Perry Scores Big Endorsement

Sen. Scott Brown endorses State Rep. Jeff Perry in the Republican primary race for retiring Rep. Bill Delahunt (D)'s seat, MA-10. Perry is popular with grassroots conservatives in Massachusetts. In order to win, Perry's going to need to appeal to independents and moderate Democrats, much the way Brown did. Brown's endorsement will likely burnish Perry's appeal in all three groups (conservatives, independents, and moderates).

An opponent of Mitt Romney's 2006 health-care reforms, Perry had strong words for the passage of the House bill (emphasis added):

I firmly believe that all Americans deserve quality health care coverage; but to be clear, I am opposed to the health care legislation passed by Congress today. I know the Bill as passed will raise taxes, increase government spending and lower the quality of care, especially for our senior citizens.

Furthermore, the version of the Health Care Mandate Bill passed by Congress today, which includes a legal requirement that individuals must purchase a private health insurance policy cannot be reconciled with our Constitution. No matter where one stands on health care reform, conservatives and liberals should be equally concerned about ignoring the limitation of powers our Founding Fathers wisely placed on the Federal government...

Although happening in small and seemingly innocuous increments, the growing size and scope of government at all levels is one of the greatest threats to the freedoms we enjoy as Americans. Often, politicians and the public in general are willing to allow small increases in government’s power in hopes that government will be able to solve some perceived problem we as a society are currently experiencing. However, this slow and steady erosion of our personal freedoms and personal responsibility is mounting a cumulative negative effect on the founding principles of the United States.

Do we really want to have a government that has the power to dictate, under the threat of oppressive sanctions that each and every person must purchase a certain product? If this can be done with a health insurance mandate, it is entirely reasonable to believe that in the near future the same logic will be applied to long term care insurance, disability insurance and why not life insurance. Where does this power and growth in government end? How much power are you willing to give to the Federal government over your life and personal choices?

During the debate on this issue in 2006, estimates of the cost of this program were unrealistic and I believe everyone knew so. However, it was politically correct to pass this mammoth social program without considering how much it would cost. My fear was then, and is now, that we have grossly underestimated the long term cost of this program and there will be many unintended consequences that will far outweigh any perceived benefits. It should also be expected that when the new tax on business is not enough to fund the program, the Legislature will be forced to raise taxes again to make up the difference as we just did with Governor Patrick’s $1 billion tax increase. Our Federal deficit is running in the tens of the trillions. How much more are we willing to place on the backs of future generations?

Perry's two-fronted attack upon the health-care bill---on matters of principle and policy mechanisms---is one that many Republicans will be making over the next seven or so months.

Rep. Alan Mollohan, a long-time incumbent Democrat in West Virginia, has Republicans and Democrats assailing him for his vote in favor of the Senate bill last night. Mollohan faces a number of Republican challengers, but he also faces State Senator Mike Oliverio in the Democratic primary. Oliverio has said he would oppose the health-care bill.

An interesting wrinkle: the WV Democratic party chair has said that he's staying neutral in the race between the two Democrats. One would guess that the chair sees a political opportunity in Mollohan's defeat: the health-care vote could very much be an albatross around his neck in the election. Having and anti-Senate bill Democrat face off against an anti-Senate bill Republican might eliminate a Republican tactical advantage in WV.

The Senate bill passes the House 219-212. No Republican voted in favor of the measure.

Stupak and some of his allies take the executive order and make a deal for their votes.

Loretta Sanchez's deputy press secretary emails me to say that the Congresswoman is uncertain about whether she'll vote for this "historic piece of legislation." (Though one wonders which way she's edging with a phrase like that...)

Via Instapundit, John Tanner (TN) is a "no." Tanner's retiring this year. He's concerned about the effects of this bill upon the deficit.

UPDATE: The Hill reports that Lincoln Davis (TN) will also be voting against the bill:

In a major development, Davis told The Hill March 21 he will vote no, saying, "I'm going to vote exactly the same way." Davis voted no in November.

Are the undecideds breaking against the bill?

Brian Baird (WA), who's retiring, has come out in favor of the Senate bill.

MSNBC reports Stupak as a "yes" (then pulls the headline). CNN reports Stupak saying he's still a "no." Is there disinformation happening? Honest confusion? The arm-twisting rages on. The Senate bill's passage isn't a done deal yet, not if the battle is this intense.

UPDATE: One of Stupak's aides confirms that there is not a deal yet. Stupak is still a no.

A warning about all vote lists: legislative history is full of people switching their votes at the last minute, as Sean Trende and Jane Hamsher remind us. Not everyone is as firm one way or another as Rep. Dan Boren, who said, “They can break my arms. They can do whatever they want to. They'll never get my vote — ever. They'll have to walk across my dead body if they want my vote on this issue.”

The Rube's Game of an Executive Order

Rumors swirl that Stupak is close to or trying to strike a deal with the Obama administration, trading the votes of the Stupak bloc in exchange for Obama issuing an executive order restating the language of the Stupak amendment from the House bill (or something like that). One can't help but wonder what a bad deal this would be for the anti-abortion Stupak bloc, assuming, that is, that their real aim is not just getting the merest fig-leaf of political cover to vote for the bill.

Executive orders depend upon the whim of one man: the president. They can be reversed at a moment's notice. The fact that an insurance mandate is in the health-care bill is all that Stupak members need to know in order to see how much they can rely upon the permanence of executive whim. Candidate Obama campaigned against the individual mandate for health insurance. Candidate Obama also campaigned against taxing health-care benefits. The Senate bill has both a mandate and these taxes. Many on the left and right have noted the host of Obama's broken promises for health-care.

To observe this is not necessarily to castigate the president for making deals. That's what politicians do. But there may come a time (and it might not be very far away) when the president could make a deal to reverse or otherwise defang his executive order. And the Stupak bloc would have traded their votes for nothing.

The Pro-Choice Caucus said that it would revolt against the health-care bill if the Stupak measure was put into the legislation. But where is the wrath about the executive order? If the Pro-Choice Caucus is willing to abide that order's promised existence, could it be that they don't have much faith in its permanence? If they're willing to let it stand, perhaps they feel it is that much weaker than the Stupak legislative language.

Changing legislation requires at the minimum the will of 260+ people (in the House and in the Senate). Changing an executive order requires the will of one. Do Stupakers really want to hang everything on the convenience and the ambition of one person?

Freshman Glenn Nye (VA), who voted against the bill in November, is voting "no" again this time.

In a surprise to many political watchers, Democratic leaders now think that Loretta Sanchez (CA) could vote against the bill. Roll Call reports:

Sanchez was nowhere to be found on Saturday — she was in Florida on a fundraising jaunt, two Democratic sources said — and while leaders expected her to return for the Sunday vote on final passage, they weren’t assured. What’s more, leaders now list the Orange County Democrat as a “no” vote...

But Sanchez has demonstrated some hesitance to supporting health care reform, joining 14 other Democrats who voted against the rule governing debate on the House bill back in November. She ended up supporting final passage of the measure, but she was the last Democrat to vote, and did so only after coaxing from leadership. The House bill passed with unanimous support from the 34 Democrats in the California delegation. And after Rep. Dennis Cardoza (D-Calif.) affirmed on Saturday he will support the Senate-passed version and a package of fixes, Sanchez was the lone Golden State Democrat apparently still mulling a vote against the bill.

The White House and Democratic leaders have been working Sanchez in recent days, with Obama calling her on Friday, according to a Democratic aide. And the pro-reform group Organizing for America on Saturday asked its members in her district to call her office and register support. One source said leaders expect they can flip her vote on the floor, if it comes to that.

And if she shows up.

One wonders if she'll try to avoid this vote totally. Sanchez usually wins her district handily, but Jane Hamsher* suggests she may be facing a tougher re-election contest than usual this year. Bush and Schwarzenegger won her district in 2004 and 2006, respectively.

Many had assumed she'd vote in favor of the bill. Are some Democrats starting to get cold feet?

*UPDATE: Correction.

Zack Space (OH), who voted in favor of the bill last year, has now come out against it. Space offers a rebuke to those who think that a bill should be passed for the sake of passing a bill:

"Getting it done just to get it done is not something we should be doing. We should be doing it right," Space told the Gannett Washington Bureau in a phone interview late Saturday.

Space said he has been getting calls and letters from his constituents, most of whom do not like the bill.

"I'm doing what I think is right," Space said. "I have been under enormous amount of pressure this week in Washington. I have spoken to the president twice, once in the Oval Office. My own leadership has been working hard to get me to vote for this. But I don't represent them. I represent the people in the 18th Congressional District."

Blue Dog Jim Matheson (UT) has also come out against the bill.

By FDL's David Dayen's count, that gives the following:

That makes it 207 No votes and 204 Yes votes. Ten are still undecided, and ten are potentially part of the Stupak bloc.

If opponents can keep the Stupak crew/undecideds/some combination of the two, this bill could be in serious trouble.

Has Pelosi released these moderates to vote against the bill, secure that she has a majority? Are the moderates about to come out more against the bill, moving as a group to protect themselves from leadership's wrath?

UPDATE: TPM says that Space's switch did not "surprise" Pelosi, but "she didn't release him to vote no either, as sometimes happens late in the game when the leadership knows it has enough votes and can spare some to protect vulnerable incumbents."

Away from Deem-and-Pass

Pelosi seems to have moved away from the path of deem-and-pass, with two separate votes on the Senate bill and the reconciliation package. One GOP staffer emails Daniel Foster:

Very interesting. Not sure what this means about their vote count. They were clearly facing revolt on this, too. They must have decided to take care of the easy one first.

This tidbit from Robert Costa shows Pelosi trying to chip away at the Stupak bloc:

Reps. Driehaus (D., Ohio) and Dahlkemper (D., Penn.), two Stu-Packers, just went into Pelosi's office.

On the Fence

Borrowing from David Dayen's whip list of undecided votes, here are some representatives who seem undecided or at least just leaning a certain way:

Voted "Yes" Last Time
Chris Carney
Bill Foster
Paul Kanjorski
Solomon Ortiz
Earl Pomeroy
Zack Space
Mike Michaud

Voted "No" Last Time
Brian Baird
Jim Matheson
Glenn Nye
John Tanner

Here's the Stupak bloc. If the Stupak deal falls through, Pelosi will want to try to pull some of them over:

Bart Stupak, Marion Berry, Jerry Costello, Kathy Dahlkemper, Joe Donnelly, Steve Driehaus, Marcy Kaptur, Dan Lipinski, Alan Mollohan, Nick Rahall

The pressure's probably pretty heavy on these members. Folks like Stephen Lynch and Ike Skelton are also probably feeling the heat.

Opponents of the Senate bill would be wise to watch these votes closely. If they hold at least a few of the undecided votes (and keep the Stupak bloc), Pelosi could be in real trouble.

UPDATE: Some union leaders are going after Lynch.

UPDATE: Carney's a Yes.

A few people are saying that there's some rumored deal about an "executive order with Stupak-like language" to win over the Stupak bloc. But wouldn't that still upset the Pro-Choice Caucus? And executive orders are pretty easy things to undo. Do the Stupak folks really want to bet on this?

Not Dead Yet

In an email, Stupak's Press Secretary, Michelle Begnoche, confirms that "[d]iscussions are continuing" between Stupak and Pelosi. Despite the delay of the press conference, Stupak's still trying. These continuing discussions probably show the difficult position Pelosi is in right now. She can't alienate the Pro-Choice Caucus, but she also needs at least some of Stupak's block. She's still trying to find the magic formula for 216. This isn't a done deal yet.

UPDATE: Pelosi has told reporters that there will be "no separate vote" on abortion or anything else for the health-care bill. A staunch negotiating position? A firm guarantee? Is Stupak holding out for an executive order? Will Pelosi try to plug ahead without him, maybe trying to chip away at his coalition?

Real Deal?

FireDogLake is reporting that Pelosi has seemingly struck a deal with Stupak and his block:

House Speaker Nancy Pelosi has made a deal with Rep. Bart Stupak in order to secure his vote and that of other anti-choice Democrats for the health care bill, which is scheduled to be voted on this Sunday. According to a member of Congress who was briefed on the matter, Pelosi has agreed to let Stupak have a vote on his amendment either before or after the House votes to pass the Senate bill. It instructs the Senate to substitute the language in his amendment for the Senate language on abortion...

The deal calls for Stupak to have a vote on his amendment either before or after the House votes to confirm the Senate bill on Sunday. Stupak is confident that he has the votes to pass the measure, and is happy to have the vote after the House passes the Senate bill. He believes that by using a “tie bar” measure, his amendment would be “tied” to the health care bill — which would require just 51 votes in the Senate.

FDL has a copy of the amendment text.

However, according to David Dayen, the type of deal is very obscure and there's a lot of uncertainty about the procedural mechanisms for it. Is it the best bet for anti-abortion Democrats? Here's one expert's take:

The question here seems to come down to how this is presented. Does this enrollment correction get tucked into the reconciliation bill and then “deemed” (there’s that word again) passed by the Senate? Would it have to be a stand-alone measure? What about the Byrd rule?

I asked Sarah Binder, a parliamentary expert and a professor at George Washington University, about all this. She doesn’t quite think it’s possible. Specifically, she says that “any enrollment corrections resolution considered to be more than a technical correction would need unanimous consent (in the Senate) to be adopted.” Failing that, it could possibly run through a cloture vote, basically 60 votes in the Senate. But if it’s inside the reconciliation process, then one Senator merely can challenge the language of one line of the bill and get the concurrent resolution ordered out of the sidecar.

This could get very very messy. Will Stupak and his crew really want to sell their votes for this? Time will tell...

UPDATE: The fact that this deal is even being contemplated shows how weak Pelosi's position is currently: she needs these votes, she thinks. Meanwhile, the Pro-Choice Caucus is threatening to take their toys (and their votes) and leave the pro-Senate bill camp if the deal passes.

Jason Altmire (PA) decides that he'll vote against the Senate bill. Altmire did not vote against the Slaughter rule yesterday.

Confidence Game

Seeing some reports, it seems as though Speaker Pelosi and her allies are now heavily involved in the confidence game, sending all the impressions that they have a secure majority on health-care. It's to their advantage to do so. No vulnerable Democrat wants to vote for an unpopular bill that fails. Most of them probably aren't too happy for voting for this bill even if it does succeed. If leadership can make each individual recalcitrant Democrat look like a lone holdout, they might be able to corral a majority, or so they hope.

However, it's not clear that Pelosi does have a majority. The fact that enough representatives are leaving their options open shows that her coalition is not firmly solidified. If it was, she could have the 216 Democrats all staunchly declare their intentions to vote in favor of the bill, and that would be that. The whip counting would be over. Right now, she's not secure enough in her allies to get those declarations. Democrats who are privately pledged to her are still unsure---about how they want to vote, about how others want to vote, etc. If the number of Democratic defectors gets big enough, will Pelosi and Obama really want to punish them all? Is Pelosi that eager to lose the speaker's chair?

John Boccieri's declaration that he will support the bill should not be unduly taken as a sign of momentum. Peter DeFazio (OR) is now saying that he can't support the bill because of issues with the funding of rural health-care. Nick Rahall of West Virginia is on the record as saying that he won't vote for the Senate bill as it stands due to its abortion language. Both voted in favor of the bill last time. No one even knew that DeFazio was thinking about not supporting the bill. DeFazio is no doubt trying to get more goodies from Pelosi, but the fact that he's even making this play shows that he knows she's vulnerable---and that she needs his vote, bad.

A key point to remember: if opponents of the Senate bill can keep all the Democrats who voted against the "Slaughter rule" (and, as far as I know, none of these Democrats have said that they will vote for the bill) and the remaining Democrats who are currently listed on FDL's list as definite "no" votes but did not vote against the "Slaughter rule," opponents of the Senate bill will have a majority. They don't even need to win over any other undecided or lean voters. The bill will be dead. I've included the list of firm "no" votes from FDL here:

24 Democrats who voted No in November:
Bobby Bright, Mike McIntyre, Stephanie Herseth Sandlin, Walt Minnick, Artur Davis, Chet Edwards, Frank Kratovil, Mike Ross, Dan Boren, Gene Taylor, Larry Kissell, Collin Peterson, Ike Skelton, Jim Marshall, Mike McMahon, Charlie Melancon, Tim Holden, Ben Chandler, Health Shuler, Rick Boucher, John Adler, Lincoln Davis, John Barrow, Travis Childers.

7 Democrats who voted Yes in November (“S” for confirmed Stupak bloc):
Stephen Lynch, Mike Arcuri, Bart Stupak (S), Dan Lipinski (S), Jerry Costello (S), Joe Donnelly (S), Steve Driehaus (S).

Here are the on-the-fence Democrats who voted against the "Slaughter rule":

Carney (PA)

Cooper (TN)

Dahlkemper (PA)

Giffords (AZ)

Kosmas (FL)

McNerney (CA)

Michaud (ME)

Michell (AZ)

Nye (VA)

Perriello (VA)

Teague (NM)

If he follows through on his pledge, Rahall would also be a "no." And there are plenty of undecided Democrats who voted in favor of the "Slaughter rule" in order to throw leadership a bone and still have some more time to think/bargain. They could switch, too.

Leadership is trying to start a stampede of support, and it is not above using the mirage of a majority to get it. Opponents of the Senate bill should keep focused on the facts of the matter---and hammer these facts home in an attempt to pierce the leadership bubble.

Making History

Since the president is reportedly urging member of Congress to "make history," it's worth keeping in mind some polling from history.

According to Gallup in 1965, the year it passed, Medicare had 63-28 support.

Flash forward to 2010, on the eve of potentially "making history," Americans disapprove of the current health-care package 55-35.

These numbers are almost a complete inversion of Medicare's level of support. It's fitting, then, that this current package has as a centerpiece taking the knife to Medicare and cutting hundreds of billions of dollars from it.

Cost Myths

Jeffrey H. Anderson has a devastating deconstruction of the various bureaucratic tricks used to make the reconciliation package look financially sustainable. Some key paragraphs:

To see the bill’s true first-decade costs, we need to start the clock when the costs would actually start in any meaningful way: in 2014. The CBO says that Obamacare would cost $2.0 trillion in the bill’s real first decade (from 2014 to 2023) — and much more in the decades to come.

But $2.0 trillion wouldn’t be the total ten-year costs. Instead, that would merely be the “gross cost of coverage provisions.” Based on earlier incarnations of the proposed overhaul, the total costs would be about a third higher (the exact number can’t be gleaned from the CBO’s analysis, which is only preliminary and is not a full scoring) — making the total price-tag between $2.5 and $3 trillion over the bill’s real first decade.

How would we pay for all of this? According to the CBO, by diverting $1.1 trillion away from already barely-solvent Medicare and spending it on Obamacare, and by increasing taxes on the American people by over $1 trillion. Among the Medicare cuts would be cuts of $25,000 in Medicare Advantage benefits per enrollee — up from $21,000 in the previous scoring.

No Escape from the Excise Tax

Jon Walker at FDL digs into the CBO's report on the reconciliation bill. His analysis finds that much of the reconciliation health-care bill's "savings" from 2020 to 2029 is predicated upon a massive tax increase through the excise tax on more expensive health-care plans:

To make it look like the excise tax will bring in a huge amount of money, they have indexed the tax to only the consumer price index instead of the CPI plus 1%. This is far below health care inflation even in countries with very slow rates of increase in health care cost. What this means is, each year, the excise tax will likely hit more and more people until it gets to a point where even very basic insurance packages would run afoul of the excise tax. Also, the subsidies that those on the exchange get will get smaller and smaller.

If that excise tax stays in place, it would represent a huge de facto tax increase on tens of millions of Americans. If it does not stay in place, much of the bill's purported savings disappear.

As Walker continues in his "math-magical" analysis, this tax could give employers much greater incentive not to provide health-insurance to their workers:

The problem is that the excise tax is a flat tax of 40% on the value of the entire insurance package. It is not even a set cap on the value the employer pays for. This 40% rate is higher than many Americans marginal tax rate. This means that it simply does not make sense for an employer to ever offer employees the choice of an insurance package that costs more than the new excise tax limit. This would make it effectively impossible for many people with employer-provided coverage to buy a quality insurance package, even if they were willing to pay more in premiums with post tax dollars. If you actually wanted a tax to remain intact for the next twenty years, this is not how you would design it.

Walker focuses on the political unsustainability of the tax, but one also might wonder if perhaps part of the strategy for this tax is to drive people away from employer-provided coverage, to make it unsustainable.

Rep. Stephen Lynch (D-MA) does a shocking thing and actually works on behalf of the members of a union organization (and not merely the leaders of a union):

Rep. Stephen Lynch (D-Mass.) is a firm “no” on health care reform — in large measure because he opposes the idea of any kind of excise tax on Cadillac plans, even one that’s delayed for years and years.

That’s put Lynch a former ironworkers union official in Boston at odds with many union biggies, who are swallowing hard and accepting a proposed House-Senate compromise.

Lynch — who voted for the tax-less House bill last year — has become a serious target of his union buddies, enduring pickets at his district office, an AFL-CIO robocall blitz and at least one recent drop-in visit from a very influential old friend — Joseph J. Hunt, president of the International Association of Bridge, Structural, Ornamental and Reinforcing Iron Workers.

Lynch is facing a lot of heat from party bigwigs on this, but it looks like he could keep to his convictions. If other stalwart Democrats like Lynch start abandoning this bill, it could be a sign that an increasing faction of the Democratic party has turned upon what it conceives of as a flawed process and poor policy.

Not over yet

The 203-222 defeat of the measure to ban the "Slaughter rule" might be a more positive sign for opponents of the Senate bill than many realize. If opponents can keep together all the Democrats who voted to ban this rule and still have the remaining Democrats who are listed as firm "no" votes by FDL, the Senate bill would be dead in the House.

UPDATE: Michael Barone has more analysis of the dynamics of this vote. See also Malkin.

Searching for the Third Way

If Republicans and moderates and disaffected "progressives" are serious about cobbling together a majority to delay the deeming and passing of the Senate bill, they would be wise to stress their openness to and even eagerness for the passing of a smaller, more targeted reform measure. As Allahpundit suggests, a pledge to make health-care reform the number two priority next year (behind jobs) on the part of Republican leaders could be effective.

I think opponents of the Senate bill might go even further and state that they want to keep working on health-care this year. There is a moderate coalition out there in support of a variety of reforms for health-care.

Currently, the lefty radicals have been driving the debate---that it's either this bill or no bill, "reform" or stagnation. Centrists cannot let the radicals monopolize the mantle of reform and they should not accept the radicals' interpretation of history. There are more choices than the partisans pose.

Currently, the centrists are serving as legislative cannon-fodder for many of the radicals in Congress. The actions of Democratic leadership, overwhelmingly supported by the left wing of the Congress, have endangered the moderates' electoral chances, and now the moderates are being asked (or threatened) to take another big swallow and vote for this measure.

If an authentically moderate reform passes the House and the Senate, the president can sign it and still take credit for it. He might express some disappointment with the limitations of the measure, but he can still sign it with fanfare. Moderate Democrats can still give their president a win, if he wants it.

Opponents of the Senate bill should give fence-sitters something to vote for or at least the possibility of something to vote for. Real legislative reform can happen that can cross party lines. There is a place still for the vital center in politics, Senate bill opponents might remind the undecideds. Voting "no" on this bill need not be a vote for inaction---merely a vote for a different kind of action.

In the Echo Chamber

According to Greg Sargent, Democratic leadership aides are circulating the following information:

In an effort to stiffen Dem spines, senior Dem leadership aides are circulating among House Dems some polling numbers from the 1960s that underscore how controversial Medicare was in the months leading up to its historic passage.

Dem leadership staff is highlighting a series of numbers from 1962 on President John F. Kennedy’s proposal. In July of that year, a Gallup poll found 28% in favor, 24% viewing it unfavorably, and a sizable 33% with no opinion on it — showing an evenly divided public.

Medicare passed in 1965, so there's a big gap there in polling.

In fact, there's a noticeable gap in all of the 1960s poll numbers that leadership aides are supposedly sending around and that left-wing bloggers are talking up: polling from 1965 when Medicare actually passed.

That's a much more depressing story for Pelosi and crew. Medicare was very popular when it passed. According to Gallup, 63% of voters supported the passage of Medicare back then. Health-care reform isn't there yet.

So the narrative that the huge bipartisan majorities that passed Medicare in the sixties (and they were huge and they were bipartisan, unlike the voting on behalf of current "reform" package) faced down huge majorities opposed to the progam? Pretty weak.

Does leadership actually think that on-the-fence Democrats will buy this? Is leadership really that much sucked into the bunker mentality? What else (with equally shoddy foundations) is leadership hoping that members will buy?

Welcome to the Future

Two telling stories in today's Boston Globe. The first is this much-ballyhooed statement by Democrat-turned-independent State Treasurer (and gubernatorial candidate) Timothy P. Cahill:

"If President Obama and the Democrats repeat the mistake of the health insurance reform here in Massachusetts on a national level, they will threaten to wipe out the American economy within four years."

He's urging the president and Congressional leaders to "come up with a new plan that does not threaten to bankrupt this country." These are strong words from Cahill, not exactly a right-wing hack.

Perhaps Cahill's fears are reinforced by another article in the Globe, one that hasn't gotten as much play. This story shows what "health-care reform" in Massachusetts has wrought: skyrocketing costs in an already expensive medical system with the prospect of rationing to come. Here are a few snapshots of what could be upcoming for the nation as a whole (emphasis added):

Moore has filed a bill proposing to cap payments to hospitals and doctors at 110 percent of what the federal Medicare program pays for medical care. But, he said yesterday, insurers and the state could save money even with a higher cap.

Governor Deval Patrick filed a measure last month that would give state officials power to review and reject rates set by hospitals, physician groups, medical imaging centers, and insurers....

Last year, a state commission proposed radical changes to the way providers are paid, with the goal of slowing the rise in the use of medical services. It urged scrapping the current fee-for-service system and paying providers a per-patient annual fee, called a global payment, to cover all of a patient’s medical care.

The state secretary of Health and Human Services, Dr. JudyAnn Bigby, and other Patrick administration officials have completed a detailed plan for adopting global payments and are expected to brief legislators on it by next week, Moore said.

But given that global payments could take five years or more to implement, he said “a quick fix’’ is need ed “to stop the bleeding,’’ particularly for owners of small businesses, who are struggling to pay soaring health insurance premiums. He said provider rate limits could slow the growth in health care costs more quickly and are a likely component of any Senate measure.

Government bureaucrats setting prices? Check. Capping payments to doctors? Check. Centralized complex mechanisms? Check. Rationing? Check. What's not to love!?

Placing limits on what doctors can spend per patient would necessarily limit the care options for each patient. This is a kind of backdoor rationing with a one-size-fits-all flavor. Part of the "progressive" dream of making care more "efficient" perhaps hinges upon this limitation in medical care. Despite the smoke and mirrors of partisan rhetoric, there are significant costs of so-called "universal health-care."

It is very likely that many of the excessive costs of our current health-care system are due to the structural inefficiencies of a few centralized providers. The Massachusetts health-care experiment and Democratic leadership in Congress seem to be doubling down on the hopes of centralization. So far, how is that bet working out?

FDL has a new whip count: 190 Yes-206 No (with leaners included: 205-209). What's interesting in this list is that there are many more members leaning to vote "yes" than leaning to vote "no." The "no" block is pretty solid, which is why Pelosi and co. are going to have to do some digging. Some more analysis at Hot Air here.

Sleight of Wrath

Ezra Klein takes the chainsaw to a David Brooks column, calling it a column that "can't be taken seriously" due to some alleged factual inaccuracies. Klein pounces on this paragraph (on the use of reconciliation to pass health-care "reform" in the Senate):

Reconciliation has been used with increasing frequency. That was bad enough. But at least for the Bush tax cuts or the prescription drug bill, there was significant bipartisan support. Now we have pure reconciliation mixed with pure partisanship.

Klein rightfully points out that the Medicare prescription drug reform under Bush was not passed via reconciliation (you mean you can pass major health-care-related measures without using reconciliation!?).

However, if Klein's going to attack Brooks on the matter of facts, he had best be sure his own facts are right. Well, check out this math:

The budget reconciliation process was used six times between 1980 and 1989. It was used four times between 1990 and 1999. It was used five times between 2000 and 2009. And it has been used zero times since 2010.

So Klein says, which suggests that reconciliation has been used 15 times since 1980. However, it seems as though reconciliation has been used 22 times. Klein's missing some reconciliation votes here. (However, there is some weight to his broader point that reconciliation was used the most in the 1980s. It was used heavily there but mostly for---I don't know---the reconciliation of budgetary issues.)

Klein also has a slight rhetorical sleight of hand in this claim:

Nor has reconciliation been limited to bills with "significant bipartisan support." To use Brooks's example of the tax cuts, the 2003 tax cuts passed the Senate 50-50, with Dick Cheney casting the tie-breaking vote. Two Democrats joined with the Republicans in that effort. Georgia's Zell Miller, who would endorse George W. Bush in 2004 and effectively leave the Democratic Party, and Nebraska's Ben Nelson. So I'd say that's one Democrat. One Democrat alongside 49 Republicans. That's not significant bipartisan support.

OK, but that's only the 2003 tax cut bill. The 2001 tax cut bill passed 58-33, with a thoroughly bipartisan majority. Brooks might---understandably---have had that vote in mind.

It is true that reconciliation votes have not always been bipartisan love affairs, but does that mean that Brooks's anxiety about a hyper-partisanization of the Senate is wholly misplaced? I realize there's a school of ideological "progressive" thought that loves partisan acrimony and division, but it is not an unworthy position to doubt that such division is good for the country.

See also Rich Lowry's take on this.

A few updated whip counts here and here. Good point from the Hotline:

Now that there's a bill, expect the arm-twisting to begin in earnest. If Dems are able to move votes, that momentum is likely to build in the next several days.

Rep. Jerry Costello (D-IL), who voted "yes" last year for health-care reform, is now leaning a little bit in the "no" direction. He's open to being swayed.

Action for Action's Sake

This National Journal poll of anonymous Capitol Hill lawmakers reveals an interesting trend: members of both parties believe that passing Obamacare will help them in November! 77% of the Democrats believe that passage will help them electorally. Michael G. Franc wonders if some of them are merely mouthing the party line, but he suspects that they believe much of what they're saying.

If so, it seems that many Democrats have fallen prey to the Washington prejudice of doing something and the Washington assumption that the public will applaud action (even action they oppose) instead of inaction. Here are the sample responses:

Help a lot

"It would regain a lot of the energy in our own base. Otherwise, we will be in deep trouble."

"We will have achieved something important."

"The Democrats need to get something passed. Otherwise, they will have fallen victim to nothing more than fear-driven attacks."

"It will help a lot of people, show that Democrats can act, and get the 'sausage-making' off the news."

"If it passes, people see it's not the end of the world and learn more about its benefits. The more they know about it, the more supportive they are. Best of all, we can begin talking about something else."

"It will help a lot to show that [President Obama] can make Washington work. But the name of the game in November will be the economy -- just like it always is."

"It's getting something done, stupid."

Help a little

"Despite a Republican and insurance industry campaign to bring reform to its knees, I still think many Americans will give Democrats credit for bringing much-needed change."

"Democrats have to deliver. We are too far into this."

"Passage means a Rose Garden signing ceremony and some immediate benefits. Failure to pass means incompetence despite our large majorities."

"That's the best-case scenario. Even many Democrats opposed to the health care bill realize it needs to be settled and put behind us."

I think many Democrats overestimate the PR value of a "Rose Garden signing ceremony." While the Washington elite may be obsessed with questions of party management, the public is much more concerned about things like the actual effects of a bill. After all, would voters be happier with a highway department that actively destroyed roads (at least it can do something!) or one that may not always be the best at keeping roads in good shape?

A few rejoinders to these Democratic musings:

• It is not this bill or no bill. A moderate, targeted bill, which Obama and co. could talk up as a "generational" achievement, could still be passed.
• This issue can be "settled" in more ways that just kowtowing to the Speaker's wishes. Nothing is stopping Democrats from talking about health-care reform (nothing, that is, other than the Democrats themselves).
• "The base" only gets you so far. Massachusetts has one of the biggest, most connected Democratic "bases" in the nation. Did that base get Martha Coakley into the Senate?
• Moderates might find passage of this bill an even heavier anchor around their ankles than the failure of this bill.

The Speaker and the president have, it seems, been somewhat successful in creating a legislative horizon, in which the fate of "health-care reform" turns upon the passage of whatever flavor of legislation party leaders have currently come up with. Buying into this myth may have negative political consequences for Democrats and unfortunate public consequences for our nation.

Not Inevitable

There are a few possible inferences from the push from House leadership to talk about having a vote on the health-care bill at the end of next week.

• They believe they have enough votes to pass the "Slaughter rule" or the Senate bill or whatever and want to push now, while they still have a seeming majority.
• They sense their position is weakening but still believe they have the votes now.
• They don't know whether they have the votes or not but just want to end the battle one way or another.
• They don't have the votes now but are in part bluffing by talking about putting their position to a vote, hoping to corral undecideds with the appearance of being confident.
• They know they don't have the votes but want to have a last charge up the hill of Obamacare in a display of progressive glory.

All of these possibilities suggest one thing: approval of the Senate's bill is not inevitable. Inevitability is one of the strongest forces on Capitol Hill, especially when members are considering voting against their party leadership. Very few in Congress like to be on the losing side; they like it even less when that losing side goes against the wishes of their party leaders.

But this measure is not inevitable. And it would not be a futile act for a Democrat to vote against this bill. There are matters of policy, some of them outlined by Mike Capuano (D-MA), among others. The new taxes, the increased premiums, the diminution of Congressional power, the centralized control of the health-care system, the ax taken to existing programs, etc. etc. etc.

There is the fact that, in a vote this tight (or at least the vote will be very tight if the measure passes), every vote matters. A Democrat voting no can actually help push the political debate in the direction of a targeted, sustainable reform. Voting "no" would not be an act of mere political vanity but a contribution to the contours of the public debate.

There is also the matter of political survival, a not wholly unworthy political motivation. Even if the Congress does pass a radioactive health-care bill, every Democrat need not be stuck on a sinking ship. Indeed, the best way to distance oneself from this measure and from an unpopular Congress would be to take a stand against a bill so unpopular, so toxic, that leadership doesn't even want to talk about the mechanisms of getting it passed and may even hope to allow members of Congress to vote for Obamacare without actually voting for it. That's the level of conviction that leadership has about this bill. Democrats serious about standing up against cronyism and secrecy and public venom could do worse than attacking the bill and its process. A personal connection with voters---one in part forged by listening to them and standing with them against this bill---could go a long way in November.

All of this is to say that the passage of this bill is not inevitable, and opponents of the Senate bill should not lose hope. The full strength of the national Democratic machine is being brought to bear against waverers and Congressional free-thinkers. But public activism defeated this machine in Massachusetts in January. There's no reason to believe that the public's Army of Davids can't win the rematch, too.

Michelle Malkin has a great roundup of resources for those interested in stopping the Obamacare train. Between phone calls, email addresses, and public demonstrations, there is plenty that private citizens can do to push back against the machine. Every vote matters here. Opponents of Obamacare need to focus on wavering Democrats who voted "yes" as well as "no" on Obamacare. Here's a good list, which shows the "no" votes have an advantage. Opponents should not merely focus on moderate and right-leaning Democrats; they should also make common cause with lefty opponents of Obamacare, many of whom have sensible reasons for opposing it.

There are a number of subterranean cracks in Pelosi's coalition, many of them covered over by the thinnest layer of dirt. If she does have a majority (which is, at the moment, a big assumption), it isn't a strong one. The right amount of pressure, debate, and public scrutiny could shatter that fragile alliance of partisanship, ideology, and fear.

Now, as the health-care battle recommences---now is not the time to give up hope.

Capuano Plays Hardball

Democratic Rep. Mike Capuano (MA-8), who voted in favor of the House's version of health-care reform in November, has released a letter raising a number of concerns with the Senate bill. Here are a few of them:

(2) DSH cuts - Currently, Medicare and Medicaid provide extra payments to hospitals that serve higher-than-average shares of people without health insurance. These hospitals are called Disproportionate Share Hospitals, or DSH. In the 8th District for example, Boston Medical Center and Cambridge Health Alliance both depend on millions of dollars a year in DSH payments. The Senate bill would cut DSH payments by $42 Billion per year, as opposed to the $20 Billion cut proposed in the House. Such cuts, made before a new health care system is allowed to fully develop, would curtail the amount and quality of health care provided by DSH hospitals and their uninsured patients, thereby driving these sick and poor persons to other hospitals that will not be equipped or paid to handle the medical and social challenges they present. I am looking into this aspect of the Senate bill as well.

(3) Value Index - The Senate bill includes a proposal to adopt a so-called "value index"; the House bill does not include this proposal. It would adjust the way payments to physicians and other non-hospital providers are calculated. Supporters suggest it would encourage practices that are more frugal by rewarding "low cost areas". Massachusetts is considered a "high cost area" due to various factors, including the regional cost of living, the relative poverty of the people served, and our financial commitment to educating America's next generation of doctors. There are no limits on how much a physician's payments could be reduced by this so-called "value index" and the method has never been tested at the physician level. Due to the probability of much lower payment rates to Massachusetts doctors, this proposal seems as though it would influence (1) where doctors practice (discouraging practice in Massachusetts), (2) how they treat patients in so-called "high cost areas", and (3) how many doctors will be trained in America. Absent a thorough study of the impact of this so-called "value index", it seems to me that it could seriously harm the quality of care in Massachusetts.

(4) Super IMAC - The Senate bill contains a proposal that would shift authority to set Medicare policies and reimbursement rates from the Congress to a board appointed by the President. This proposal has been referred to as the "Super Independent Medicare Advisory Council" by many. The House bill does not contain such a proposal, although it does require formal studies on many specific initiatives to improve the quality and cost effectiveness of the American health care system. Traditionally, reimbursement rates from Medicare are based on many factors including efficiency, complexity of the medical issues, whether the provider also bears costs associated with medical education for future doctors, whether the provider engages in research that advances medicine and the cost of living in different areas. Some argue that Medicare should focus ONLY on cost containment without regard for all the other factors that affect the cost of care and that have been traditionally considered. I am concerned that if this appointed board adopts the cost-containment only approach, Massachusetts could lose BILLIONS of dollars PER YEAR. Such a loss would hurt our world-renowned medical schools, teaching hospitals, and research programs. Those losses would undermine the quality of care we provide to our own citizens and slow progress in biomedical sciences globally. To make matters worse, I am concerned that it would quickly and inevitably result in Massachusetts losing tens of thousands of jobs and would seriously undermine one of our region's economic engines. Other regions with heavy concentrations of health care would feel a similar impact, such as New York City, Philadelphia and Los Angeles. Finally, to add insult to injury, the elected representatives of the people impacted would no longer have a say in accepting, rejecting or amending any new approaches - the entire decision would be up to Presidential appointees. Moreover, I ask people who are happy to entrust these decisions to persons appointed by President Obama to remember that there will be other Presidents, with, perhaps, very different levels of commitment to medical care.

Members of Congress have made points like this on both sides of the aisle. The last may be one of the more pressing to members of Congress; passage of Super IMAC would represent a significant blow to the power of Congress and give the executive branch even more power to intervene in the health-care of the nation.

Martha Coakley won Capuano's district in January 2009, so he might not be purely motivated by electoral concerns here. This may be an attempt to extract as many concessions from leadership as possible. It may also be a sign of principled disagreement, one from which he might not be swayed.

It's Happening

As Sen. Lindsey Graham (R-SC) tries, without much success, to round up a new Gang of 14 to forge a bipartisan consensus of health-care reform in the Senate, Democrats who are now proving deaf to the calls of bipartisan cooperation might pay attention to these rumblings from Harry Reid:

Senate Majority Leader Harry Reid (D-Nev.) pledged on Wednesday to take a serious look at revising the filibuster rules at the beginning of the next Congress, calling the current level of obstruction in the Senate unacceptable.

In a reflection of the party's commitment to changing the parliamentary rules, Sen. Chuck Schumer (D-N.Y.) followed the majority leader by saying that his committee would address the topic soon.

"The rules committee is going to start holding hearings on how to undo the filibuster rule," said Schumer, who chairs the Senate Rules Committee. The New York Democrat told the Huffington Post after the speech that the hearings would take place two or three weeks from now.

Pledges are only words, and "serious looks" in Washington are often anything but serious. But this story does indicate the increasing interest in "reforming"/doing away with the filibuster for the Democratic leadership in the Senate.

Furthermore, the attempt to bypass the filibuster using reconciliation may be a tactic that leadership is just getting started with, as Senate leaders weigh passing other measures via reconciliation.

The loss of the filibuster would likely be a significant blow to the power of moderates on both sides of the aisle. As many "progressives" have noted (often with deep disappointment in their voices), the demands of folks like Ben Nelson and Mary Landrieu would not be taken nearly as seriously if Democrats did not need at least 60 votes to pass health-care reform. The filibuster also encourages members of one party to work across the aisle with members of another party in order to pass legislation. This fact also usually ends up helping Senate moderates, often giving them a hand in legislation even when they're in the minority.

Is it really in the long-term interest of the US Senate and the United States to make senators mere bobbleheads for leadership, nodding whenever the leader says "yes"? Harry Reid might not, according to many polls, be long for the Senate, but moderate senators ought to consider the long-term implications of the path that leadership is on.

The Boston Globe has an interesting story on a possible GOP resurgence in New England, noting increased Republican activity in Congressional districts in Massachusetts, New Hampshire, Rhode Island, and Connecticut.

A Democratic Congressman claims that supporters of Obamacare only have 201 votes, well short of the number that they need. Hot Air has some more speculations, as does Ace. Hotline has a good, thorough list of possible persuadables.

Diffusion of Power

Ben Smith passes along this note from a "prominent Chicago Democrat":

First, court intrigue is the way of politics in Chicago and Illinois.

Second, Ax's -- and to a degree Obama's -- problem is that they aren't used to governance that requires multi-party and intra-party skills, where the chief executive isn't in absolute control of all levers of government. The "Chicago Way" is profoundly misunderstood. It isn't, first and foremost, about bullying politics; it's about absolute control and the means to achieve it. The "Chicago Way" would never work in DC, and I believe their frame of reference doesn't allow them to see DC otherwise.

Absolute control has often served as a key goading mirage for presidents. If only they could achieve it, if only they could impose their will upon the whole of the United States and usher in a Utopian age! However, American federal politics are built upon contention (between parties, between branches of government, and so forth).

The attempts by the White House and Congressional leadership to ram through some kind of health-care "reform" show the difficulty of achieving this level of control. Pelosi and Reid have been trying hard to muster this control, by releasing bills just before they are voted on and twisting the arms of recalcitrant Democrats right out of their sockets, but, for all their cajoling and threats and promises, they run into a serious problem: the voters, and not leadership figures, have the power to return a member of Congress to office. They also run into the problem that many in Congress are quite rightly suspicious of attempts to centralize power in the hands of the legislative few.

The Weekly Standard notes at least two other potential yes-to-no switchers in the House: Dan Lipinski (D-IL) and Jim Oberstar (D-MN). Both have said they will not vote for a health-care bill with federal funding for abortion.

Don't count on House retirees to switch to back Obamacare: Rep. Brian Baird (D-WA) says they might stick to their guns.

Health-Care's Twin Edges

House Democrats from swing districts face a troubling dilemma. No one wants to be the 216th or so vote in favor of the Senate's version of Obamacare. That would allow every Republican running against endangered moderates to slam them as the final vote in favor of a radically unpopular bill. However, no one wants to be the 216th or so vote against Obamacare. Then the wrath of leadership can fall upon them.

That may be one of the reason on-the-fence members of the House have increased incentive for forming blocs. It's harder for leadership to punish/threaten a group than it is for it to punish/threaten a lone lawmaker. That's why Stupak is probably trying as much as he can to keep his coalition together. If it starts to fray, leadership might smell blood.

There's one probable switch against Obamacare: Michael Arcuri (D-NY) is saying he will very likely vote against the Senate bill on the House floor.

Voting for Courage

Courage! Courage! That's what Democrats most need now! Or so Nancy Pelosi tells us:

“Our members, every one of them, wants health care,” Ms. Pelosi said. “They know that this will take courage. It took courage to pass Social Security. It took courage to pass Medicare. And many of the same forces that were at work decades ago are at work again against this bill.”

There is perhaps some irony in Speaker Pelosi's appeal to Medicare when one considers that a centerpiece of many Democratic proposals on health-care has been cutting Medicare, but let's leave that to the side for the moment.

In terms of political and bipartisan support, Medicare and Social Security are on a different plane from Obamacare. Social Security passed the House 372-33 and the Senate 77-6 in 1935. Medicare passed the House 313-115 and the Senate 68-21. In both cases, overwhelming (and overwhelmingly bipartisan) majorities passed significant changes in the American architecture of power.

You see, FDR and LBJ (along with members of Congress) had this crazy idea: go out convince voters and politicians to support a bill. And you know what? They did! Medicare was hugely popular, while Obamacare remains hugely unpopular.

Democrats in the House and Senate could create a moderate, focused bill that could probably rack up big majorities, but, so far, Congressional leadership and the president have chosen not to. Now putting forward a moderate sensible bill, in this political climate---that would be an act of real courage.