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Updated health care reform projections

Updated projections

I am lowering from 50% to 35% my prediction for the success of comprehensive health care reform.  I now think the most likely outcome is a much more limited bill becomes law.

  1. Pass a partisan comprehensive bill through the House and through the regular Senate process with 60, leading to a law; (was 30% -> 30%)
  2. Pass a partisan comprehensive bill through the House and through the reconciliation process with 51 Senate Democrats, leading to a law; (was 20% -> 5%)
  3. Fall back to a much more limited bill that becomes law; (was 15% -> 45%)
  4. No bill becomes law this Congress.  (was 35% –> 20%)

My last update was 3 1/2 weeks ago, right before the motion to proceed was adopted.  My prediction then that “there is zero chance a bill makes it to the President’s desk before 2010” has been proven correct.  At the time that was not an uncommon prediction, but it was inconsistent with what the White House, Speaker Pelosi, and Leader Reid were all saying.

I still believe that if a comprehensive bill becomes law, I anticipate completion in late January or February, with the latter more likely.

In mid-November I wrote,

I would expect that as the third week approaches, Reid would begin to signal that the Senate has worked hard on the bill and needs to bring debate to a close.  Around the middle of week three, he would file a cloture motion on his substitute amendment, with the cloture vote happening on or near Friday, December 18th.

Public and private sources suggest this is likely to play out as predicted.

New prediction:  I think Leader Reid will not invoke cloture before Christmas.  What’s harder to figure out is whether he’ll even try.

Analysis

I’m still stuck on my “two equally strong stories” model:

  1. It appears the President’s private meeting last Sunday with Senate Democrats had a similar effect to his September Address to Congress.  He unified them, rallied them, and generated tremendous team spirit and legislative flexibility.  It appears that 60 Senators agree that they need to agree on something, and are willing to bend a lot to reach their common legislative goal.  No one of those 60 Senators wants to be vote #41 against cloture, and they’ll give up a lot to avoid that situation.  The internal caucus politics and vote counting leads me to believe there’s a 90% chance that cloture will be invoked.
  2. But the substance of the Reid amendment, and especially his public option “deal,” are in big trouble.  The bill is weakening substantively and politically every 2-3 days.  On the substance and politics of this particular amendment and deal, I think there’s a 90% chance that cloture will fail.

The question then becomes which force dominates.  At the moment, I think it’s the substance, and therefore I think cloture will fail pre-Christmas.  Senate Democrats want to agree on something, but no reasonable something yet exists for them to agree upon.

To invoke cloture next week, Leader Reid needs all of the following to go his way:

  • He needs CBO to come back with a Medicare buy-in premium that isn’t so high that it scares away members.
  • He needs 60 members to support the buy-in, despite the Washington Post editorial page and other center-left elites are trashing it.
  • He needs the CBO score to not have other problems that scare away his members.
  • He needs none of his members to fold to provider pressure, especially from hospitals.  I remember that pressure well from my time in the Senate, and it can be intense, especially from home-state hospitals.
  • He needs abortion to be resolved such that none of his 60 votes will bolt on cloture.  Is it?
  • He needs those Democratic senators favoring reimportation who look like they may not get a vote to be willing to support cloture anyway (e.g., Sen. Dorgan).
  • He needs nothing else to go wrong.

If any one of the above goes wrong and he loses a single vote, then he cannot invoke cloture.

I think the Achilles heel at the moment is the new Medicare buy-in component of the so-called public option deal.  Press reports are that Reid picked five liberals and five moderates to negotiate a compromise.  Early last week he proudly announced a deal that was supported by all 60 Senators.  It appears, however, that all he had was an agreement among the 60 to not blow up the proposal until seeing what CBO said about it.  Even so, there is fraying around the edges of even that tenuous agreement as his staff work behind the scenes with CBO.

I’m going to guess that by mid-week that proposal has imploded, probably due to a combination of:

  1. CBO saying the buy-in premium is astronomically high and/or there’s a big cost to taxpayers,
  2. medical care providers (especially hospitals and doctors) pounding on Democratic Senators,
  3. more attacks from the press elite,
  4. exacerbated by continued pressure from Senate Republicans, who are attacking the bill’s quantitative effects:  higher spending, higher premiums.

Leader Reid raised expectations by asserting there was a deal when there really wasn’t.  If the deal collapses, it’s not just a loss of momentum, it’s moving in reverse.  Cloture would not be invoked, and the week could end with a partial implosion.

By | 2009-12-17T09:38:00+00:00 Thursday, 17 December 2009|