Scott Spiegel

Each of the two ratified versions of the health care bill currently waiting in Congress was barely passed, by virtually the slimmest margin possible, in a hectic last-minute stampede.  Dozens of harsh compromises had to be hammered out to cobble together the fragile framework now standing in each chamber.

The two bills are like delicate Jenga towers, swaying nerve-wrackingly in the breeze, that must now be reassembled by a team of 535 clumsy attention-seekers into a tower twice as tall.  But legislators across the two chambers—and even within them—are not even speaking the same language.

Here are a few of the myriad discrepancies legislators must reconcile to ensure that their monument to Obama’s greatness doesn’t fall:

In the House version of the bill, a government-run insurance exchange is created on a national level and includes a public option.  In the Senate version, exchanges are created on the state level and do not include a public option.  Virtually identical!

The House completely bans the practice 0f charging those with preexisting conditions higher premiums.  The Senate allows insurers to offer unlimited discounts for customers who engage in subjectively defined wellness activities: say, exercising, eating healthy, “not having contracted lung cancer”…

Insurance exchanges are implemented in 2013 in the House bill and 2014 in the Senate bill.

In the House version, employers are forced to provide insurance for their employees and pay a fine if they do not.  In the Senate version, employers are not required to provide insurance, but pay a fine for employees who opt for government-run insurance and receive federal subsidies.  The House has higher penalties than the Senate.

The House version funds the bill by imposing a surtax on families making over $1 million a year.  The Senate version establishes a tax on those with “Cadillac” plans, which includes not only many union members, but millions of families who will unexpectedly find themselves unlucky Cadillac owners over the next 10 years due to the non-inflation-adjusted nature of the provision.

The House version does not tax insurance offered by employers; the Senate version taxes employer insurance above a threshold.

The House version charges older people a maximum of twice the premiums as younger people; the Senate version sets a maximum ratio of three-to-one.  The House offers fewer insurance subsidies for the middle class than does the Senate.  The Senate offers weaker measures to limit out-of-pocket costs than does the House.

The House bill covers 5 million more people than the Senate bill by expanding Medicaid to those earning up to about $2,000 more than in the Senate bill.

The Senate version gives $100 million to Nebraska for indefinite coverage of all new Medicaid enrollees in the state (to buy Ben Nelson’s vote).  The Senate bill gives $300 million to Louisiana for Medicare increases (for Mary Landrieu’s vote); $10 billion to Vermont for new public health centers (for Bernie Sanders’ vote); billions to Nebraska and Michigan to waive nonprofit insurers’ excise taxes (for Ben Nelson and Carl Levin’s votes); millions to Massachusetts and Vermont for Medicaid; and millions to Florida, New York, and Pennsylvania for Medicare Advantage.  None of these provisions is in the House bill.

The Senate version includes, per the insistence of construction unions, an important exception to the employer mandate.  As an article in the New York Times titled “In Health Bill for Everyone, Provisions for a Few” reports, “Under the Senate bill, businesses with fewer than 50 employees would be exempt from the penalties in every industry but construction.”  In the construction industry, the mandate holds for employers with as few as 5 employees.  The House includes no such provision.

Restrictions on abortion funding are tight in the House, with no federal funding allowed; and loose in the Senate, with mere separation of federal and private money, and states allowed to make up whatever rules they want regarding abortion funding.

Coverage for illegal immigrants is not disallowed in the House; it is explicitly banned in the Senate.

It should be sobering for Democrats to realize that if just one Senator or two Representatives decide they can’t tolerate the alternative version of even one of these provisions, that will be enough to topple the whole health care reform edifice.

It’s no wonder, then, that Congressional Democrats now plan to merge the bills behind closed doors, shutting out all Republicans from discussion of the reconciliation process and preventing them from using parliamentary procedures to slow consideration of the bill and allow the public to digest the proposed changes.  Talking Points Memo cites one Democratic House aide who proudly admits, “This process cuts out the Republicans.”  The House will simply take the Senate’s bill, amend it, vote on it, and send it to the Senate; who will then amend the bill, vote on it, and send it to the House; and back and forth until some hideous, lopsided, structurally unsound blueprint garners enough votes in both chambers.

If Democrats had to merge these two bills in a public conference committee—never mind on C-SPAN, as previously promised and recently offered by the network’s CEO—it would take about five minutes for the cacophonous clatter surrounding their health care Tower of Babel to bring it crashing down.

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The pile of victims President Obama has thrown under the bus in his attempts to get health care reform passed is growing so large that just treating their internal injuries is going to bankrupt the national health care system.

First it was the insurance companies.  When Obama realized early on that Americans weren’t chomping at the bit for socialized medicine, he subtly changed his language to imply that he was merely seeking “health insurance reform.”  Insurance companies, to remind Obama, by definition have a vested interest in not covering costly treatments for people with a 100% risk of having a particular medical condition.  But the administration nobly promised to go after, as the New York Times put it, “unpopular insurance industry practices, like refusing patients with pre-existing conditions”—also known as “providing insurance.”

Nancy Pelosi swore to oppose the “shock and awe, carpet-bombing by the health insurance industry to perpetuate the status quo”—as opposed to the couple, two-three homemade signs proffered by paid armies for Health Care for America Now, Organizing for America, SEIU, and ACORN.  Obama promised to “reform the insurance companies so they can’t take advantage of you.”  Pelosi slandered insurance companies as “villains.”

Surprisingly, insurance executives didn’t take kindly to being called monsters.  Karen Ignagni, CEO of America’s Health Insurance Plans, seethed, “Attacking our community will not help get anyone covered…  We have to… correct the record.”

Next it was the pharmaceutical industry: in June, Obama twisted drug companies’ arms into forking over $80 billion toward health care reform, on the condition that the government would not bargain for reduced drug prices for Medicare or mandate price rebates.  Industry lobbyists, just to make sure they weren’t going to be stabbed in the back like the insurance companies, wrote the White House and secured confirmation from White House officials that these promises would be kept.

Congressional Democrats heard about these communications and had a fit.  The administration subsequently claimed that no such conditions had ever been discussed.  One of the House versions of the bill emerged containing provisions mandating both government drug price negotiations and additional price rebates.

Obama then started sacrificing groups less directly involved in health care but assumed to be shoo-in supporters of his agenda.  First he falsely claimed that AARP had endorsed Congress’s health care legislation: “We have the AARP on board” and “AARP would not be endorsing a bill if it was undermining Medicare.”  AARP’s terse response: “Indications that we have endorsed any of the major health care reform bills currently under consideration in Congress are inaccurate.”

Then Obama tossed 760,000 U.S. Post Office employees in the street when he argued that private health insurers wouldn’t be threatened by a public option: “If you think about it, UPS and FedEx are doing just fine.  It’s the post office that’s always having problems.”

The President of the National Association of Postal Supervisors responded to this charming occupational morale booster by sending Obama a letter asking him to rescind his comments: “On behalf of the 35,000 members of our association, I am writing to express our collective disappointment that you chose to use the Postal Service as a scapegoat…  [Y]our negative references to the Postal Services without knowledge of the facts was a disservice… to all postal employees…  [I]t was a kick to the chest to have you take a shot at a group of federal employees who are working hard every day to support this country…  [W]e would like to be treated fairly and not have our current situation misrepresented, especially by the Commander-in-Chief.”

Such Obama tactics recall his disastrous health care forum last month, in which he planted a question about Cambridge Police Department Sergeant James Crowley’s arrest of Henry Louis Gates, Jr., which gave Obama the chance to change the subject and denigrate blue-collar Massachusetts police officers who support him.  As department member Sergeant Kelly King stated after Obama declared that her department had acted “stupidly”: “It’s unfortunate.  I supported the president.  I voted for him.  I will not again.”

Obama even threw his dead grandmother under the bus—again.  When Sarah Palin charged that proposed legislation would lead to death panels that ration health care and decide which old people are not worth saving, Obama said he had favored his grandmother’s hip operation while she was alive, but could understand how a government panel might have calculated otherwise.

Unlike insurance companies, drug companies, the AARP, the post office, and the police, Obama’s grandmother couldn’t respond to his delightful remarks.  Would Obama have dared use that example if she were alive and in need of the operation?  Why doesn’t he try using it on seniors at townhall meetings who are in need of costly treatments?  “I’d pay for your operation if I were your relative, but I can see how a government panel made up of people you don’t know might feel otherwise.”

The latest Obama special interest group to be Greyhounded is House Democrats.  In June, Obama declared, “Any plan I sign must include an insurance exchange… including a public option.”  On Sunday, Obama demurred, “The public option, whether we have it or we don’t have it, is not the entirety of health care reform.”  Health and Human Services Secretary Kathleen Sebelius insisted that a public option, which House Democrats heavily favor, is “not the essential element” of the plan.  Why, whatever gave you that idea?  Was it perhaps inclusion of the ambiguous word “must”?

Predictably, House Democrats have not accepted this about-face without a fight.  According to New York Representative Anthony Weiner, “Some of us who have gotten roughed up pretty good at town hall meetings and stuck in there because we believe in this, now kind of feel like we have a tire track on our chest where the bus that rolled over us is.”

Fortunately, House Democrats are the one party in all of this who deserve to be thrown under the bus—which is probably why the administration is already backtracking on their disavowal of the public option.