How to finish up health care reform: There is only one way

The way forward for health care reform at this moment seems rather murky, indeed, one might say grim.

Both the House and the Senate had adopted reform legislation prior to Christmas and the game plan going into January was to try to work out an informal agreement between House and Senate.

leadership that could be run back through both houses to work out a final legislative package to be sent to the President (the “ping-pong” strategy), hopefully before the State of the Union address.

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It was understood that the final bill would look more like the Senate than the House bill because there were no votes to spare in the Senate, while.

the Democrats hold a comfortable majority in the House where presumably a majority could be persuaded in the end to vote for a compromise.

Indeed, some members who had initially voted against the bill in the House might have found a version closer to the Senate version more acceptable.

It was clear, however, that there would have to be compromises on issues of great importance to the House, such as the excise tax on high-cost health plans.

the allocation of the affordability credits to give more support to lower income families, and the reallocation of responsibility for enforcement and for exchanges to give more authority to the federal government, with perhaps even a national exchange.

Then came the Massachusetts special senatorial election. The impact of Scott Brown’s victory in the election was two-fold.

First, the Democrats lost their filibuster-proof majority in the Senate, taking a ping-pong strategy off the table.

Second, the fact that a Republican took Ted Kennedy’s seat in Massachusetts left many Democrats in Congress scared to death, believing that there are few safe seats anywhere and that members .

Congress up for election in 2010 had better figure out which way the wind is blowing on health care reform.

Many analysts believe that reform faces a pretty strong headwind. It is clear that support for reform in the opinion polls has dropped substantially and opposition grown.

But it is hard to know exactly what that means.

How much of the opposition, for example, comes from those who are disappointed that Congress abandoned the public option, or, indeed, never took up a single-payer approach?

How much of it comes from those who believe that the legislation will create death panels, or “put the government between you and your doctor,” or other lies and distortions?

How many Americans are really completely satisfied with the status quo? Presumably not many of the 50 million Americans who are uninsured or the 25 million more who are underinsured.

Education is clearly necessary, but it is less clear that the public is overwhelmingly opposed to reform.

So what is the way forward? The simplest option would be for the House to adopt the Senate bill and send it to the President.

Some of the provisions of the Senate bill, however, are highly objectionable to some House members, and the Speaker has made it clear that this strategy is not going to fly.

There is nothing close to a majority of the House in favor of simply adopting the Senate bill.

Another option, proposed by Senator McCain and other Republicans is for the Democrats to sit down with the Republicans and come up with bipartisan legislation.

It is hard to take this offer as anything other than a cynical insult. From the beginning of the health reform effort, President Obama invited the Republicans to participate.

Senator Baucus spent precious months negotiating with Grassley, Enzi, and Snowe. Legislation would have been on the President’s desk weeks ago had it not been for these negotiations.

According to Senator Durbin, Congress adopted 170 amendments offered by the Republicans.

Indeed, the entire bill is much closer to traditional Republican proposals based on managed competition among insurers and tax credits for purchasing private insurance than traditional Democratic social insurance-based proposals.

Unless McCain means, “We’re ready to talk if you are ready to limit health care reform to insurance deregulation and barring malpractice suits,” it is hard to understand what the Republicans want to talk about.

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