The American Spectator

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Building Health Care Without Wiring or Plumbing

By W. James Antle, III on 8.24.09 @ 9:07AM

Byron York writes that the Democrats might ram a health care bill through the Senate using reconciliation, even if that means not getting everything they want. He quotes "one old Senate hand" as saying, "You can build a building that's missing certain features. Maybe the plumbing's not there, or the wiring. But the bottom line is, you have laid the foundation, and built the structure, and it becomes easier later on to add the plumbing, and add the wiring. You have set up a structure so that all you have to do in the future is make incremental changes."

The problem with this is that reconciliation probably can't be used to create health insurance exchanges or to require insurers to cover people with pre-existing conditions, among other things. Those two provisions are more fundamental to the Obama approach to health care reform than the public option. You can be missing the plumbing and the wiring, but without those elements you haven't laid the foundation or set up the structure.

Second, while I think an incremental strategy would serve the Democrats well, that doesn't seem to be where their base is right now. They don't want another SCHIP or an expansion of Medicaid. They want federal universal health care. And for single payer advocates among them, the public option is the incremental compromise. Take that element away and the plan's poll numbers dip, its grassroots support melts away, and some liberal House members' votes are lost (or at least that's what they are claiming right now). Plus, a stripped down health care bill that would be worth passing from the perspective of an Obamacare supporter would politically be all pain -- it would have to contain an individual mandate now while saving the public option for later.

Granted, the Democrats could still go this route. And maybe they'll be able to roll the parliamentarian, so that things that are technically extraneous to the budget process still get passed through reconciliation. But to move away from the building metaphor, they seem to want to go for the touchdown rather than call in the field goal unit.