The Health Care Express

Congress has only 22 working days left to reform America’s health care system.

As a lifelong Amtrak passenger, Joe Biden is comfortable with train metaphors. Asked to describe the state of the administration’s health care reform efforts, he did not disappoint. “Folks, reform is coming. It is on track; it is coming,” he said at the White House Wednesday. “We have never been as close as we are today, and things remain on track.”

Like a true Amtrak passenger, Biden is engaging in a little wishful thinking. Yes, health care reform is moving along at a steady pace. But it’s not going as fast as it needs to. It’s like the Sunset Limited, still scheduled to arrive in Los Angeles on time even though it left New Orleans a day late. If Congress is to deliver legislation to the president’s desk before it leaves for its monthlong recess on Aug. 8, it has precisely 22 working days left, which isn’t much given all that’s got to be worked out.

Biden emphasized the positive Wednesday, announcing that hospitals have agreed to $155 billion in reductions as a part of comprehensive reform. It was the latest in a carefully orchestrated roll-out of commitments from key players. Two weeks ago, drug makers committed $80 billion. Doctors may announce their contribution soon. “The train is leaving the station and everyone wants to be on board,” says a senior White House official, also playing conductor.

But as fast as the train may be moving, it’s hit a slow patch. (At this rate, we’re going to take the metaphor all the way to the depot.) In the Senate, where they have to turn commitments of the kind Biden was announcing into legislation, the process is grinding along and time is running out to meet the president’s deadline. We’re rapidly approaching the moment when Congress will have either to put together a slapdash bill or to disappoint the president and delay a vote on legislation until after its August recess.

The president wants quick action, because delay gives opponents of his plans more time to raise doubts. In the House, where the majority can move things along faster, they will probably make that deadline. In the Senate though, it’s going to be a squeaker.

Two Senate committees are producing the health care legislation. The Health, Education, Labor, and Pensions Committee has already presented its bill and is in the process of markup, through which amendments are added, debate takes place, and the legislation is rewritten. In the crucial Finance Committee, however, there’s been a snag. A bill was supposed to go to markup this week, but it’s not going to make it. Senators, who have been working behind the scenes for months, are wrangling over the so-called public option as well as how to pay for reform. Momentum for one of the ways to raise the most money—taxing some portion of the health insurance employers provide their employees—has flagged, in part, says budget committee chairman Kent Conrad, because senators have been shown polling that suggests three-quarters of the country is against such a tax. 

Senators on the Finance Committee must finish their behind-the-scenes negotiations before they can start the public negotiations. Once that public markup starts, it will take about a week.

When the Finance Committee bill emerges from a week of public debate, it will then have to be merged with the health care bill produced by the HELP Committee. How long that will take is not clear. This kind of massive legislative merger does not happen every day in the Senate, and the differences will take a little time to work out. (Senators are reforming the entire health care system, after all.) But staffers from both committees have been working together all along and have promised Senate Majority Leader Harry Reid that the merger will take only a couple of days.

Once the bill is stitched together, there will be two weeks of debate on the floor of the Senate, bringing the total number of days to get the bill through the legislative track to 17. That means the Senate Finance Committee has about five days (roughly by next Wednesday) to end the behind-the-scenes negotiations and begin its public work. Otherwise, everyone is going to have to start working through the night and on weekends—or Reid will have to reduce the number of days for public debate.

Senate Democrats still have enough time. But with each passing day, the risk grows that it’ll come to an ugly end in order to meet the president’s deadline. If that happens, it will be similar to the confusion that reigned during the final days of the stimulus bill, when even the people writing the bill didn’t know everything that was in it. As former Majority Leader Bob Dole used to joke: “Hurry up and vote before anyone has time to read the bill.”

It doesn’t help the administration’s case that doubts are emerging about the effectiveness of the stimulus bill at just the time the president is calling for quick action on health care. Republicans, who want to stall reform, kill it, or work the angles for a better deal, can use the stimulus bill as proof that faster is not necessarily better. If they’re searching for a metaphor, perhaps they can argue that health care has become a runaway train.