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Obama Needs to Go Chicago-Style on Health Care: Albert R. Hunt

When President-elect Barack Obama, immediately after the election, was deciding who should be Treasury secretary and who should head the National Economic Council, Timothy Geithner told the transition team he wouldn’t take the White House job.

Geithner might have gotten Treasury and Lawrence Summers the NEC job anyway; Obama wanted fresh faces and fewer Clinton administration retreads in his Cabinet. A case can be made this was a mistake. It’s possible both men, and the administration, would have been better served if they had gotten the other job.

Yet Obama never considered putting it to Geithner, then the head of the New York Federal Reserve Bank, like this: “In the worst economic crisis since the Great Depression, your country needs you in the job I have in mind for you.” That’s not the Obama style; he tends to be patient, persistent, sometimes charming; although from Chicago, he doesn’t practice the arm-twisting politics the city is known for.

After the Blair House health-care summit Feb. 25, he’ll need to adopt that style over the next few weeks.

There are three realties in the final chapter of the legislative dance that will be the focus of scholars for years: Time isn’t on Obama’s side and any legislation probably has to pass before the congressional spring break at the end of this month. It can only pass with the support of reluctant Democrats, with the House more of a problem than the Senate; and it’s only going to happen if the president uses forceful persuasion on his wavering party members.

Fixed Positions

As the summit showed, Obama very much wants a health-care bill; the Republicans very much don’t. (Instead of offering major changes, the Republican mantra was start all over again, a euphemism for killing it.)

The minority party started on a high note with Senator Lamar Alexander of Tennessee, but the true feelings were manifest in the angry outbursts of Republican House Leader John Boehner of Ohio. Obama can’t count on a single Republican vote in either chamber.

About 90 percent of Democratic lawmakers want to see a health-care overhaul. However, 10 percent to 15 percent of that group wants it passed without their vote.

Those numbers don’t add up. To win simple majorities in both houses, Obama and congressional leaders are going to have to persuade as many as a half-dozen senators and about two-dozen House members to cast a tough vote.

Using Reconciliation

The strategy for achieving this has been clear for some time. The House has to pass the Senate-approved measure, with the promise that both houses will fix some of the imperfections through a process called reconciliation, which requires only a majority vote in both chambers.

Republicans charge using reconciliation in this way would be outrageous and unprecedented. Senator Lindsey Graham of South Carolina says it would be “the end of minority rights in the Senate” and a “destructive act” the likes of which hasn’t been seen in ages. Alexander says reconciliation has “never been used for anything like this.”

The facts are otherwise. Under the Democrats’ strategy, the health-care overhaul wouldn’t be enacted through reconciliation. It would be approved separately, and then some of the abuses in the Senate bill and a few political compromises would be handled in the reconciliation bill. About 80 percent of the $950 billion measure would go through the normal procedure.

Legislative Precedent

In the past, this reconciliation process has been used for major health-care measures, including COBRA, which allows people to retain their health coverage after they lose their jobs. The acronym stands for Consolidated Omnibus Budget Reconciliation Act because that’s how it was passed. The 1996 welfare bill also passed under reconciliation.

Those measures pale in scope compared with President George W. Bush’s 2001 and 2003 tax cuts, which totaled about $1.8 trillion over 10 years. Both were passed through reconciliation, requiring only a majority vote. Combined they are almost 10 times larger than the health-care elements that may go through that procedure this year.

Nevertheless, Obama is going to have a daunting challenge to win a majority in both houses, especially since there is bad blood between Democrats in the two chambers and growing resentment of the White House. In the Senate, the president won’t be able to offer special deals to the likes of Nebraska Senator Ben Nelson. He can’t lose more than nine of the 59 Democratic votes.

Tougher in House

It will be tougher in the House, which passed a health-care measure by only five votes in November. As many as a dozen previous supporters could defect because they don’t like the Senate bill or because of narrower issues like abortion.

To win, Obama’s going to have to persuade some of the 39 House Democrats who voted against the legislation last year. And 31 are from districts that were carried in the last presidential election by Republican nominee John McCain (One unfortunate concession the White House made to facilitate this task was to dilute the provision that taxes more expensive private insurance plans. Politically unpopular, it nevertheless would help control spiraling health-care costs, and, despite union objections, was a progressive step.)

Today, there are two political imperatives for the president.

One is to insist that Congress act quickly; the Democrats paid a terrible price for delays, both last summer in the Senate Finance Committee, and then with colossal blunders by the leadership in waiting too long to bring the bill to the Senate floor in December. If it goes past the scheduled March 29 recess, sayonara.

Obama will have to employ some heavy persuasion in explaining the political and personal consequences to Democrats if a bill goes down. If the measure passes, it will be controversial and a subject of great debate in the fall campaign and probably the next presidential election.

If it fails, there will be no debate. It will simply be the Democrats’ failure.

(Albert R. Hunt is the executive editor for Washington at Bloomberg News. The opinions expressed are his own.)

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