The Senate's Turn: Can Democrats Close the Health Care Deal?

It didn't much matter what Bill Clinton had to say to Senate Democrats when he made his unusual appearance at their weekly caucus lunch Nov. 10 on Capitol Hill. Yes, he talked policy and economic imperatives and all that. But the former President was really there, at Senate majority leader Harry Reid's invitation, as the ghost of 1994 — a reminder of what happened the last time lawmakers took up the cause of health care reform and didn't finish the job. That failure not only dealt a near crippling blow to a young Democratic presidency but also cost the party its majorities in the House and Senate. And most important, it left the country with a dysfunctional health care system that 15 years later costs more and covers millions fewer. "It's not important to be perfect here," Clinton told reporters after his private lunch with the Democratic Senators. "It's important to act, to move, to start the ball rolling. The worst thing to do is nothing."

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Now that the House has passed its health care bill with a vote of 220 to 215, Democrats on both ends of Pennsylvania Avenue feel an even greater sense of urgency. Momentum is crucial for Barack Obama's top domestic priority, and time is his enemy. While Reid still says passage of a final bill is possible by the end of the year, that is looking more and more doubtful. Speaking from his experience of watching the slow death of his health care bill, Clinton told the Senators they must get one to Obama's desk by the State of the Union address in January at the latest, according to one participant, Senator Sherrod Brown of Ohio. (See 10 players in health care reform.)

But as difficult and close as the health care vote turned out to be in the House — requiring a last-minute deal by Speaker Nancy Pelosi to appease antiabortion Democrats and secure her 5-vote margin — things get exponentially more complicated in the Senate. There the ideological balance among Democrats is closer than in the liberal House, and the rules allow amendments that could send the bill in almost any direction. Most crucially, it will take a supermajority of 60 votes — exactly the number Reid has in his Democratic caucus — to progress in the face of a GOP filibuster.

It is hard to overestimate the complexity of Reid's task. His first challenge, which is expected to come as soon as he can obtain cost estimates for his bill from the Congressional Budget Office (CBO), will be to get the legislation onto the floor, with a normally routine procedural vote known as a "motion to proceed." While Reid doesn't have his 60 votes locked down for it, the betting is that he will. More uncertain is whether he will find that many to get the bill out of the Senate, which will require a second, more contentious vote to cut off the promised filibuster. (See how to prevent illness at any age.)

Reid will have little margin for error along the way. Between those two votes will be weeks of deliberations over scores of amendments, many of which will be designed more to produce 30-second attack ads than to influence the actual shape of the legislation. There will come the arguments that Pelosi, whose office gives her far greater command of the floor, successfully kept out of a House debate that lasted a mere 12 hours: Will a government-run public option be among the choices offered to the uninsured? Should individuals be required to buy health insurance, and businesses to provide it to their workers? Who should have to pay for health reform? How much should be squeezed from Medicare, with the attendant risk of outraging seniors? The House fight over abortion guarantees a repeat in the Senate, where conservatives are demanding a similar airtight ban on the use of federal funds to pay for the procedure, and liberals are vowing to stop one they say will also prohibit some women from using private funds. (See how to plan for retirement at any age.)

In addition to all these public battles, Reid is waging private ones as well, according to sources on and off Capitol Hill. He has complained to colleagues that the White House has pressured him to lean on the CBO to speed its cost estimates of the measure — something that could easily be seen as exerting improper influence on the CBO's calculations, which are supposed to be free of political pressure. And he has been pleading with liberal interest groups to ease up on Senator Joe Lieberman — an independent whom Reid counts as part of his 60-member caucus — over Lieberman's public declaration that he will filibuster any bill that contains a public option. It was Reid who made the risky call to put a version of the public option in the bill that he will be taking to the Senate floor. "He's telling everybody, 'Leave Joe Lieberman alone. I'll handle him. I know Joe,' " says a Democratic strategist who has been part of those conversations.

But for all the coming bumps, a health-reform bill is starting to become inevitable, if only because of the consequences of falling short. Obama's presidency, even more than Clinton's, may depend on the Democrats' ability to deliver on his biggest domestic priority. And if anyone needed a reminder why, there could hardly have been a more poignant one than the appearance of the Ghost of Failures Past.

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