Real wrangling over health care reform to begin

Senate Majority Leader Harry Reid managed to keep the 60 Democrats (including two independents who caucus with the Democrats) together to defeat a filibuster and open debate on the 2,028-page health care bill he cobbled together from various bills that different Senate committees have passed. That should be just the beginning of what has been a rancorous discussion that will only get more rancorous.

Almost before the vote had been recorded, several Democratic senators who had voted for closure to open debate declared that they will not do the same if the final bill is substantially the same as what is before the Senate today. Independent Joe Lieberman of Connecticut reiterated that he would oppose a bill that includes a government-run insurance company, or “public option.” Sen. Ben Nelson of Nebraska said the same. Moderate Democratic Sens. Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas have also expressed misgivings about a public-option plan.

Other issues will complicate consideration of health care legislation, scheduled to begin today. Government funding of abortions, explicitly prohibited in the version that passed the House, has raised significant controversy. Some liberal Democrats say they won’t vote for a bill with such an explicit prohibition, and you can be sure numerous versions will be offered as amendments. Some conservatives seek explicit language that would deny government-paid or government-subsidized health insurance to illegal immigrants.

Meanwhile, some liberal Democrats say they will not support a bill that does not include a public option. And you can expect serious wrangling over provisions that require employers to provide health insurance to employees or pay a special tax to the government (beyond the obvious question of whether such a sweeping mandate is constitutional). Moderates like Sen. Nelson want to modify the bill to ease the burden on small businesses, but “liberals” like Massachusetts Sen. John Kerry want to strengthen the mandate to include part-time workers.

A more fundamental problem was identified by Washington Post columnist David Broder regarding “the plausibility of its claim to be fiscally responsible.” Despite sympathy for the idea of health care reform, Mr. Broder concluded that “these bills, as they stand, are budget-busters.”

The best outcome would be for all these complications to result in a stalemate that induces legislators to turn to more modest reforms focused on cost reduction, like allowing health insurance to be sold across state lines, letting individuals take the same tax credit that companies take when buying health insurance and facilitating efforts by private associations to arrange for group coverage for members.

Unfortunately, the more likely outcome is a bill pared back from the most ambitious dreams of those who want government to be the decisive player in health care, but is still expensive. That would do less harm than the versions currently being considered, but would not be likely to do much good.