Health care reform legislation, declared dead so many times by its enemies and sometimes its friends, became an accomplished fact last night via House enactment of the Senate-passed bill. The House also passed the closely associated reconciliation bill “fixing” the Senate bill, and final action on that measure in the Senate will take a while. But no matter: the most important health care legislation since the enactment of Medicare in 1965 is on its way to the president’s desk. It will ultimately provide coverage for 32 million people lacking health insurance; will finally outlaw the denial of insurance (or outrageous premiums for) those with pre-existing conditions, beginning with children; will undertake the most serious effort yet to move the health care system from payment for procedures to payment for good health results; and is estimated to reduce federal budget deficits by $120 billion in its first decade. For dessert, the bill closes the arbitrary “donut hole” for the Medicare prescription drug benefit.

The winding road leading to this accomplishment almost defies description, particularly after Republicans gained a 41st seat in the Senate in January and with it the ability to veto any legislation that didn’t proceed under budget reconciliation rules. After endless mockery for their handling of the issue last year, the administration and the Democratic congressional leadership all earn a great deal of credit for the ultimate victory: Harry Reid for getting all 60 Senate Democrats on board for a bill in December; Nancy Pelosi for the deft negotiations that produced 219 votes in the House; and the White House and the president for refusing to heed a thousand calls to totally revamp or abandon the legislation.

And despite the many conflicts among Democrats over the composition of the ultimate bill, it’s significant that joy over the vote last night extends all across the party, from single-payer fans to managed competition advocates to all sorts of people focused on narrow issues. It appears we owe a special thanks to the Catholic nuns whose strong support for the legislation seems to have shamed Rep. Bart Stupak and several other House colleagues into a face-saving deal on abortion language, mainly a symbolic gesture offered to secure real live votes.

Now Republicans, of course, are predicting a huge public backlash and then a quick repeal of the legislation if and when they retake control of Congress. There will be a lot of noise made in the days just ahead by Tea Party activists who have become invested in apocalyptic rhetoric about the dangers of health reform, and perhaps others who have bought some of the lies and distortions conservatives deployed to fight this legislation, from wild claims about “death panels” to pervasive predictions that premiums will skyrocket and Medicare benefits will be cut. When these disasters don’t occur, much of the negative excitement will die down, even as the merits of health reform become more apparent.

As for threats that the bill will soon be repealed: the very tools of obstruction that Republicans so eagerly utilized to try to thwart health reform will be available to those trying to stop its repeal. Will 60 senators vote to withdraw health coverage from tens of millions of Americans any time soon? Will 60 senators go to the mats to re-establish the “right” of insurance companies to deny coverage to children with pre-existing health conditions? Will Republicans vote to re-open the Medicare prescription drug “donut hole”? Where will they find the funds to offset elimination of health reform’s deficit savings? Maybe they ignored the president’s recent arguments about how the most popular reform measures won’t work without a comprehensive approach. But if Republicans try to repeal reforms piece-meal, they’ll finally figure out what he was talking about.

All in all, it’s clear that President Obama and most congressional Democrats did one thing that cynical voters don’t much expect of politicians these days: they kept a promise to meet one of America’s most urgent national challenges, and they kept it despite a collective Republican decision against any cooperation, despite vast institutional barriers in the Senate, and despite predictable public nervousness about — and, for many, hostility towards — comprehensive action on such a complex issue.

That’s an accomplishment worth celebrating, extending and, if necessary, defending. Let’s prove America’s not ungovernable after all.

As we count down towards the health reform vote(s) in the House, it’s clearer than ever that there are two distinct but mutually reinforcing conservative takes on the bill. The most obvious, of course, is the bizarre construction of “ObamaCare” that the Right has been building for nearly a year now, based on distortions, fear-mongering, a few outright lies and sweeping smears, all in order to make legislation pretty close to what moderate Republicans have promoted for years seem like a socialist revolution if not a coup d’etat. This is the hard sell, and it will continue up to and well beyond this weekend’s votes.

But then there’s the soft sell, beloved of today’s model of “moderate” Republicans, such as they are, which involves lots of tut-tutting at the unedifying spectacle of the health reform debate, constant if unsupported claims that there are plentiful opportunities for a bipartisan “incremental” approach, and above all, phony concern for what Barack Obama is doing to his party and his country. This approach typically ignores or rationalizes the hard sell that most conservatives have undertaken, and the lockstep obstructionism of the congressional GOP, and blames Obama and Democrats for all the problems they are encountering in getting this legislation done.

A pitch-perfect example of the soft sell is Peggy Noonan’s latest Wall Street Journal column, presumably her final pre-vote expression of contempt for the president in the guise of respect for the presidency, which alas, isn’t what it used to be when her mentor, Ronald Reagan, stood astride Washington and the globe like a colossus.

The column begins with an extended expression of horror that Obama would postpone a trip to Indonesia and Australia in order to lobby for this little domestic bill that would deal with the trifle of health coverage for 40 million or so Americans:

And to do this to Australia of all countries, a nation that has always had America’s back and been America’s friend. How bush league, how undisciplined, how kid’s stuff.

It’s characteristic that Noonan does not mention that Obama is trying to give Americans the universal health coverage that Australians have and take for granted, or that final passage wouldn’t have been delayed until now if Scott Brown hadn’t come to Washington pledging to kill “ObamaCare.”

Noonan then engages, with the air of someone examining an especially loathsome insect, in a lengthy attack on the procedural issues involved in House passage of health reform, asserting that Obama’s trying to hide something in the legislation via the “deem and pass” (which she suggests sounds tellingly like “demon pass”) mechanism that House Democrats are apparently going to deploy this weekend. She endorses as self-evidently correct the complaint of Fox News’ Bret Baier, in his obnoxious interview of the president last week, that “deem and pass” means nobody will know what’s in the bill that’s “deemed” and “passed.” Like Baier, Noonan doesn’t seem to understand the simple fact that the underlying bill we are talking about here is exactly the same bill passed by the Senate in December — long enough even for Peggy Noonan to have gotten wind of it. The changes in the bill — namely, the reconciliation measure — were made available, along with a CBO scoring of their impact, before the votes were scheduled, and will be voted on explicitly by the House (and later the Senate). Yes, this is complicated, but you’d think someone with Noonan’s experience and pay grade would be able to figure it out, and again, Democrats would have never resorted to this approach if Republicans weren’t using their 41st Senate vote to thwart the normal process after a majority in the House and a supermajority in the Senate had already passed similar legislation.

But whatever — Republican obstruction is never much mentioned in Noonan’s stuff on health reform. And so it is entirely in character that Noonan concludes her column by blaming Obama for the rudeness exhibited by Baier in last week’s interview, and hence for diminishing the presidency! Ah, if only we had a real president like you-know-who:

[W]e seem to have come a long way since Ronald Reagan was regularly barked at by Sam Donaldson, almost literally, and the president shrugged it off. The president—every president—works for us. We don’t work for him. We sometimes lose track of this, or rather get the balance wrong. Respect is due and must be palpable, but now and then you have to press, to either force them to be forthcoming or force them to reveal that they won’t be. Either way it’s revealing.

I’d say it’s hardly as revealing as Peggy Noonan’s inveterate habit of not only ignoring conservative hubris, but attributing it to its victims.

This item is cross-posted on The Democratic Strategist.

Over at TNR, congressional expert Sarah Binder provides a very useful and detailed explanation of the procedures the House will go through this weekend in dealing with health reform. There will be (assuming things go as planned and Democrats have their votes) four separate votes: one on a Republican motion to recommit the rule for consideration of the reconciliation bill, one on the rule itself, one on a Republican motion to recommit the reconciliation bill, and one on the reconciliation bill. If the first or third motions pass, or the second or fourth votes fail to pass, health reform will have been defeated, at least for the moment if not forever.

But it’s the vote on the rule that will (assuming the Rules Committee goes in the direction Speaker Pelosi has indicated is likely) “deem” the Senate health care bill as having been enacted. This “self-executing rule” is what all the yelling and screaming on the Right is about. But since everybody understands what’s going on, it is fundamentaly erroneous to say that the House is trying to avoid a vote on the Senate bill. The vote on the rule is a vote on the Senate bill, and will have exactly the same effect as an explicit vote on the Senate bill, no more and no less.

That fact obviously does raise the question of why the House leadership is utilizing the “deem and pass strategy,” since anyone voting for the rule is actually voting for the Senate bill. I can’t answer that question, but presumably this basically meaningless distinction matters to at least one House Democrat. But in any event, the conservative charge that the House is going to enact the Senate bill without voting on it just isn’t true, and is simply part of the fog Republicans are trying to spread over the fact that by the end of this process (again, if all goes as planned), majorities in both Houses will have twice approved health reform.

This item is cross-posted at The Democratic Strategist.

There’s been some interesting talk going on this week involving a post mortem assessment of “the Left’s” strategy on health reform, particularly in terms of the ultimate emptiness of threats from progressive House Democrats that they would vote against any bill that didn’t include a “robust” public option.

Glenn Greenwald argues that progressives have once again exposed–and possibly even increased — their “powerlessness” within the Democratic Party. Chris Bowers challenges the premise by arguing that progressives did secure significant changes in the Senate bill, most notably the agreement to “fix” it, which certainly wasn’t the path of least resistance.

Meanwhile, Armando of Talk Left has compared the lack of leverage of progressives over items like the public option to the success of the labor movement in forcing concessions on the “Cadillac tax.” And Nate Silver has responded by arguing that progressive threats didn’t work because they weren’t credible in the first place.

I think everyone in this debate would agree that it’s generally a bad idea in politics to make threats you are entirely unwilling to carry out, but the real division of opinion is on whether such threats should be tempered or in fact intensified. But Nate makes one point that bears repeating: the political value of aggressiveness and posturing can and often does get exaggerated.

It feels good to assert that progressives just need to be tougher — perhaps even to the point of feigning irrationality. These arguments are not necessarily wrong — a reputation for being tougher bargainers would help at the margins — but it misdiagnoses the problem on health care. The progressive bloc failed not because of any reputational deficiency on the part of the progressives but because their bluff was too transparent — they claimed to be willing to wager enormous stakes (health care reform) to win a relatively small pot (the public option). That would have been beyond the capacity of any poker player — or activist — to pull off.

I’ve never much liked the strain of progressive analysis that endlessly promotes “fighting” and “spine” and “cojones” as the answers to every Democratic political problem. Sometimes “brains” or “heart” are more important, and moreover, if politics is reduced to a willingness to project brute force, the bad guys are going to win every time; it’s like getting into a selfishness competition with the Right — we’ll never win. But in any event, however you feel about the Will to Power theory of politics, Nate’s right, people aren’t all stupid, and macho posturing by progressives when it doesn’t make sense isn’t going to convince anybody. Poker playing is a relatively small and overrated part of politics. Real conviction and strategies based on conveying those convictions to friends and potential friends are the best building blocks for successful strategy.

This item is cross-posted at The Democratic Strategist.

A couple of weeks ago, I wrote about the ridiculous attention that the media — cued by the GOP — lavished on process in general and budget reconciliation in particular:

Regardless of the outcome of the Democratic health reform push, one point is obvious: at every turn, they lost the messaging battle to Republicans and the Tea Party. The latest reminder came this morning, as the umpteenth story on budget reconciliation came on the radio. These days, to talk about health care reform is to talk about process — exactly where the GOP wants the conversation to be.

Replace “reconciliation” with “deem and pass” and the same post pretty much applies to today. “Deem and pass” is the procedure by which Democrats are reportedly planning on using to pass health care reform, allowing House members to “deem” the Senate bill passed while voting on the bill fixing it. The reasoning is that this would enable House Democrats to say that they didn’t technically vote for what they see as a flawed Senate bill. Let me repeat that: they’ll be voting for the Senate bill but can claim that they didn’t vote for the Senate bill. Really, what could go wrong with that strategy?

Republicans have pounced, and the media have been right there with them. Today’s Washington Post headline: “House Democrats’ tactic for health-care bill is debated.” From a New York Times on the “controversy”: “Democrats struggled Tuesday to defend procedural shortcuts they might use to win approval for their proposals in the next few days.” Clearly Dems did not think through the politics of this move.

But its head-slapping idiocy notwithstanding, is “deem and pass” really all that controversial? Congressional scholar Norman Ornstein, hardly a lefty advocate, calls out Republicans for their hypocritical rending of garments over its anticipated use for health reform:

In the last Congress that Republicans controlled, from 2005 to 2006, Rules Committee Chairman David Dreier used the self-executing rule more than 35 times, and was no stranger to the concept of “deem and pass.” That strategy, then decried by the House Democrats who are now using it, and now being called unconstitutional by WSJ editorialists, was defended by House Republicans in court (and upheld). Dreier used it for a $40 billion deficit reduction package so that his fellow GOPers could avoid an embarrassing vote on immigration. I don’t like self-executing rules by either party—I prefer the “regular order”—so I am not going to say this is a great idea by the Democrats. But even so—is there no shame anymore?

Steve Benen sums up my thoughts on the latest demonstration of GOP faux outrage and media complicity nicely:

Let me get this straight — the single biggest story in the political world yesterday was over consideration of a House procedure, used many times before by both parties? Republicans decided they don’t like “self-executing rules” anymore, so the matter dominated the discourse?

As with the moronic furor over reconciliation, the same dynamic is at work: a relentless GOP messaging machine that puts process ahead of substance — canny on their part because it’s the process, rather than the policy, that voters are fed up with; a tone-deaf Democratic caucus (They really thought that adding a layer of complication to the process was what health care reform needed? Really?) and feckless communications operation that seems to perpetually be on the defensive; and a mainstream media expertly played like a piano by the GOP.

I know, I know, paying attention to anything Rep. Michele Bachmann (R-MN) says is a bit lazy, since she offers up irrational outrages on a near daily basis. But her remarks suggesting that Americans don’t have to comply with health care legislation if it’s enacted via procedures she doesn’t like really do blaze some new trails for the American Right — or at least trails not pursued since the early 1960s, when segregationists urged noncompliance with Supreme Court decisions and civil rights laws.

Here’s Bachmann flirting with jail-time in defense of the great American principle of unregulated private health insurance, or whatever it is she’s standing for:

If they pass the bill legitimately, then yes, we have to follow the law — until we repeal it. But if they pass it illegitimately, then the bill is illegitimate, and we don’t have to lay down for this. It’s not difficult to figure out. So if for some reason they’re able to get their votes this week and pass this 2,700-page Senate bill — if they get it, trillions of dollars is what it’s gonna cost, when we didn’t vote on it, we need to tell them a message: That if they get away with this, they will be able to get away with anything — with anything. And you can’t say you voted on a bill when you didn’t, because it’s fraud. But we are not helpless here. We are not helpless, there are things that we can do.

What Bachmann is thundering about here specifically are reports that the House may vote on a reconciliation bill to “fix” the Senate bill, and then by a Rules Committee provision “deem” the Senate bill itself as having passed the House via efforts to amend it. Turns out the “deem and pass” strategy was used by Republicans during the Bush administration to enact a debt limit increase — never a popular vote — so there is, ahem, some bipartisan precedent for the procedure. And for all the talk about its sneakiness, it should be remembered that it is being considered not because of some substantive concerns about a “fixed” Senate bill, but because House members fear the Senate will just celebrate House passage of their bill and not bother to get around to the “fix.” In other words, it’s all procedural mumbo jumbo that’s unrelated to real health care reform. Any House member voting for the “fix” is, in fact, going to be held responsible by Republicans for supporting “ObamaCare,” so conservatives are being more than a little disingenous in claiming that “deem and pass” is some sort of devilish trick to avoid accountability.

In any event, the courts are where such matters should be thrashed out, not the streets. And by suggesting that her own view of “deem and pass” as representing “tyranny” should trump the law of the land, Bachmann is taking a fateful step towards the revolutionary posture that her Tea Party allies have been hinting at all along.

I’m reminded of an incident back in Georgia some time ago when Congress had enacted a tax bill that imposed a state-by-state volume limitation on the use of tax-exempt financing for private development projects. I was part of a state government team that designed Georgia’s system for implementing this law, and after a public briefing on the new rules in one locale, a local development official replied: “We appreciate y’all coming down here to explain all this, but we think we’ll just use the old system.” We decided not to humiliate the guy by pointing out that the IRS wouldn’t exactly let him “use the old system,” but instead informed him of that privately.

I hope someone informs Michele Bachmann and her listeners that she doesn’t get to pick and choose which laws are “valid.” And if she’s willing to go to the hoosegow to resist ObamaCare, there are quite a few other Americans who think the supremacy of law is a rather important principle who will be happy to accomodate her.

This item is cross-posted at The Democratic Strategist.

As the political world prepares for what appears to be Last Stop Week on health reform, conservatives seem astonished that the president and congressional Democrats are pushing ahead for final enactment of legislation passed by both Houses last year, instead of folding their hands and fleeing in terror. They are particularly incensed that Democrats aren’t being shamed or frightened by the prospect of–gasp!–a poisoned partisan atmosphere in Washington. Here’s how Julie Mason of the conservative Washington Examiner presents the threat:

The White House claims it’s above worrying about the politics of health care — they just want a bill passed this week.Good thing, because politics in Washington could become a lot more ferocious and partisan, whether their plan flies or not.

“If they pull off this crazy scenario they are putting together, they are going to destroy a lot of the comity in the House,” said Brian Darling, a congressional expert at the conservative Heritage Foundation. “Even in the current, highly partisan atmosphere, it can get a lot worse.”

Sorry, Brian & Julie, you are wrong. It really can’t get much worse. And for that, conservatives have no one but themselves to blame, if they actually even care.

Just to cite the most obvious example, there were many moments over the last year when the White House and congressional Democrats might well have significantly changed health reform legislation in exchange for just a few Republican votes (in fact, they made unilateral concessions in the Senate again and again simply to keep the possibility open). And after the loss of the 60th Senate vote last month, had Republicans offered any suggestions other than complete repudiation of the bills already enacted by a majority in the House and a supermajority in the Senate, Democrats would have snapped them up instantly. But in an atmosphere where long-held Republican ideas on health reform like the individual mandate were suddenly being denounced as socialist or even fascist by the Right, no serious offers were forthcoming, unless you think such “ideas” as sweeping away state regulation of health insurers via mandatory interestate sales is “serious.”

So let’s not hear any empty threats about Republican “partisanship.” For better or worse, the GOP made a clear and collective decision last year to take partisanship to the max on every conceivable front, and they have been quite successful with that strategy in a nilhilistic sort of way. But there are no arrows left in that particular quiver.

This item is cross-posted at The Democratic Strategist.

Today’s big whoop in the manic conservative drive to kill health care reform is a Washington Post op-ed by Pat Caddell and Doug Schoen urging Democrats to abandon reform and work with Republicans on “bipartisan” proposals like “purchasing insurance across state lines, malpractice reform, incrementally increasing coverage,” and so on and so forth.

Now normally I don’t like to get into the motives or personality of people making political arguments, but in this case it’s unavoidable. The only reason anyone on earth is paying any attention to the views of Caddell and Schoen on this subject is that, as they note prominently in the WaPo piece, they used to work as pollsters for Democratic presidents (Schoen for Clinton, though it was really his business partner, Mark Penn, who had the White House account, and Cadell way back in the Carter administration). But the impression they give of being good Democrats who have finally spoken out in exasperation at the folly of health care reform is completely false. Schoen has never been much of a loyal Democrat; his latest enthusiasm has been encouraging a third party. And Caddell has a history of cranky eccentricity dating back at least a few decades. As Jon Chait points out, both of them have become fixtures on Fox News recently.

They are entitled to their opinion like anyone else, but Schoen and Caddell should check their worn-out Party Cards at the door before they write a piece repeating Republican talking points on health care reform.

This item is cross-posted at The Democratic Strategist.

The president held a press conference today to announce that yes, indeed, he will press Congress to act on health care reform this month. There’s was nothing immensely new about that development, but it’s interesting that Obama used the occasion to lay out, quite succinctly, the three key points he made in his health care summit with Republicans: why comprehensive reform is essential, why the time for “negotiations” is over, and why there’s nothing that unusual about the use of reconciliation (though he did not use the word, a very unfamiliar term to most people outside Washington) to get the job done. He essentially took another bite at the apple of responding to the most effective Republican lines of attack, and will apparently do so some more in appearances on the road this month.

On the other hand, the presidential press conference may get demoted on the nightly news if a possible scandal involving Rep. Eric Massa (D-NY) continues to develop. Massa, a freshman from a highly marginal district, abruptly let it be known he was retiring. Some sources say he’s suffering from a recurrence of cancer, but Politico is reporting that he was about to come under investigation by the Ethics Committee for allegedly sexually harrassing a male staffer. If the latter story has a basis in reality, it will be big news tonight.

This item is cross-posted at The Democratic Strategist.

The White House today released a letter from President Obama pointing a way forward for passing health care reform. True to the course that he set at the Blair House summit last week, he stressed the areas of agreement between the two parties, even as he acknowledged some unbridgeable differences.

A considerable portion of the letter — and the part that has gotten everyone’s attention — goes into detail about four GOP ideas that the president said he would like to see in any final package. The president writes:

1. Although the proposal I released last week included a comprehensive set of initiatives to combat fraud, waste, and abuse, Senator Coburn had an interesting suggestion that we engage medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other Federal programs.

2. My proposal also included a provision from the Senate health reform bill that authorizes funding to states for demonstrations of alternatives to resolving medical malpractice disputes, including health courts. Last Thursday, we discussed the provision in the bills cosponsored by Senators Coburn and Burr and Representatives Ryan and Nunes (S. 1099) that provides a similar program of grants to states for demonstration projects. Senator Enzi offered a similar proposal in a health insurance reform bill he sponsored in the last Congress. As we discussed, my Administration is already moving forward in funding demonstration projects through the Department of Health and Human Services, and Secretary Sebelius will be awarding $23 million for these grants in the near future. However, in order to advance our shared interest in incentivizing states to explore what works in this arena, I am open to including an appropriation of $50 million in my proposal for additional grants. Currently there is only an authorization, which does not guarantee that the grants will be funded.

3. At the meeting, Senator Grassley raised a concern, shared by many Democrats, that Medicaid reimbursements to doctors are inadequate in many states, and that if Medicaid is expanded to cover more people, we should consider increasing doctor reimbursement. I’m open to exploring ways to address this issue in a fiscally responsible manner.

4. Senator Barrasso raised a suggestion that we expand Health Savings Accounts (HSAs). I know many Republicans believe that HSAs, when used in conjunction with high-deductible health plans, are a good vehicle to encourage more cost-consciousness in consumers’ use of health care services. I believe that high-deductible health plans could be offered in the exchange under my proposal, and I’m open to including language to ensure that is clear. This could help to encourage more people to take advantage of HSAs.

None of those suggestions should surprise anyone who saw the summit or has been paying attention to the president on health care the last few months. Three of the four touch on cost control, which is also not a surprise considering that’s the one area that both sides agree needs to be addressed (although only one party seems to be willing to actually pass legislation to do something about it). As TNR’s Jonathan Cohn rightly points out, the fraud and Medicaid payment proposals should win Democratic support, while the other two might have more trouble.

The key part of the letter, however, comes at the end:

I also believe that piecemeal reform is not the best way to effectively reduce premiums, end the exclusion of people with pre-existing conditions or offer Americans the security of knowing that they will never lose coverage, even if they lose or change jobs.

The president, who is scheduled to speak tomorrow to chart his way forward for passing reform, here seems like he’s laying the groundwork for Congress to go down the path everyone has already discussed: passage by the House of the comprehensive bill that the Senate has passed, and a sidecar reconciliation bill to “fix” parts of the bill that House members find objectionable.

What’s important, too, is the language that he uses to justify the continued push. If cost control was the issue on which he could reach out to Republicans, coverage and affordability for ordinary families are the talking points as far as selling reform to the public and to the Democratic caucus. Ending exclusions based on pre-existing conditions, lowering out-of-pocket costs, keeping coverage even after losing your job: these are all hugely popular and marketable ideas. The Democrats have thus far done a poor job of explaining the kitchen-table benefits of reform. But those benefits are real, and they will redound to the benefit of the party who can make reform happen, something Obama seems to understand.