The Senate Finance Committee Writes a Health Care Bill

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It starts–finally–in just a few hours. With the bang of a gavel in the high-tech cavern that is the conference room of the Senate Hart Office Building, the Senate Finance Committee will sit down around a table and confront the question of whether it can actually produce a health reform bill.

One of the worst kept secrets on Capitol Hill is that “mark-ups”–the formal public sessions in which legislation is ostensibly drafted–are not where any real work gets done. Where the real deals get cut, and where the favors get traded back and forth, is in private. The mark-up itself is little more than theater, a chance for everyone to give speeches and then march toward a pre-ordained conclusion.

There will be plenty of dealing on the sidelines here as well. But the Senate Finance Committee’s markup of health reform legislation is likely to be more revealing than most. On public display will be all of the ideological and philosophical fault lines that have for decades stymied every President and every Congress that have tried to do something about this issue.

And there will be additional pressure. The mark-up comes as the culmination of months in which Chairman Max Baucus made a thus-far fruitless effort to woo a handful of GOP members, shutting out some of his fellow Democrats in the process. As a result, the bill that Baucus produced has been the target of intense criticism from both sides. It faces hundreds of amendments, promising a tug of war between the left and the right that will be the best test yet of whether this legislation has any chance of ever reaching the President’s desk.

Baucus and his staff are predicting that the committee will actually reach its final vote by the end of the week. That looks pretty optimistic to me, though Baucus has been moving with uncharacteristic speed to resolve as much as he can in advance. Already, he has modified his original bill to meet some of the broader concerns of his members. He has made the subsidies more generous, so that the uninsured will be able to better afford the coverage that they would be required to purchase under the legislation. And he has trimmed back his initial plan to slap a hefty excise tax on the most expensive health insurance policies.

But there are a raft of other issues that can only be settled the old-fashioned way, by an up-or-down vote. Among them: Will there be a new government-run “public option”? Should employers be required to offer coverage? Should individuals be forced to buy it? And what should be the consequences if they don’t?

There are other bills out there. Three committees in the House and one in the Senate passed theirs this summer. But this is the one that matters the most, if only because the degree of difficulty is so much greater. If Baucus manages to get his legislation through his committee intact, it will become the template–first on the Senate floor, and then in the conference committee. If he doesn’t, Democratic leaders will have to recalculate their entire strategy amid new questions as to whether health reform, Barack Obama’s most ambitious domestic priority, is doable at all.

Kate Pickert, Jay Newton-Small and I will be following the progress of the mark-up here in Swampland, so check back with us often in the coming days.

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