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Where Health Care Is Headed

Ed Kilgore is managing editor of The Democratic Strategist, a senior fellow at the Progressive Policy Institute, and a frequent contributor to a variety of political journals.   

Believe it or not, it's becoming possible to get a feeling for how the health care reform struggle may play out this fall.

The House will almost certainly pass a bill that includes a "public option." The Senate won't; any Senate bill will almost certainly be based on some version of the "health care cooperative" idea. Votes in both Houses will be very close, leaving little room for error. In the Senate, vast concessions will have to be made, on the bill in question and on other issues, to get to 60 votes, and even then, a couple of Democrats will vote "no" and a couple of Republicans will have to be pulled across the line. Perhaps a couple more Democrats will vote for cloture and then vote against the bill itself.

Then the real fun will start, in a House-Senate conference where the White House will be a very active player. As Jane Hamsher reminds us, enough House Democrats have pledged not to vote for any bill that doesn't include the public option to sink a conference report. And Sen. Kent Conrad is probably right that there aren't and never have been 60 votes for a plan with a public option in the Senate.

So somebody will have to flinch, and that's where it will become important to pay close attention to all the less-prominent, but potentially critical, issues that will be at stake.

At TAPPED today, Dana Goldstein has a good list of those issues, including the size and strength of cooperatives, the breadth of a Medicaid expansion, coverage of legal immigrants, and the adequacy of subsidies.

It's possible, of course, that House progressives and Senate centrists will get so dug in on the public option issue that no conference report can be crafted that can get a majority in the House and 60 votes in the Senate, and nothing at all will happen this year even if there is substantial agreement on other issues. That's why it's pretty important that the White House and the congressional leaders tell Members from all factions to stop issuing public threats that this or that provision is a deal-breaker. They should also strongly discourage participation by Democrats in any bipartisan "gangs" that purport to control the outcome (e.g., the one that has already formed to control the Senate Finance Committee markup). A deal that works in one House probably won't work in the other, and promises to impose provisions on one House or the other in a conference committee aren't worth a whole lot. So it makes abundant sense to push back the ultimate bargaining to big barbecue that will be held at the very end of the tunnel.

[Cross-posted at The Democratic Strategist.]

--Ed Kilgore