Saving Health Care After Coakley

Over the next 24 hours, there will be plenty written about the ineptitude required to lose a Senate race in Massachusetts as a Democrat. There are simply an endless number of reasons to criticize Martha Coakley today.

That her campaign chose to go dark after the primary rather than running ads; that Coakley herself did only 20 events during the general election, compared to nearly 70 for her opponent; that when they did finally run ads, the Coakley campaign spelled Massachusetts wrong.

There were the shocking quotes from Coakley, one decrying shaking hands with voters at Fenway, the other calling Curt Schilling a Yankee fan. And of course, there was the Election Day memo from Coakley's advisers, who blamed the loss (in advance of the polls
closing) on the White House and the failure of national Democrats to pay the race due attention.

As a candidate, saying Curt Schilling is a Yankee fan doesn't just make you seem like you're out of touch; it means you're out of touch. As a political strategist, believing you can save your reputation by attacking the White House before polls have closed is proof in itself that you aren't very good at messaging, and should consider another career.

There is no sympathy to be had for Coakley. The laziness of her campaign, the lack of due care paid to the legacy of the senator that preceded her, the recklessness with which she put the entire Democratic agenda at risk -- none of it can be understated, dismissed or defended. There is no spin. Not any at all. Martha Coakley should be deeply, deeply ashamed. That isn't to say that she isn't smart and capable. But on the campaign trail, she was neither. And now health care reform, after nearly a year of fights and debates and compromises and struggles, is once again in serious jeopardy.

With Brown's win comes a set of very tough choices for Democrats. Within the next ten days, Brown is likely to be seated, stripping the Democrats in the Senate of that critical 60th vote. That leaves Democrats with few options. They could quickly pass health care reform before Brown gets to Washington. But that would have required that they already reached a compromise. They haven't. At this point, even if a compromise is reached tomorrow morning, there isn't enough time to get it to the CBO for scoring, get it back, and overcome the procedural hurdles to get the bill through the Senate once more.

The next option is reconciliation, but a reconciliation bill, as has been the problem since the idea was first floated, cannot include in it the critical insurance regulations that make up the bulk of the bill's value. And reconciliation, if used, will surely drag out the health care debate for a number of additional months, leaving Democrats even more vulnerable in November.

There is however, a third option, one that if used, may actually, shockingly, incredulously result in a health care bill that is better than it would have been had Coakley not lost Ted Kennedy's seat for the Democrats.

It's not the Senate bill. It's not reconciliation. It's both. The House could agree to pass the Senate bill, but with the caveat that the substance of their negotiations be dealt with later this year, during the reconciliation process. This does a couple of things: it allows liberals in the House to vote for the Senate bill they don't like, assured that in the very near future, they will be able to improve it. It allows Democrats to take a curtain call on health care, perhaps even in time for the president's State of the Union on January 27th. And most importantly, it presents the potential for creating a health care bill that is substantially stronger than it otherwise would have been.

As of yesterday, negotiations at the White House between the House and Senate were buffered in large part by the reality that any compromise would need 60 votes in the Senate. Given the difficulty of garnering 60 votes the first time around, the possibility of reaching substantive agreement on major changes was remote at best.

But in the new context, these compromise negotiations would require only 51 votes in the Senate, allowing House progressives to get a bill much closer to the one they had originally crafted and hoped for. And while the political capital might not be there for the effort, in this context, it might even be possible to revive the public option yet again.

This is not to suggest that things are better than they seem, or that the brighter side here is particularly bright. The Coakley loss is a severe one, and the consequences of that loss will reverberate through the rest of the year, perhaps beyond. The health care bill, while still passable, has come up against its most substantial hurdle yet.

What happens from here will be a long, hard slog. But still, in the end, we may get what Ted Kennedy fought for all along. Let us hope that Democrats in Washington move forward today in his name, on his behalf, and ours.