, he's fooling himself (or the American people). Many months ago, you may recall, the White House and Dem leaders in the Senate threatened to pass health care with 51 votes - using a process called "reconciliation" that allows tax and spending bills to be enacted without filibuster - unless Republicans came on board. It's time to pull the trigger.

Why haven't the President and Senate Dems pulled the reconciliation trigger before now? I haven't spoken directly with the President or with Harry Reid but I've spent the last several weeks sounding out contacts on the Hill and in the White House to find an answer. Here are the theories. None of them justifies waiting any longer.

1. Reconciliation is too extreme a measure to use on a piece of legislation so important. I hear this a lot but it's bunk. George W. Bush used reconciliation to enact his giant tax cut bill in 2003 (he garnered only 50 votes for it in the Senate, forcing Vice President Cheney to cast the deciding vote). Six years before that, Bill Clinton rounded up 51 votes to enact the Children's Health Insurance Program (CHIP), the largest expansion of taxpayer-funded health insurance coverage for children in the U.S. since Medicaid began in the 1960s. Through reconciliation, we also got Medicare Advantage. Also through reconciliation came the COBRA act, which gives Americans a bit of healthcare protection after they lose a job ("reconciliaton is the "R" in the COBRA acronym.) These were all big, important pieces of legislation, and all were enacted by 51 votes in the Senate.

2. Use of reconciliation would infuriate Senate Republicans. It may. So what? They haven't given Obama a single vote on any major issue since he first began wining and dining them at the White House. In fact, Senate Minority Leader Mitch McConnell and company have been doing everything in their power to undermine the President. They're using the same playbook Republicans used in the first two years of the Clinton administration, hoping to discredit the President and score large victories in the midterm elections by burying his biggest legislative initiative. Indeed, Obama could credibly argue that Senate Republicans have altered the rules of the Senate by demanding 60 votes on almost every initiative - a far more extensive use of the filibuster than at any time in modern history - so it's only right that he, the President, now resort to reconciliation.

3. Obama needs Republican votes on military policy so he doesn't dare antagonize them on health care. I hear this from some quarters but I don't buy it. While it's true that Dems are skeptical of Obama's escalation of the war in Afghanistan and that Republicans are his major backers, it seems doubtful R's would withdraw their support if the President forced their hand on health care. Foreign policy is the one area where Republicans have offered a halfway consistent (and always bellicose) voice, and Dick Cheney et al would excoriate them if they failed to back a strong military presence in the Middle East. This is truer now than ever.

4. Reid fears he can't even get 51 votes in the Senate now, after Scott Brown's win. Reid counts noses better than I do, but if Senate Dems can't come up with even 51 votes for the healthcare reforms they enacted weeks ago they give new definition to the term "spineless." Besides, if this is the case, Obama ought to be banging Senate heads together. A president has huge bargaining leverage because he presides over an almost infinite list of future deals. Lyndon Johnson wasn't afraid to use his power to the fullest to get Medicare enacted. If Obama can't get 51 Senate votes out of 58 or 59 Dems and Independents, he definitely won't be able to get 51 Senate votes after November. Inevitably, the Senate will lose some Democrats. Now's his last opportunity.

5. House and Senate Dems are telling Obama they don't want to take another vote on health care or even enact it before November's midterms because they're afraid it will jeopardize their chances of being reelected and may threaten their control over the House and Senate. I hear this repeatedly but if it's true Republicans have done a far better job scaring Americans about healthcare reform than any pollster has been able to uncover. Most polls still show a majority of Americans still in favor of the basic tenets of reform - expanded coverage, regulations barring insurers from refusing coverage because of someone's preexisting conditions and preventing insurers from kicking someone off the rolls because they get sick, requirements that employers provide coverage or pay into a common pool, and so on. And now that many private insurers are hiking up premiums, co-pays, and deductibles, the public is even readier to embrace reform.

So what's been stopping Obama from using reconciliation? Even if some of the arguments held water before now, none does any longer.

My free advice to the President: If you want to get healthcare enacted you must use reconciliation and quickly. Host your bipartisan gab fest at the White House on Thursday. Tell Republicans you've been eagerly awaiting their ideas for over a year, but the American public can't wait any longer. Explain to them how our current economic mess is directly related to the health care mess - we're paying 16 percent of our GDP for health care while health insurers are hiking rates and Americans are losing their health insurance every day. Then tell the House and Senate to get to work on putting their bills together (or tell the House Dems to enact the Senate bill and then save their disagreements for reconciliation), and tell Harry Reid you want the Senate bill on a fast track of reconciliation.

Explain to the American people you understand their impatience. The Constitution does not require 60 votes in the Senate to pass legislation. A majority will do. That's called democracy.

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Robert Reich is Professor of Public Policy at the University of California at Berkeley. He has served in three national administrations, most recently as secretary of labor under President Bill Clinton. He has written twelve books, including "The Work of Nations," "Locked in the Cabinet," and his most recent book, "Supercapitalism." His "Marketplace" commentaries can be found on and iTunes. your social media marketing partner


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+11 # Guest 2010-02-23 12:57
Could it be that:
6. House and Senate Dems (and the Obama administration) don't WANT to enact health care reform because they know it will infuriate the insurance industry and jeopardize a major source of campaign contributions.
+6 # Guest 2010-02-23 13:42
You bet. They are in debt to insurance lobbyists like never before.
Liberman - $3.5 millions
Buccas - $2.5 million
on and on and on.
+6 # Guest 2010-02-23 13:46
The insurance companies are going to win no matter what. Since there will be no public option, they will get new forced customers. Insurance conscription. Oh yeah, there will be "rules" and "laws." Right. Just like in CA where Blue Shield is facing the dreaded "investigation" for raising its rates 39%. Oooh.. they're running scared now! So what? Investigators will say they shouldn't. They will insist they need to. Guess who will win? Now what happens if cases of exclusion or non-payment for services go to court or arbitration. Will your cancer patiently wait years for a settlement before it metastasizes? Will that heart or liver put their deterioration on hold while your case settles? Oooh there are going to be arbitration panels made up by insurance company appointees. A kangaroo court made up of paid-for kangaroos! Wake me when the screwing is done.
+4 # Guest 2010-02-23 13:51
Obama has been a center at best moderate who was wrapped in progressive clothing during the campaign. The smoking gun as to how nuts the right is how they unbelievably call this guy a socialist. If only!

If Obama wanted a public option we would have a public option by now. He's done a few good things but overall he has been pretty disappointing to we true progressives.

The sad truth is he likely is as far left as the corporate media will allow, notice how quickly they marginalized lefties like Feingold and Kucinich.

We are in a real pickle and that was true even before the 5 semi fascists on the Supreme Court voted for that dreadful corporations are people edict.

Welcome to "1984" in 2010.
+8 # Guest 2010-02-23 14:23
1. Remove the status of being a legal person from corporations.
2. Enact Clean Elections
3. Get rid of the Electoral college
4. Get rid of electronic voting and institute mandatory paper ballot verification procedures.

this is a beginning. reclaim the country for the people. that is our job!!!

then we have no fear of corporate money in congress. big fight? yep! necessary fight--absolute ly.
+2 # Guest 2010-02-23 15:11
I think the Democrats can still pass a bill with a public option with 51 votes. Senators keep on signing on, maybe because the public is telling them they want it. That should make the Democrats more popular: at last, someone does something! And the sentiment among the public, despite the Repub lies, is in favor of it.
+5 # nancy 2010-02-23 15:19
Look under the cloak of self-interest to discover the "why" of those reluctant to push for the public option. I hope we remember who they are at election time and vote them out. I hope you are telling them as much. Of course, they will just go on to the well paying position of lobbyist but at least we'll know who they are.
+10 # Guest 2010-02-23 15:44
Since Reich doesn't, will somebody else please explain why anyone would choose private insurance over a true "public option" (no age, income, or other conditions). If there are any conditions under which one cannot choose a "public option", then it is not a real option. For those 65 and older (like myself), we do have a public option already; it is called Medicare. By and large, it works very well, in spite of efforts to dismantle or blunt it. If we would just enlarge the public option we have now by dropping the age eligibility to zero, and allow the insurance companies to "compete" with Medicare (they can't and they know it), we would have the universal health care this country needs and deserves. Scuttle the Obama bill! Pass HR-676 (Expanded and Improved Medicare For All)!
+1 # Guest 2010-02-23 17:58
Touche' David and Tanya
+9 # Guest 2010-02-23 15:58
Just DO IT. Dammit.
+2 # Guest 2010-02-23 16:26
I do not want them to pass the Health Care bill options recently proposed by the President, unless they also add a public option. We need something that can really reduce the cost of Health Care and the recent proposals won't do nearly enough and will probably make all our premiums go up even more.
+1 # Guest 2010-02-23 16:56
If the President does not use reconciliation to push the health care to everyone, where will he ever do it? Republicans cannot be responsible for the horrible health care we've received, and they should be crazy for having done so.
+3 # Guest 2010-02-23 17:39
Let's remember that BEFORE the bill gets back to the Senate, it also must get paste a somewhat dysfunctional Democratic House of Representatives . This is not all about getting 51 votes in the Senate.

And by the way, Sandip K, Lieberman is only a "Democrat" when it's to his advantage. He's pretty much a Republican disguised as an "Independent."
+2 # Guest 2010-02-24 00:22
Hooray for Reich and all the comments from readers! Looks like we've been deceived by Obama, . . . but reading all these forceful letters from around the country, let's hope someone is tapping him on the shoulder and telling him to get with it! It's now or never, pass Medicare FOR ALL, RIGHT NOW!!!!
+2 # Guest 2010-02-24 07:44
And: urge Obama & Co to read George Lakoff on how to "frame" the debate in winnable terms. Terms most Americans--not those who read the NYT--can understand and be moved by. Bad or no health care "terrorizes" millions of Americans. Failing to care for "our" citizens is unpatriotic, un-American. Never mind charts, diagrams, statistics. People have to be moved, and health care is and should be thought of in moral terms.
0 # Guest 2010-02-24 10:41
As inidcated, RR and first responders are correct in terms of the courage and political will necessary for the reconciliation to occur. The risk is phenomenal because its impact and effect cannot be measured this year, regardless of passage of any health care bill. The public has been assailed with promises by an all too public group of elected messiahs and chicken-little officials whose messages - from either side - are neither clear nor always credible. Never take the decision-maker to a hostage negotiation situation. Keep the President back so we know less until he makes an informed decision.

September '64. RR entered the Richardson Hall dorm room and introduced himself as the next class president...and so he was.

CRB Dartmouth '71
+1 # Guest 2010-02-24 11:38
The republicans are being set up and they will fall into the trap.They will be seen as the obstructionists that they are. The democrats will capitalize on this during the midterm and next presidential elections. Now that we have an administration that is thinking long term we have to be supportive-rega rdless of our own short-term goals.
0 # Guest 2010-02-24 12:14
What if Reich is wrong, and this "health summit" is not really about trying to garner a few more Repub votes? What if there is really method to Obama's madness? After all, he is an incredibly intelligent and worldly man and he has been giving signs lately that he understands that the Repubs will not back anything he does, even if it is supported by the public, just because they want to make him fail. Further, he can see in the polls that he is still more popular and credible than either side of Congress. Maybe his plan is to really use this summit to publicly "call out" both parties in Congress; the Repub's obstinacy and utter lack of viable alternative, and the Dem's spinelessness? Sure, it's a huge risk for Obama, but he is the only one with the savvy and credibility to potentially pull it off and get anyone to move off the dime; and the risk of getting this far and losing all is far worse.
-1 # Guest 2010-02-24 14:34
The only problem with the public option is that it is an option. There should be very strong incentives against any private option.
+1 # Guest 2010-02-25 08:23
Such a relief to read all these comments -- my first time on this site.
May I just add that Paul Krugman told us in 2008 that Obama was much further to the middle than Clinton (Hillary, that is).
ON other hand, sexism being deeply rooted (even accept as fact) in our culture, the Republicans would have stomped on her every move without being seen as bigots. The most certainly would have skewered her effort create a public option.
On the other hand, she wouldn't have wasted a whole year trying get a bipartisan looking health reform.
+1 # Guest 2010-02-25 08:38
Reconciliation is going to pass health care. The sheep are invited to the WH and once there what can they do? Walk out? Hold their breath? Within a month the Congress will conduct a reconciliation vote and all of the Rep. moaning/gnashin g will evaporate and they will have to try to find another issue with holding power. The Pres is very smooth when it came to this issue and will win some support with it but it sure does cause angst among his supporters. But, what the hell, we are on the road to passage of health care legislation.
0 # Guest 2010-02-25 18:23
The Supreme Court Decision to allow unlimited corporation contributions to political campaigns probably has more to do with the impasse on Health Care Reform than any other factor.
Financing of re=election efforts is a priority to congressmen and senators, surpassing any citizen need regardless. Is it any wonder that the so-called War on Drugs programs is the source of major financing of political campaigns? Health Reform, NOW, is essential to our existence, regardless.
+1 # sinig88 2010-02-26 08:17
Mr. Reisch is absolutely correct. If by now, President Obama does not know or realize that the Republicans on both houses of Congress will always be against whatever he is for, then he is not the intelligent person I believe him to be. He must know this and take the bull by the horns, and institute the Reconciliation preocess. Don't listen to anyone else, be it Pelosi or Reid, or whatever. Use the Power of the Presidency. If an Idiot like GW Bush used this process, than an intelligent person like President Obama should use it. Forget the Republicans in Congress. They are the Party of NO NO NO and will vote against whatever President Obama is for. So, beat them at their own game, use the Reconciliation process to pass the Health Reform Law. I myself would like to see the Public Option included, however, it can always be added later as long as the original one is first passed into law.
0 # Guest 2010-03-12 01:52
Without the public option, there's little to love with so-called health care reform other than allowing those with pre-existing conditions to receive health insurance. But this is huge and its importance unquestionable. Otherwise, the bill is a baby step in the right direction and there's far from a guarantee that true reform will follow. The late Senator Pat Moynihan was correct when he said no major social legislation has been enacted without bipartisan support. This was doubtless on the president's mind when he called for the summit. But I fully agree that he has bent over backwards to gain opposition support, throwing the dice that the worst that can happen is the Democrats having a strong issue to place before the electorate in the upcoming midterm election. Still it is amazing how successful Republicans have been at getting American middle class voters to cast ballots against their own interests. We are not only the least insured industrialized nation, we are the least informed.

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