Can Speaker Pelosi bring health care reform back from the dead? Did it ever really die?

Doctors say that Nordberg has a 50/50 chance of living, though there’s only a 10 percent chance of that.

– George Kennedy as Ed Hocken in The Naked Gun: From the Files of Police Squad

In addition to my last health care post, Nate Silver summarizes well the forces pushing in both directions. John Podhoretz also has a good strategic overview. I’ll add a few assorted observations to begin the work week.

Vote counting & strategy

  • Focus all your attention on Speaker Pelosi’s attempts to get 216 votes. If she can lock them down I think there’s a four in five chance there will be a law (or two).
  • The Stupak/abortion issue appears to be the biggest substantive hurdle. Chatter about a possible three bill strategy (!?) to address this is stunning. Two bills isn’t hard enough?
  • The sequencing/trust problem still appears hard. How does the Speaker get her members to vote for Bill #1 based only on a promise that Bill #2 will make it to the finish line?
  • Occasionally a Congressional leader calls a vote without having the votes locked up, in the hope that the pressure of a floor vote will help close those last few remaining holdouts. This is incredibly risky. Sometimes there is no better option.


  • Public signs of optimism from the President, his team, and Democratic Congressional leaders tell us little. We don’t know if they actually think they will have the votes, or if they are asserting that to try to make it true. Imagine the impact if Speaker Pelosi were to tell the press “We might not succeed.” Doing so would further embolden those marginal Members she is trying to convince to vote aye. They are telling us they think they will succeed, but they have to say this whether or not it’s true.
  • The President’s chance of legislative success is way above the 10% I projected shortly after the Brown election when I declared a comprehensive bill dead. Was I wrong, or have things changed dramatically? A little of both, I think.
    • I underestimated the willingness of the President and Democratic Congressional Leaders to press forward against extremely long odds. They appear to be doing serious medium-term political damage to their party. They appear to be placing in jeopardy a fairly large number of their Members, which could damage the rest of the President’s policy agenda. They are directly contradicting their stated strategy of focusing on the economy. You decide whether this is principled persistence, a confident smart strategy based on superior information, a different assessment of the voters and the polls, or a pathological obsession with killing the White Whale at any cost. Call me Ishmael.
    • I also underestimated the Democratic party cohesion under tremendous political pressure. Assuming they think they are doing the right thing, they are doing so at tremendous cost to themselves. I can’t figure out if most rank-and-file Democrats agree with their leaders’ strategy or are just afraid to buck it.
    • As of this posting, Intrade estimates about a 50% chance of success. That seems a little high. I’ll guess it’s a coin toss as to whether the Speaker can round up 216 votes for two bills, multiplied by an 80% chance that if she does they can overcome other hurdles to get two signed laws. That puts me at a 40% chance President Obama gets to declare victory, but with lots of uncertainty.
  • To those who think the probability is higher, remember that they have been trying to rally these votes for six weeks and have not yet succeeded. Each time I hear rumblings of a new strategy, I conclude only that Congressional leaders have decided that the last new strategy won’t work. Even if the Speaker and her team are maximally effective they may fail. Sometimes the votes just aren’t there, and you don’t know that until you have tried every path and failed, or you have decided the clock has run out.
  • If there is a path to 216 votes, I am confident the Speaker will find it. She has a remarkable ability to bend her colleagues to her will.


  • There are three full work weeks until the Congressional Easter Recess. Recesses can be delayed. I ignore the White House’s urgings to vote by the end of this week. They’ll vote when they think they can win, and not before.
  • The conventional wisdom is that if they can’t get it done by Easter Recess, it will never happen, so they’ll give up. That feels right, but if the President wants to press forward after recess, nothing precludes him from doing so. I had mistakenly thought they would have given up long ago. I’ll guess that the real deadline is for House passage before the Easter Recess.


  • In response to comments on my procedural postsabout reconciliation:
    • Concerns about a revenue measure precluding the Senate from going first are overstated. There are well-established and Constitutionally-consistent ways to work around that if necessary. Still, I expect the House to go first, so I think this is irrelevant.
    • Yes, the Presiding Officer (the VP if he wants) can overrule the Senate Parliamentarian. Technically, the Chair rules after taking “advice” from the Parliamentarian. 99% of the time that advice is followed, but it’s up to the Chair. When that advice is overruled, it’s a well-coordinated exercise between the Presiding Officer, the Majority Leader, and sometimes others.
    • I don’t know what would happen if Senate Republicans were to offer an extended sequence of amendments (hundreds) to a reconciliation bill. I agree with those who say that it’s possible the Chair would rule that such amendments are dilatory and sustain that ruling by a majority vote. This is a gray area.
  • With all the attention focused on the House, some observers may be overlooking Senate challenges. Even if 50 Democratic Senators are willing to use the reconciliation process for a second bill, that does not mean they will necessarily accept a Speaker-drafted Bill #2 and pass it without amendment. Any Senate amendments must then either be accepted by the House or worked out in a conference. At a minimum this would slow the process down.


  • This is almost entirely a Democratic party exercise. Republicans have few procedural tools available to them. Their power lies mainly in their ability to influence wavering Democrats not to follow their party leaders. Leader Boehner and Leader McConnell have both been threatening/promising that they will keep health care front and center through November no matter what. This is an attempt to reinforce the political costs of an aye vote with those wavering Democrats. They want those Members to believe that an aye vote will cost them their seat in Congress. This is hardball strategy.
  • The extended and public intra-Democratic party thrashing this month means that if legislation fails it will be difficult for Democrats to credibly blame Republicans for that failure.
  • I agree with those who argue that using reconciliation in this case is an abuse of that process. This argument appears to have little traction with those swing Democratic votes, so I recommend opponents to the bill return to substantive concerns as their primary point of attack. Spend more of your time and energy explaining why this bill is bad policy. You don’t have to abandon the process arguments, but I think they are less effective than the substantive ones.
  • Republicans should not use Medicare scare tactics as their primary weapon against this bill. There is a legitimate Medicare argument to be made, but many Republicans are instead following the easier, possibly more effective, but less responsible path of trying to scare seniors. We need to slow the growth of Medicare spending. We just shouldn’t spend the Medicare savings on a new entitlement. There are plenty of other effective lines of attack against these bills that don’t limit your ability to do good policy in the future.
  • The McCain/Graham amendment to preclude changing Medicare in reconciliation was irresponsible showboating and a recent low point for Republicans in this debate. A primary purpose of reconciliation is to change large entitlement spending programs, including Medicare. At least the Senate didn’t vote on it during consideration of the extenders/jobs bill. I hope it never returns.
  • Republicans were at their best in the Blair House debate. Let’s see more of that: floor speeches and press appearances explaining why these bills are bad policy.

The partisan strategic gap

I am struck by the enormous gap between the two parties on the strategic calculation being made by the President and Democratic Congressional leaders. If you set aside your policy views, do you think the current path makes strategic sense for the majority? Almost every Republican insider I meet shakes his or head in befuddlement and says no, I just don’t get why they’re doing this.

Dan Meyer was Speaker Gingrich’s Chief of Staff in the mid-90s, and later served as the head of Legislative Affairs for President Bush (43). He and I survived the 95-96 government shutdown conflict between Congressional Republicans and President Clinton. I worked for Senate Budget Committee Chairman Pete Domenici at the time. Dan made a comparison the other day. Imagine, he said, right after the government had reopened in January of 1996, after Republicans had been getting hammered every day for a month, if I had run up to you and said, “I’ve got a great idea! Let’s shut it down again!” You’d think I was crazy.

That’s what this feels like. The President and his allies could now quite easily enact a massive expansion of Medicaid and S-CHIP, paid for by a subset of the offsets in these bills. I would oppose such a bill, but it would be a legislative slam dunk with few political costs (for them) outside of a disappointed left wing. To my chagrin they might pick up a few Republican votes. And yet they press onward with a super-high risk strategy. This is a classic bird-in-the-hand tradeoff.

In addition to my policy problems with this bill, I too have difficulty understanding the continued push. In addition to our policy differences, I can think of four areas where my assessment might differ from that of the decision-makers:

  1. They may assess the probabilities of success differently. If estimate their strategy has only a 40% chance of success (and 10% six weeks ago). If they think their chances are twice as large, that changes the calculation. They have better information than I do about where the votes are, but they have not exactly been a model of legislative competence so far.
  2. They may assess the politics differently. The day after Senator Brown’s victory, Team Obama was on TV arguing that the voters did not reject the President, Congressional Democrats, their agenda, or their health care bill. Fine, they had to say that. Do they actually believe it? If so, they may believe that a signed law will cause the political damage to their vulnerable Members to diminish. (I don’t.) They may believe what they are telling those Members, that there is no individual political benefit from flipping aye to no. (I don’t, because you can now respond to the attack ads that will hit you.) If so, they probably assume that a signed law will help their Members in November.
  3. They may value the costs and benefits differently. They appear to be willing to place at risk dozens of Congressional seats from Members of their party for the possibility of achieving this one legislative goal. They may believe that the policy victory is worth those likely losses and the harm it will do to the rest of their agenda. If you focus only on health care policy this is principled persistence. If you look at health care as one part of a broad policy agenda, then it is a prioritization, in which they are sacrificing other policy goals for this one accomplishment.
  4. The leaders may be narrowly self-interested and able to exert tremendous party discipline on those with different interests. Legislative failure could harm a rank-and-file Democrat from a purple district, but it would be devastating to the President and the Speaker, who are judged on their ability to lead others. We know that some Congressional Democrats don’t like this bill as a policy matter. We know that some are afraid of the political consequences of voting aye. Yet many in both groups appear willing to vote aye.

(photo credit: Defibrillator latt by Olaf)