Congress Doing Health Care The Hard Way

As lawmakers enter the last lap in the effort to pass a health care overhaul bill — merging the measures passed by the House and Senate — Congress watchers say looking back at how the debate got to this point may provide some important clues to where it might lead.

Jonathan Oberlander, who teaches health policy at the University of North Carolina in Chapel Hill, says he's not all that surprised that the effort has been painstaking so far.

"As the president has said, if it was easy to do, it would have been done already."

Indeed, there was some tension over whether the House and Senate would convene a formal conference committee to bridge the differences between their bills. The Senate preferred not to, because Republicans could require several more time-consuming cloture votes, of the sort that consumed the chamber in the days leading up to Christmas.

But some House members resisted the idea idea of purely informal negotiations, because they feared they might lose some leverage in the bargaining.

House Speaker Nancy Pelosi told reporters Tuesday, "We don't know what route we will take. We will take the route that does the job for the American people."

As a result of the meeting Tuesday night at the White House with President Obama, House and Senate leaders agreed to pursue the Senate's approach — to negotiate informally, rather than via a formal House-Senate conference.

Despite the fact that the bill is overdue, at least according to the schedule originally laid out by President Obama, Oberlander says in the long run that probably won't make much difference.

"If they're able to get legislation passed in the next month that looks like what the House and Senate have already passed, it will be a tremendous political victory," Oberlander adds. "And nobody is going to remember that it was legislated and signed in February rather than in October. It's just not going to matter."

What will matter is what's in the bill. And that's still a big concern to people like Neil Trautwein of the National Retail Federation. His group is particularly concerned about provisions of the House bill that require employers to offer their workers health coverage.

"It's a huge problem for retailers who have thin profit margins," Trautwein says. And the House and Senate has "ultimately produced product that we don't care to buy and judging from the polls, a lot of Americans also don't care to buy."

What's really frustrating for Trautwein, though, is that 2009 wasn't supposed to turn out this way. He and representatives from interest groups spanning the spectrum met for more than a year with the late Democratic Sen. Edward Kennedy of Massachusetts and his staff in preparation for the anticipated push for a health overhaul bill.

As a result of those meetings, Trautwein says, "There was great commonality between business, labor, medical, hospitals, pharmaceuticals and others on the appropriate steps" to take in health overhaul. "But there's a warping process that goes through the political prism. And that really took health reform into a direction we don't think is ultimately good for America."

Trautwein says that might not have happened had Kennedy, who died last summer, remained part of the debate. Kennedy was legendary for his ability to bring opposing groups together. "We needed that bellowing baritone to drive people back to the center," Trautwein adds.

But Oberlander says he thinks Democrats didn't get enough credit for what they did manage to accomplish, particularly after Republicans decided to oppose the entire effort.

"If you look historically, Democrats are like cats, they're difficult to herd," Oberlander says. "And there's actually an extraordinary amount of coordination, from the committee chairs in the House onward. And to get, at the end of the day, all 60 Democrats in the [Senate Democratic] caucus to vote for this legislation is pretty remarkable and something I think most of us would have bet against at the beginning of the year."

But Trautwein and Oberlander agree on one thing: Even if the bill does pass — and both assume a bill will — selling it to a skeptical public will be a big job.

"You have an issue that the public is very divided over, that is accompanied by a lot of controversy, a lot of mythology, and a lot of misunderstanding," Oberlander says. "And people aren't actually going to experience most of the benefits for at least four years. That's two election cycles, and that's a big risk."

In other words, as he puts it, even after a bill is signed by the president, the debate will be far from over. Democrats will want to start expanding right away, while Republicans already are talking about repeal efforts.

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