Has Obama Made Health Care Reform Too Big to Fail?

A decisive vote or votes on the latest version of the health care reform bill may be held in the House on Sunday. The Slaughter rule may be used to shield nervous Democrats from having to cast two votes (one for the original Senate version, one for the “fixes" that will become the reconciliation package to be passed in the Senate). Instead, only one vote may be taken for the “fixes” and the original Senate bill will be deemed to have passed when that occurs.

Democrats are eager to change the subject from the sleazy approach they may use to help ensure passage to the good news they are trumpeting from the CBO’s latest scoring of the bill. The scoring is a joke, but that is not the CBO’s fault. The Democrats insisted on scoring the cost for the first ten years, not the first ten years the program is fully in effect. As a result, Nancy Pelosi is beaming that the cost of the new reform package is under a trillion over ten years.

The reality is that it will cost over two trillion dollars for the first ten years the full benefit package is provided. The alleged deficit reduction is a bigger  distortion. The doctor-payment fix for Medicare that will cost over $250 billion in the next ten years, and double that the following decade, is not included in the bill. The new long term-care benefit has a positive cash flow in the first ten years, since young people are paying in, but that will not pay out until later decades.

Does anyone really believe that huge Medicare cuts, half the financing for the bill, will be kept in place once the bill is passed? The tax on high-cost health plans has now been deferred to 2018 to please the unions. Will the Democrats, over the next eight years, find a way to push this back even more or kill it entirely? The reality is that the spending is real and probably understated, and the financing is not.

But will the CBO score, and the Slaughter rule, give the reform backers enough cover to squeeze the last few wavering Democrats to vote yes and finally get this to the president to sign next week?  President Obama certainly has to hope so. As has been the case throughout the saga of this bill’s slow progression through the House and Senate, every time the president makes a personal push for the bill, his approval ratings collapse.

The Rasmussen survey shows that 23% strongly support President Obama at this point and 44% strongly oppose him -- the largest deficit (-21%) since he became president. His overall approval score  is -10% (45% approval, 55% disapproval) according to Rasmussen. In the Real Clear Politics average, Obama’s average approval score  went negative for the first time this week; it also turned negative for the first time in the Gallup survey.

The president first delayed and then postponed his trip to Asia. He even stopped bashing his favorite whipping boy, the nation of Israel, for a few days in order to concentrate on health care reform, since he regarded passage as of “paramount importance."

Will the president push Pelosi’s number to the 216 needed for passage? Bettors think that is now likely, with the Intrade numbers rising all week and now suggesting the chances for approval are about 80%. As would be expected, Speaker Pelosi and her lieutenants have been very confident in public statements  all week that she will have the votes when she needs them.

What this obviously means is that Pelosi does not yet have the 216 votes, and that is why the president is sticking around to break a few more knees (with help from Rahm Emanuel when necessary) or offer a few more bribes. The Republicans have no leverage among wavering Democrats.