Stop Yapping about Healthcare: Go Reconciliation and Attach the Rest to a Defense Appropriations Bill

"And [Lieberman] will at last be only a minor annoyance" -- Casablanca, 1942, paraphrase shown.

Time to get on with it. Just as the President has done all in his power to get countries like Iran to engage as a full partner with the rest of the world, but has been rebuffed, Harry Reid has done a remarkable job (and I am no Harry Reid fan) of keeping the fingers in the dike of health care reform (HCR) to get it to this point. The Senate Democrats have gone the extra mile, reached out their hands, and have had nothing in return.

Time, now, for the Senate to act under reconciliation. That is what it is there for. And, it need not act on a bill that contains the myriad of compromises that has diluted its effects. It can act boldly. By doing so, it may even induce the naysayers to come back on board for a good 60-vote comprehensive bill in "normal (non-reconciliation) order" in exchange for some compromises. With Medicare, after opposing it as socialized medicine leading to the loss of liberty, even some Republicans voted for it when it was clear it was going to pass. With HCR about to be passed under reconciliation, some wayward Democrats may see the light.

Every part of the health care bill that involves how the government spends or receives money can be handled by reconciliation. That includes: a public option (might as well make it robust), the provision for individuals to buy into the Federal Employee Health Benefits Plan (FEHBP) enjoyed by Members of Congress; reducing Medicare eligibility to age 55 along with premiums to cover costs; enabling seniors who are on Medicaid and Medicare to purchase drugs at the (lower) Medicaid prices; expanding Medicaid, establishing a minimum medical loss ratio of 90% for insurance companies that take any federally subsidized insured. That's all pretty good stuff and needs 51 votes to pass it.

Those parts that are not subject to reconciliation (not directly related to how the government receives or spends money), such as removing anti-trust exemptions from insurance companies (how the hell did that ever come about anyhow?), prohibiting life-time caps and rejections for pre-existing conditions, establishing a commission to recommend best practices, and so forth, would be handled separately, requiring 60 votes to break the filibuster.

After passing reconciliation-enabled legislation, take these remaining parts and send them to the floor as a separate bill. Since Joe Lieberman and his Republican colleagues have claimed they support these 'common sense' measures, let us call their bluff. If 60 votes do not rapidly appear, however, attach it instead to a Defense Appropriations bill and let us watch them filibuster common sense reform.

I realize many would scoff at the following because it may be unnecessary under reconciliation in the short run, but I urge the longer view: let inclusion of the robust public option be left to each state (either opt-in or opt-out); this will provide a political safety valve from the "shoving down our throats" claim (as if 51% is a minority vote!) and, also, will put Republicans running in 2010 on the defensive -- do they support their states participation the public option or not? I would love to be a Democrat running against a Republican who said "no"; or a progressive Democrat challenging a conservative Democrat in the primary who said "no." Even Blanche Lincoln's constituency strongly favors the public option. The more robust the public option the more attractive it will be to the citizens of the state. Thus, the opt-in/opt-out strategy will provide a more progressive legislature in 2010 to fight many more battles such as breaking up the big banks, getting real clean energy legislation, and so forth.

And, for those states that vote "no," let us see in a couple of years how many businesses remain, what the insurance premiums are, and how Republican they remain. How many states that did not opt-in to Medicare in 1965 would still have their senior citizens covered by private insurers, and what would the insurance premiums even for younger residents be if there were no Medicare to absorb the most medically expensive cohort?

The main point, however, remains: enough wrangling and delay. The Senate should pass what it can under reconciliation, and take that to conference committee with the House; it should subsequently pass the other provisions under "normal order," either as a stand-alone -- calling the bluff of Lieberman and his fellow Republicans -- or, if that does not work (i.e., we have called their bluffs, and they have not responded), attach them to a key defense bill and get them passed like that.

And, then, just ignore the right wing whining. They are given far too much press. For tens of millions of ill and/or worried Americans, you will have provided some Xmas cheer.