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The Latest Health Care Developments

The politics of health care are tricky, and nobody yet has a firm grip on how it will play out or even how both sides should play it. The latest development is that it's starting to look more likely that health care reform will depend on every Democrat voting to stop a Republican filibuster. Roll Call reports:

Democratic sources said Democratic leaders still do not see Republican support for health care reform as sustainable in the long run — even if Baucus succeeds in persuading a handful to back the bill that he ultimately pushes through his panel. That calculation played heavily into Reid’s decision Tuesday to encourage Baucus to abandon efforts that were sure to cause more Democrats to drop off the proposal and make it harder for the Senate to pass anything.

One Democratic Senator said leaders are focused on unifying the majority party.

“The question now is, how do we get the Democrats,” the Senator said.

Ed Kilgore argues (persuasively) that Democrats should stop pressuring Senators to stand with the party on this or that legislative detail and instead stand on the simple principle of voting for cloture and allowing an up-or-down vote:

That's why yesterday's statement by Senate Democratic Whip Dick Durbin defining party discipline not in terms of support for the "public option" or cap-and-trade or any other substantive position, but in terms of unity on cloture votes, was potentially very significant if it represents the beginning of a serious and sustained effort. It serves as a reminder that 60 votes are not in fact required to enact legislation in the Senate, and that supporting cloture is not in fact the same as supporting passage of a given bill. Inversely, a vote against cloture is (except in the rare circumstances of a rushed Senate bill) a vote to do nothing--to obstruct any and all legislation in favor of the status quo. And unless I am missing something, no senator has ever been defeated for re-election solely on the basis of voting for cloture on a bill they intend ultimately to oppose.

Insisting on these forgotten facts day in and day out could have an effect, if only to undermine the sixty-votes-myth and force wavering Democratic senators to explain why heterodox views require them to obstruct any action on major challenges facing the country, as though their constituents pay any real attention to procedural votes (news flash: they don't). That should be a given. The harder question is whether the next step should be to impose real sanctions on senators who rebel on cloture votes.

Relatedly, Stephen Teles games out what aspects of reform Democrats should compromise on and which they should hold firm:

If we think of this as a game with multiple iterations, then it becomes clear that you need to evaluate policy change by two criteria--is the change you're getting now going to be politically sustainable (that is, will you be able to hold whatever territory you're gaining) and politically generative (will the changes you're making now make your side comparatively stronger when the game is played again in the future).

My gut tells me that, when judged by this standard, the real bottom line in health care is the structure of the exchanges, rather than the amount of subsidy or the presence or absence of a public plan. It is relatively easy to imagine incrementally adding to the level of subsidy each year, much as Henry Waxman did with Medicaid expansion in the 80s and 90s. That costs money, but there isn't a huge amount of built-in organized opposition. So if you're thinking about living to fight another day, leave the easiest battle for later. In addition, expanding the subsidies is the politics of credit claiming--members of Congress will happily vote to put more money in their middle-class constituents pockets, and the employee mandate will probably put pressure on them to do so.

--Jonathan Chait