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Patients and patience in health care end game

In a time of lingering recession, there is no more compelling pocketbook issue than health care overhaul. It's an effort that's intensely personal because it could affect every American.
/ Source: The Associated Press

In Congress these days, the health care debate is as much about patience as patients.

In a closed-door meeting of feisty House Democrats this past week, Speaker Nancy Pelosi, D-Calif., served notice that in these final days before the Senate and House present comprehensive bills to overhaul the nation's system, hers is running short.

Rep. Earl Pomeroy, D-N.D., had interrupted Pelosi's presentation about one version of the bill with questions about its cost. According to Pomeroy and others, she cut him off — twice — with a question of her own:

Is there any version you could support?

Yes, Pomeroy said, but not the one most likely to succeed.

Pelosi moved on
To the White House and Democratic leaders, Pelosi's question is the only one that matters at this late date. The answers help divide lawmakers into two columns: "yes" and "yes, if" under certain conditions. In another private meeting Friday, Pelosi forced her rank and file on the record by asking for a show of hands to register support for the public option plan she prefers which would reimburse doctors at Medicare rates plus 5 percent.

In the Senate, Majority Leader Harry Reid, D-Nev., select committee chairmen and senior White House officials are meeting nightly in search of a bill that could win the 60 votes needed to overcome a Republican filibuster.

At the White House, President Barack Obama is willing to play lobbyist in chief, but first he needs a bill.

So close to that pivot point and getting close to year's end, it's no longer a debate about whether there will be a health care bill. The questions are when, how — and who can compromise.

Democratic leaders expect their members, looking ahead to next year's elections, to vote for a health care bill despite any misgivings. But the vote-counters have no real way of knowing until each chamber produces a bill.

That's why negotiators have slogged through months of hearings, hundreds of amendments and meetings with members that require interminable listening, waiting, reassuring, cajoling and answering questions from the recalcitrant.

For Reid and Pelosi, that process continues. Making a member feel heard — and promising something he or she can boast about at home — can pay off.

Sen. Mary Landrieu, D-La., sent out a blaring news release Friday after her meeting with Reid, saying she raised "the unique challenges Louisiana is facing in terms of Medicaid and the special concerns I have about teaching hospitals." She said he understood these challenges and considered ways to address the problems.

Patience is limited, however
Reid and Sen. Charles Schumer, D-N.Y., had a testy exchange after Schumer made comments on cable news that some saw as pressuring the Nevada Democrat to make up his mind about putting a government-run insurance option in the Senate bill.

Senate Finance Committee Chairman Max Baucus, D-Mont., said Friday that patience among negotiators runs out "a little more often now" than earlier in the process.

"I say, 'Hey, we are in this together. Sixty votes. Let's keep our eye on the ball,'" he said.

The pressure on Democratic lawmakers is enormous.

The success of a health care bill is largely the success of the Democrats who control Congress and the president they helped elect. In a time of lingering recession, there is no more compelling pocketbook issue than health care overhaul. It's an effort that's intensely personal because it could affect every American.

Much depends on each lawmaker's needs — political, substantive, even temperamental — leading up to an election in which all 435 House members and one-third of the 100-member Senate face election. The calculus is different for each member on the fence.

The vote of one might hinge on fear of voters' cries about government-run health care. A lawmaker with an eye on growing deficits might want to know about containing costs. What someone might really want is the ego-stroke and the political cover of a personal appeal from the president.

Long way away
An awkward meeting with Obama in the Oval Office Thursday evening illustrated just how far senators are from putting those pieces together. The only takeaway not likely to be disputed: Reid grabbed an apple on the way out.

Neither of the government-run options had received pledges of support from 60 senators but both could hit that threshold, Reid told Obama, according to congressional officials who spoke on condition of anonymity because of the sensitive talks.

One version would use the public option as a threat that would kick in if private insurers do not lower premium costs by certain deadlines. Some liberal senators would have trouble voting for that one, Reid said. The other would allow states to opt out of the public option, chief proponent Schumer told Obama.

The meeting ended with the president pledging to help rally support for whichever version crosses the 60-vote threshold first.

For Reid, it was back to his office and the phones. On Friday, Reid was meeting one on one — with no staff — with Landrieu, Sen. Carl Levin of Michigan and Baucus, whose committee had passed one of the two Senate health care bills.

"We're having a debate, and members have to reflect and represent their districts," Pelosi said. "And we're hearing from them."