Message to Lawmakers Who Favor Health Care Reform: Keep Calm and Carry On



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At the start of World War II, the British government designed a poster with the words "Keep Calm and Carry On," to motivate the public during trying times. Perhaps they'd be getting this poster out again if a minority of their non-representational House of Lords found a way to halt any and all legislation during a health care crisis. Fortunately for the clear-thinking Brits, they decided long-ago that having a simple majority of elected legislators approve a bill was a sensible and democratic way to legislate.

On our side of the pond, Senate Republicans voted in lockstep against the health care bill approved by the chamber on Christmas Eve. It will be difficult to pass another health care bill in the Senate. Under the chamber's current rules, the Republicans only need 41 votes to filibuster a bill, and they appear to have obtained that 41st vote with the election of Scott Brown as the new U.S. Senator from Massachusetts.

The House, which had already passed a bill that most advocates find superior, may not have the votes to pass the Senate bill as it is, according to Speaker Nancy Pelosi. Of course, that's presumably because the Senate bill does not do as much to make health care affordable and because the Senate's main revenue-raiser is an excise tax on insurance companies offering high-cost benefit plans, which is less progressive than the high-income surcharge in the House bill.

There is a simple way around this logjam. The House and Senate seemed to be on the brink of agreeing to a final health care bill. Whatever changes would be needed to make the Senate bill look more like that final agreement can probably be passed through the "budget reconciliation" process.

That's the process that the Senate uses from time to time to pass legislation by majority vote (meaning 51 votes are needed instead of 60). One would think that all legislation would be passed this way. The reconciliation process was originally created in the 1970s to fast-track bills that would help balance the budget, but since then has been used for all sorts of legislation. (President Bush and the Republican-led Congress used it to cut taxes and increase the budget deficit.)

Reconciliation can only be used to pass legislation that has a quantifiable budgetary impact, and many parts of health care reform might not meet that standard. But Congress does not have to pass an entire health care bill using reconciliation. It could just use reconciliation to pass those changes that are needed to make the Senate bill look more like the final bill that the Democratic leadership has been negotiating. And these changes, according to our sources, would meet the standard of having a budgetary impact.

So, the Senate could pass a reconciliation bill to improve the original bill they passed on Christmas Eve, and then the House could pass the original Senate bill and the reconciliation bill almost simultaneously.

Some Senators have historically been hostile to reconciliation, claiming that it's unfair to change the rules to pass legislation. This argument is incoherent and bizarre. We are quite confident that passing a law with a majority vote in the House, a majority vote in the Senate, and the President's signature (that's approval from three separately elected institutions) is a sufficiently democratic process that no one should feel that their rights have been trampled.

The Senate Budget Committee chairman, Kent Conrad, a traditional foe of reconciliation, seems to agree with us now.

The path ahead is clear. Keep calm and carry on.

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