Darcy Burner says public option can be a winner IF...

The debacle in Massachusetts will lead to an even weaker health care bill, right? Not if you listen to our favorite never-an-office-holder progressive politician, Darcy Burner. We're beginning a four-day political week on state of the union Wednesday. Tomorrow and Friday, we'll put up Michael Hudson's two part preview of the state of the union, to measure the actual speech against. On Saturday, we'll do Robert Kuttner's "What a Week!" post to see whether history is shaping up to his vision.

How we can get the healthcare bill across the line
Ironically, it appears the most likely way to get healthcare reform is to pass GOOD healthcare reform.

The Democrats in Washington DC are likely to spend most of this week consumed by the question of how they can pass healthcare reform now. Fortunately, there's a fairly clear path.

Here are the constraints:
The Senate won't have 60 votes for diddly-squat. No Republican is going to vote for cloture on anything. Whatever the Senate is going to do needs to be done with 50 votes (plus Biden), which means budget reconciliation will have to be used.

The House doesn't trust the Senate. House members believing the Senate will fix something later is about as likely as pigs flying. Over and over in the last year, the Senate has completely screwed the House. No faith remains. That means the Senate is going to have to go first.

The House can't get 218 votes for the Senate bill. Every single House member is up for re-election in ten months. They've seen the polling, they've seen what happened in Massachusetts. They don't have political death wishes, and the profoundly flawed insurance giveaway that is the Senate bill isn't going to inspire them to take one for the team. The team they'd be asked to take one for is Aetna and United Healthcare and Joe Lieberman, friends - not their constituents. No way.
Ok, so is it hopeless?

Not at all.

Use sidecare reconciliation, with the Senate going first

All you need to do is figure out what fixes can be passed through reconciliation that would make the bill palatable to 218 House members. Speaker Pelosi and Majority Leader Reid are discussing that now. Then you have the Senate pass that reconciliation bill and send it over to the House. The House passes the reconciliation fixes and the underlying Senate bill. The President signs them (in the correct order), and viola! You're done.

So the key question is this: what needs to be in the package of fixes that can qualify for reconciliation, get 50+ votes in the Senate, and get 218 votes in the House?

Counting the votes

How do we get 218 votes in the House? Well, starting from the 220 who voted for the House bill; you're clearly not going to pick up any Republican votes on the House side, but the some of the Democrats who voted no the first time around are probably in play.

Abortion language = Nelson

It appears unlikely that reconciliation can be used to change the abortion language, so the Nelson language will prevail. For some House members who supported Stupak, that's a dealbreaker. You will lose some votes, likely between 10 and 20.

The freshmen and sophomores

Vulnerable freshmen and sophomores look at the Massachusetts race and the polling and conclude that to vote for the Senate bill as is against the wishes of their constituents is to guarantee they won't be re-elected. (It's really hard to argue for a mandate with no real choice or competition. Add that to pissing off the unions with the excise tax, and the giveaways to Nelson and Landreiu, and you have one gigantic PR problem.) So you lose between 10 and 20 votes there.

Progressives and the pro-choice caucus

Now let's be clear about something. The House progressives and pro-choice caucus members who voted yes for the House bill (which is pretty much all of them) are fundamentally team players. They were team players the first time around, they're likely to be team players again the second time around. So they can likely all - or nearly all - be brought home by leadership again.

But looking at the numbers and the members it's possible to please with a fix in reconciliation, it would appear that it's probable that all of the remaining votes you need to win back are from vunerable freshmen and sophomores.

How do you convince Betsy Markey and Tom Perriello and Steve Driehaus and Frank Kratovil and Mary Jo Kilroy et al to vote for the bill? Show them that it'll help their re-election chances.

The public option is (ironically) the key

So far, the only thing polling has shown works is public buy-in to a government healthcare program - either the public option or a Medicare buy-in. Polling done in September by Lake Research showed that a mandate with no public option was acceptable to only 34% of the public; add in a public option, and support nearly doubles to 60%. In December when CBS News/New York Times asked, "Would you favor or oppose the government offering some people who are uninsured the choice of a government-administered health insurance plan - also known as a 'public option' - that would compete with private health insurance plans?" 59% of voters were in favor.

If you want to win back the voters, give them the one thing they clearly understand is a win for them over the insurance companies: the option to choose a public plan.

Oh - and it appears that a significant portion of the problem in Massachusetts was that the Democratic base wasn't excited. They were downright frustrated, in fact. Want to give the Democratic base some change they can believe in? Then give them the public option they've been clamoring for.

Either a public option or a Medicare buy-in can be done through reconciliation. Sen. Harkin claimed 52 Senate votes for the public option over the summer, and it appears it was only Lieberman who killed the Medicare buy-in at the 60-vote threshold.

Look, I know the DC conventional wisdom has been that the public option is dead, and that the Medicare buy-in is a non-starter. The excuse was always, "We can't get 60 votes for it." Guess what? Now that it's clear they're going to have to use reconciliation, they don't have to get 60 votes.

(If you're feeling inspired to contact your Senators and Congressperson, we've made it easy at http://www.congressionalplan.com .)