After yesterday’s panic over House Speaker Nancy Pelosi's not having enough votes to pass the Senate version of health-care reform, there’s a new narrative picking up a lot of steam today: Pelosi needs to get her caucus in order, follow the original White House recommendation, and pass the Senate version of the bill through the chamber.
So, how exactly did we get from "Pelosi doesn’t have the votes" to "Pelosi needs to get the votes" in a mere 24 hours? It has to do with a letter, released this morning, addressed to the House leadership and signed by “virtually all the top health-care policy experts on the progressive side," as TPM describes it.
The letter comes with the support of, among others, Yale's Jacob Hacker (the man who basically introduced the idea of the public option), MIT’s Jon Gruber (health-economics wonk extraordinaire) and Princeton’s Paul Starr, who has a Pulitzer for his writing on health care in America. One of the professors who got the group together to write the letter, Timothy Jost of Washington and Lee Law School, literally wrote the book on health-care law. In short, these are the people whose ideas, recommendations, and writings have by and large shaped both versions of the bill into what they are today.
Here’s what they have to say (and a link to the full text):
While the House and Senate bills differ on specific points, they are built on the same framework and common elements—eliminating health status underwriting and insurance abuses, creating functioning insurance markets, offering affordability credits to those who cannot afford health insurance, requiring that all Americans act responsibly and purchase health insurance if they are able to do so, expanding Medicaid to cover all poor Americans, reforming Medicare payment to encourage quality and control costs, strengthening the primary care workforce, and encouraging prevention and wellness.And:
The Senate bill accomplishes most of what both houses of Congress set out to do; it would largely realize the goals many Americans across the political spectrum espouse in achieving near universal coverage and real delivery reform.Aside from those of us who have spent the past two months anxiously watching C-Span, poring over the differences between the bills, my guess is most Americans don’t really know about, or care about, the differences between the two pieces of legislation. They both create an individual mandate, bar insurers from discriminating on the basis of preexisting conditions, and make insurance more affordable to low-income individuals. As Paul Krugman points out on his blog today, House Democrats have a pretty clear choice:
Do they pass the Senate bill, or do they go back to the drawing board and spend several months cobbling together a plan that’s worse in almost every dimension, generating thousands of stories about hapless Democrats—and almost surely find that Senate Republicans block the new plan, too.
Both in terms of policy and politics, the smart choice for House Democrats seems to be to pass the Senate bill. Policywise, they'll accomplish many things they had aimed to with their bill. The Senate bill is more conservative than the House bill—but it still does a lot. And politically, passing the Senate bill saves representatives from having to explain, in their 2010 stump speeches, why they were for health-care reform before they were against it. Moreover, if the House is up in arms about the Senate’s too-conservative bill, how can it possibly justify passing this scaled-back "consensus bill," which would get about 15 million more Americans covered? That’s less than half of what the Senate bill would cover (31 million, according to the CBO). "What makes this situation so bizarre, however, such a watershed in some ways, is that each calculus points to the same conclusion," TPM's Josh Marshall writes. "Everybody can see it. But a lot of members of Congress want to drop this bill and pretend that they're going to pass a bunch of smaller bills later in the year."
As a very long debate comes to a close, some very worried and frustrated health-care experts are basically saying this: a health-care bill is a health-care bill is a health-care bill. Pass it, fix it later, and definitely do not lose momentum now. What remains to be seen is whether the House Democrats are listening.