Sunday, February 28, 2010

Bipartisan health care reform: the sound of one hand clapping

As Paul Starr demonstrated back in September and as Obama has repeatedly emphasized recently, the Democrats' health care reform plan has a largely Republican pedigree. Plans depending in large part on subsidized private insurance were proposed by Republicans including Richard Nixon and Jacob Javits in the late 1940s, by Bob Dole and John Chafee in the early Clinton years, and again by the trio of Bob Dole, Howard Baker and Democrat Tom Daschl last year.

Ezra Klein recently documented six more contemporary Republican ideas incorporated into the current Democratic bills: an allowance for interstate compacts; the exchanges themselves, which pool risks for individuals and small businesses; a "waiver for state innovation" that allows states to structure their own plans; encouragement of state innovation on malpractice reform; the excise tax, which is a start on reigning in the employer tax deduction for health care; and the absence of a public option. 

All this conceptual bipartisanship has of course won the Democrats zero votes (okay, one House vote, to be retracted in the next round) from the present-day extremists who have taken over the Republican party. Yet the Democrats are still singing the same tune -- whether to win over the more conservative members of their own party,who largely replaced moderate Republicans, or to demonstrate their moderation to the country at large -- or both, as a centrist cast to the bill makes it easier for blue dog Democrats to justify a yea vote to their relatively conservative constituencies.

Here's Nancy Pelosi, contradicting herself in two sentences, defining the new bipartisanship in the second:
“Bipartisanship is a two-way street,” House Speaker Nancy Pelosi declares in an interview airing Sunday on CNN’s State of the Union.

“But let me say this,” Pelosi continues, “The bill can be bipartisan, even though the votes might not be bipartisan, because they [Republicans] have made their imprint on this.”
Pelosi went on to emphasize that more than 100 Republican amendments were incorporated in the House bill.

And here is Robert Gibbs (in a 2/26 press briefing - full text here),  insisting that the summit of irreconciliables was a  "productive session" that revealed "some common ideas," and indicating that as the Democrats move forward they will add yet more Republican ideas:
TAPPER: So -- but just to clarify, the -- what you guys put on the website on Monday is not necessarily what an outline would look like if a bill goes to Congress, right? You might change it even more.

GIBBS:Right, I -- look, I think there are concepts -- again, concepts that were discussed yesterday that the president would  work with the team on, adding into what a piece of legislation or a  series of ideas that we started with on Monday; add to those and see  if agreements on selling insurance across state lines -- with some  minimum requirements, some movement on dealing with defensive medicine and medical malpractice-- if some of those issues can't garner greater bipartisan support.
At the same time, Obama and Pelosi have been unequivocal in asserting that they will not give up on putting a comprehensive health care reform package to a vote. And they have to know that they will not get any Republican votes, whatever they throw into the pot. That leaves the rationale noted above, which is well-articulated in an article by The Hill's Alexander Bolton:
Democrats acknowledge there is little chance that any Republicans will vote for the controversial health bill. But some argue that including GOP proposals will give the legislation more “bipartisan appeal” and make it easier for centrist Democrats to support.
Since the House Democrats will lose some votes that were conditioned on the Stupak Amendment's absolute ban on abortion coverage for any insurance plan offered on the exchange (the Senate bill has marginally less restrictive abortion provisions), Pelosi will presumably need to gain some votes from blue dogs who voted against the House bill but may be able to stomach the more fiscally stringent Senate bill.

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