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.

Republican candidates will run hard against the undecided Democrats in November, whether these members vote for or against the bill. Only the constituents in each district have leverage with their representatives, which is why polls showing a majority or plurality of Americans opposed to the bill (not only nationally, but in every district of every undecided congressman) are what have kept some of them from taking the plunge and agreeing to vote yes. The undecided Democrats are in a position not unlike the pledges in the rich guy's Omega fraternity on pledge initiation night in the movie Animal House, with the vicious pledge master Niedermeyer ferociously paddling their backside and the pledges repeating: “Thank you, sir! May I have another?”

So what is the gain to go with the pain for these last few votes (a likely defeat in November for those who vote yes)? Here is where the bribe part matters. Much as the administration tried to “persuade” Pennsylvania Congressman Joe Sestak to leave the race against party switcher (and 60th vote for health care reform in the Senate) Arlen Specter  with a job offer to be secretary of the Navy, congressmen who walk the plank and vote yes will be offered future jobs if they lose in November.

These plums will be in the administration or in think tanks such as the Center for American Progress (George Soros can direct a few million more to CAP to pay the salaries). "Correct" voters might also be assured high-paying lobbying jobs. Tom Daschle, defeated in a reelection run for the Senate in 2004, can tell the members just how lucrative a career in lobbying can be .

So where is the vote count today? The two most serious attempts to count the votes are by the theHill.com and David Dayen of Firedoglake.com. Dayen separates committed yes or no votes from leaners and undecideds. While the major media have been broadcasting all week about the  momentum for the administration and Pelosi, Dayen’s count has become less favorable on the chances of passage the last few days. At the beginning of the week, his net count was 205-209 and then 208-208. Today it is 207-212. That would mean Pelosi must pick off nine of the 14 undecided members. But Dayen says the hard count is 201-209, suggesting that including leaners with undecideds, Pelosi must win 15 of 21 remaining wavering members.

TheHill.com’s whip count has had roughly the same number of Democrats in the firm no, leaning no, or likely no category all week -- 36. Added to 178 Republicans, that means the no side would be at 214 and need only two from the 47 listed as undecided to kill the bill in the House. But the 36 in the no category are not all hard nos. Some have gone public in opposition to the Senate bill, but might vote for the Slaughter approach. Others are leaners. The 47 undecideds include some who Dayen includes as firm yes or leaning yes. I think Dayen’s count is closer to the current reality.  Many of the 47 “undecideds” in theHill.com count are likely to commit to yes in the next few days.

If Pelosi can get her number to 210 or above, then I think she will get to 216. No Democrat wants to be the one identified as the last vote to kill the bill. The SEIU enforcers might ensure that that member would need security for  the remainder of his or her term in office.

On the other hand, if the undecideds do not  start to crumble one by one, then many of the lean yes as well as most of the undecideds may vote no in the end. In essence, Pelsoi will win small or lose big. Winning small (by 216-215 or 217-214) is ideal for  her side, since it means the maximum number of Democrats will be able to vote no and perhaps improve their chances of holding their seats.

Over the last few days, the Stupak pro-life bloc has started to crater after a fig leaf was offered by a few dozen nuns on Thursday to support the bill. In the end, moderate Democrats will vote to protect themselves (and vote no) or protect Obama (and vote yes).

If the math for self-preservation and winning in November was between 60% with a no vote and 40% with a yes vote, then I think the undecided Democrats might resist the president’s overtures. My guess is that many of the moderate Democrats believe they are  doomed regardless (say a 40% chance of winning if they vote no, 30% or less if they vote yes). In that case, the lure of future employment and making fellow Democrats and the president happy will win out.

If members voted their conscience, without pressure, I think the bill would get barely over 150 votes. It is an extremely expensive new entitlement that does almost nothing to curb the cost explosion in health care, and is financed by smoke and mirrors at a time when annual federal  deficits are running $1.5 trillion a year for three years running, or more than 10% of GDP. It is the height of irresponsibility for Congress to have created a large new middle class entitlement in such an environment, when the nation is  clamoring for jobs, not a massive health-care overhaul. But the liberals in Congress and the president, who is their BFF soulmate, seem obsessed with passing this very bad bill now.

I hope I am wrong, but I think the odds slightly favor passage (not 80%, maybe 60%). To ease the pain, I will watch more of my picks go down in the NCAA tournament on Sunday.