Health Care Overhaul: 'One More Night It Didn't Die'

A senior Senate staffer who has worked all year on the health system overhaul was asked to sum up that rare weekend session that brought the bill to the brink of formal consideration on the Senate floor.

"One more night it didn't die," he said.

And that pretty much gets it. The bill remains a patient in precarious condition, beset by all manner of ailments and infections. But it also remains alive, and at this point you could argue that whatever doesn't kill it outright makes it stronger.

As the bill survives each of the tests in the legislative process, from committee to committee and from chamber to chamber, it arguably gains a lumbering sort of momentum.

Each night it doesn't die adds to the sense that somehow, for all the problems, the bill will become law. With each turn of the wheel, the entire political community moves a little closer to imagining the final turn

This can make a difference in the way everyone behaves. Gradually, those who would kill the bill if they could may find it more urgent to address what will be in the bill in its final form.

The Senate Takes Action

The latest Peril of Pauline melodrama featured Majority Leader Harry Reid's struggling to amass the 60 votes needed to cut off a filibuster on the motion to consider the bill. Some said he "barely" made it; and it is true that 60 is the minimum. But it is also true that 60 was the maximum number Reid could have collected, given the Republicans' uniform support for the filibuster.

Historically, heading off a filibuster has required either party in the majority — and especially the Democrats — to capture at least a few votes from the minority to make up for the inevitable defections. But in the current Congress, embattled Republicans have hung together like shipwreck victims on a raft. So Reid had to get every non-Republican vote in the chamber without exception.

He had to be perfect or lose.

Republican leader Mitch McConnell closed the debate Saturday night by begging just one Democrat to defect, pointing to polls he said showed the American people opposed to the bill.

But in the end, all the Democrats and independents sided with Reid. So health care will be the business before the Senate after Thanksgiving, with the goal being passage by Christmas. That would allow a conference between House and Senate in January.

More Challenges Await

But first the legislation will need to survive several more brushes with death. The Senate's freewheeling amendment process is perfect for picking a coalition of supporters apart.

The public option remains a potential deal-killer whether it's in the bill (goodbye several Democrats) or out (goodbye several other Democrats). The Senate will face extended floor debate on the bill's effect on abortion access, immigration and even gun rights. The Gun Owners of America weighed in over the weekend suggesting "nothing in the bill would prohibit" an insurance company from penalizing those who have guns in the home (by listing the weapons as a risk factor).

But the greatest threat to the bill will continue to be the generalized fear it has engendered across wide swaths of the populace. And this rises and falls with events that are largely out of anyone's control. Last week the fear flared when a government-sponsored panel of doctors said it was not necessary for women ages 40 to 50 to get regular mammograms in most cases. The specter of the government denying coverage of what many consider a lifesaving test raised red flags everywhere.

In fact, the finding would be just as likely to cause private health insurers to deny coverage of these mammograms under the current system. It might well be easier for women to appeal such coverage decisions under provisions of the new bill. And in any event, the kind of routine exams being discouraged by the study would not be a big-ticket item. Women who wanted them could pay for them out of pocket, as in fact some do today.

But the breast cancer issue was enough to bring fears to the fore and encourage those who decry every detail of the bill as a deadly government intrusion.

Looking For A Salesman

Reid and his allies will have all they can handle holding their Senate crew together on the floor the rest of this year. They'll need help fighting the battle of the bill's public image, and it's not entirely clear where they'll find it. The media are committed to parsing the bill and finding stories in details, a worthy task that has the effect of emphasizing problems.

That means selling the bill to the people will depend on some other marketing force, and only two individual Democrats have shown much of a gift for selling this bill: the late Sen. Ted Kennedy and President Obama. One's gone, and the other is frequently distracted by foreign travel or foreign issues. And you can make only so many prime-time speeches on a bill few can read or understand.

In the end, just surviving from crisis to crisis may not be enough. To whom will the bill's backers turn for the final push over the top?



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