Health-care reform entering end game

Overshadowed by the tumult and shouting at those town meetings, the great 2009 debate on health-care reform is entering its end game.

Those weekend statements in which Obama administration officials opened the door to dropping a government-run alternative to private health care are no real surprise, frankly, except perhaps in timing. A key health care player from the Clinton years suggested to me three months ago that that’s what would ultimately happen.

Administration officials also are showing flexibility on other controversial aspects, such as willingness to drop the provision to reimburse end-of-life counseling that opponents have twisted into an opening to permit euthanasia.

Other substantive aspects may be even more crucial, most notably how to ensure the cost of health care begins to decline.

But the shape of the end game will depend as much on how President Barack Obama and congressional Democrats resolve the issue’s political aspects as how they settle the substantive ones.

Already, there are signs that administration acceptance of substantive compromises might complicate the politics.

“You can’t really have reform without a public option,” former Democratic National Chairman Howard Dean said on CBS News’ “The Early Show.” He expressed skepticism a bill would pass without it.

That may be true in the House, where liberals form a substantial part of the Democratic majority. That’s why House leaders say they will retain the public option when their bill comes to a vote next month. But it may have to be dropped later when competing House and Senate versions are resolved in conference committee.

The situation is very different in the Senate, where any public option could cost the votes of some moderate Democrats, as well as most Republicans open to seeking a bipartisan bill.

That’s one reason the administration still seems to hope the six Finance Committee negotiators can agree on a bill that would attract some GOP support. But the White House also needs to stick with its desire for a Sept. 15 agreement by the panel, given the pressure from liberal Democrats who fear too much compromise. Besides, time to finish action this year will soon begin to run short, given how long Congress takes to act.

The success of the Finance Committee effort may determine if Democrats feel they can pass a bill in the Senate through the normal legislative process, which could require 60 votes, or have to resort to the controversial budget reconciliation procedure, which would only require 51.

A bill that keeps the entire Democratic caucus together would only require one or two Republican votes.

Tactical political decisions

Beyond those impending tactical political decisions, Obama and his congressional allies face an overriding strategic one that may ultimately determine if there is to be action this year.

Having promised for years to provide comprehensive health reform, Democrats must recognize as a party that their failure to do so now would be disastrous, especially for many members of Congress facing re-election next year.

That realization won’t require all Democrats to go along on every detail, especially in the House. A lot of the votes may be cliffhangers.

But in the end, a Democratic Party that wants to be seen as the natural governing party needs to show the same unity of purpose it displayed last fall in helping the Bush administration pass the bank bailout bill during last September’s financial collapse.

At Harvard’s post-election examination of the 2008 campaign, Republican pollster Bill McInturff contrasted that unity with the disorganized way individual Democrats followed their personal political instincts during the Clinton years, thus contributing to their party’s disastrous losses in the 1994 elections.

While some Republican backing would give this effort at least a modicum of bipartisanship, Democrats realize they will have to provide virtually all of the votes if Congress is to pass a major health care reform bill this year.

And that means acceptance of the view that, despite some differences on details, they and the country will be better off by passing one.

X Carl P. Leubsdorf is the former Washington bureau chief of the Dallas Morning News. Distributed by McClatchy-Tribune Information Services.