The Senate debate over the economic recovery package provides some sobering context for the upcoming debate on health reform.
It looks, as of this writing, that a package will go through, but with a bare minimum of the Republican votes needed to get the 60+ votes to pass something. In order to get those “moderate” Democratic and Republican votes, they had to cut out tens of billions of dollars for state fiscal stabilization and school construction, and other items. On health, the compromise removes $5.8 billion for Health Prevention Activity and $2 billion for HIT grants. (Medicaid matching funds and COBRA subsidies seem intact.)
Health reform will be harder–by a lot–filled with tougher decisions and ideological issues, major conflicts between interested stakeholders, and tough trade-offs on financing and regulation.
The ideological divide on the economic recovery–on which there is an economic consensus on the urgency and the general framework–is stark, where only a handful of Republican Senators were even willing to entertain the notion of compromise.
The debate in the Senate seems to suggest that if health reform happens, it won’t be with 70 or 80 votes; but it would still need to be seen as acceptable to centrist Republicans and Democrats in order to get the needed 60 votes to pass.
Don’t get me wrong: the SCHIP win a few days ago shows that the terrain has shifted somewhat, with the ability to pass a bipartisan bill that raised tobacco taxes to cover children, and even remove some unneeded barriers to coverage.
We’re not even in March yet, but given the pace we have a good lay of the land for the health reform debate. If politics is the art of the possible, then we are getting a better sense of what is possible.