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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In anticipation of the humiliating defeat of their socialized medicine scheme, Democrats are feverishly working to get their legislation passed by cheating.

Their plan, known as “budget reconciliation,” works as follows: (1) have Senate committees expand Medicaid, cut Medicare, force individuals to buy and businesses to offer insurance, give subsidies to low-income people and tax credits to small businesses, levy new taxes, and do everything else Democrats wanted to do in their health care bill but knew would never pass; (2) lump it all into a bill; and (3) pass it with 50 votes and no filibuster.

The bill would also contain language to support enactment of a health care overhaul, but because provisions unrelated to the budget cannot legally be included, the Senate parliamentarian will likely strike these from the bill.  According to the New York Times, which favors the reconciliation swindle, it is unclear whether two key elements will be allowed in the bill: the requirement that insurance companies accept all candidates and charge the same regardless of condition, and the creation of a government health insurance exchange.

The Times eggs Democrats on to declare that these two provisions, while irrelevant to the budget, “are so intertwined with other reforms that they are [necessary] for other provisions that do affect spending or revenues.”

If that ruse doesn’t work, the Times notes, then the process could “leave the reform package riddled with holes—perhaps providing subsidies to buy insurance on exchanges that do not exist, for example.”  In this eventuality, Democrats would pass a second bill, subject to filibuster, that fills in gaps where budget-irrelevant provisions were removed.

Ignore for the moment the fact that Democrats’ chess-playing skills obviously aren’t very good: to wit, why would Republican senators support a bill to prop up the reconciliation bill, if the two bills in combination would lead to an outcome they opposed in the first place?

Ignore, too, the stipulation that the reconciliation bill may not legally cause deficits to increase, which a health care overhaul clearly would do.

There’s just the inconvenient detail that reconciliation was never designed to be used for anything remotely like what Democrats propose to use it for.

According to the U.S. House of Representatives’ Committee on Rules, the purpose of budget reconciliation is to “fine tune revenue and spending levels.”  Admittedly, in the Obama era, adding a trillion-dollar program here or there could be characterized as “fine tuning,” but I don’t think this is what the creators of reconciliation had in mind.

Democrats have offered the following compelling argument for using reconciliation to socialize health care: Republicans have used reconciliation!

Yes, Republicans have used reconciliation—for things it was supposed to be used for, such as adjusting tax rates and decreasing entitlement spending.  Claiming that reconciliation can be used for health care because Republicans have used it is like claiming that pesos can be used at Taco Bell because Mexicans have used them.

Even the New York Times admits, “The approach is risky.  Reconciliation bills are primarily intended to deal with budget items that affect the deficit, not with substantive legislation like health care reform.”  Note the sneaky, dishonest addition of “primarily.”

As Judd Gregg explained to Norah O’Donnell, who insisted Gregg was a hypocrite because he had favored reconciliation in the past, “Reconciliation is meant to adjust already existing programs.  You adjust tax rates, or you adjust already existing programs at the margin.  What’s being proposed here is, ab initio, a brand-new, major initiative which is the total rewrite of the health care system of the United States.”

President Clinton floated the idea of using reconciliation to pass health care legislation in 1993, but Senator Robert Byrd reminded him that reconciliation was meant to be used to square away budgets, not turn us into Canada.  In 2003, Congressional Republican leaders considered, then rejected, using reconciliation to pass their prescription benefits program.

In 2005, Senate Republicans introduced a provision allowing drilling for oil in the Arctic National Wildlife Refuge, an attempt that failed when the provision was removed during reconciliation.  Whether this attempt was appropriate or not, it should be pretty clear that if we’re not allowed to use reconciliation to drill in a barren wilderness that makes up less than 0.5% of Alaska in the middle of an energy crisis and a war in Iraq, then it’s not appropriate to use budget reconciliation to take over 17% of the economy.

There’s a reason budget reconciliation was introduced as a separate parliamentary process: it was to be used to make adjustments to existing programs, not introduce massive new ones.  The total amount of debate time allowed for reconciliation is only 20 hours—about twice as long as Congress had to read the 1,600-page stimulus bill before voting, but still not very long.

By the way, I don’t fault Obama for threatening to violate the spirit of bipartisanship with the reconciliation maneuver, inasmuch as (1) I don’t favor Republicans in charge having to compromise when Democrats propose screwy ideas and (2) in order to put a halt to bipartisanship, Obama would have had to actually start practicing it first.  But it’s ironic that Congressional Democrats believe they are putting aside their longstanding, magnanimous display of bipartisanship by resorting to sleazy use of a tactic called “reconciliation.”

The new test of liberal political ideology seems to be, not whether you favor Obama’s health care plan, but how long it takes you to realize what a disaster it is.

The American people were, as usual, first out of the gate to demonstrate their common-sense conservatism.  Although a slim majority voted for Obama in November, a growing preponderance has been telling pollsters they disapprove of the President and his handling of health care.   On Sunday, Rasmussen reported that Obama had reached a new low in their Presidential Approval Index, with health care one of his lowest-rated issues.

Like a teacher indulging a failing student’s pleas to find a way to give him extra points on his test, the Congressional Budget Office has spent all summer admonishing Obama for presenting legislation that will be more expensive than advertised, produce no savings, and yield expanding and unsustainable deficits for the next 10 years.  (“Now, Barry, I’ve already given you all the credit I can—next time you’ll just have to try harder.”)

The Mayo Clinic, which Obama cites as a model for cost-cutting measures, called the Medicare payment model proposed by Congress a “catastrophe.”

Seven state medical associations banded together with private medical societies and two previous AMA presidents in a letter to the President opposing the legislation.  The American Hospital Association is imploring hospital directors to counter Congress’s bill, as are specialty associations such as the American College of Physicians.

John Mackey, CEO of Whole Foods, penned an op-ed in the Wall Street Journal cataloging the myriad flaws in Democrats’ proposal.

Sixty-thousand AARP members have cut up their cards since July over their leadership’s endorsement of Congress’s approach.  Though AARP supports the President’s general strategy, even they had to smack Obama down for claiming they had endorsed a bill when they had not yet done so.

After Obama insulted the Postal Service in his quest for a bill, the National Association of Postal Supervisors wrote Obama a letter expressing “our collective disappointment that you chose to use the Postal Service as a scapegoat …  [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.”

Pseudo-moderate network CNN recently chronicled “Five Freedoms You’d Lose in Health Care Reform,” including the freedom to negotiate details of your plan, cut costs by living healthier, choose a high-deductible plan, keep your current plan, and select your doctors.

The Associated Press fact-checked Obama’s claims and called him out for continuing to tell the same lies: e.g., if you like your health insurance, you can keep it—the implication being that you can keep it for as long as your employer and insurance company would otherwise have offered it without government health care, which is outlawed in Congress’s plan.

The Washington Post, no friend to conservatives, has been barraging readers with columns opposing ObamaCare.  Columnist David Hilzenrath affirmed that the administration would not be able to ensure that employees can keep the plans they have now.  Martin Feldstein explained that the 85% of Americans who now have insurance would pay higher taxes and receive fewer services.  Maya MacGuineas ridiculed the administration’s pledge that it can add an expensive new health care plan covering millions more Americans that will cost no extra and actually alleviate the budget deficit.

The Post’s editorial board also reminded the administration of the CBO’s harsh projections and warned him not to treat these lightly.  In a separate editorial, they scorned Democrats’ stubborn, mindless fixation on a public option.

Obama’s own Hyde Park doctor suggests that Congress’s legislation is worthless and adds of his patient, “I’m not sure he really understands what we face in primary care.”

In the workers’ paradise to our north, the current and incoming presidents of the Canadian Medical Association recently bemoaned the failures of Canada’s universal health care system, calling it “sick,” “precarious,” and “imploding,” and urged Canadian doctors to support free market reforms to the system.

The artist of the Obama “Joker” poster, Palestinian socialist and Dennis Kucinich supporter Firas Alkhateeb, admitted, “[Y]ou had all of these people who basically saw him as the second coming of Christ.  From my perspective, there wasn’t much substance to him.”

Air America host Christiane Brown decried Obama’s reversal of his promise not to bar negotiation for lower drug prices, then purred, “He’s such a charming liar, though.  He’s such a nice guy when he lies like that.”

On Sunday, Senator Joe Lieberman, who caucuses with Democrats, said he’s changed his mind on proposed legislation and urges postponing it until the economy recovers.

Now The New York Times has gotten on the bandwagon; you might say they finally have some “skin in the game.”  Times reporter David Pear reported a few days ago that there is, after all, a legitimate basis for elderly Americans’ fear that legislation will lead to rationing of health care.

Paul Krugman criticized the President’s priorities, belittled his dwindling ability to inspire confidence, and lamented that “his speeches and op-eds still read as if they were written by a committee.”

Bob Herbert scolded Obama for not explaining why a gargantuan new government program is in our country’s interest in the middle of a recession: “Many sane and intelligent people who voted for Mr. Obama… have legitimate concerns about the timing of this health reform initiative…  [He] has not been at all clear about how the reform that is coming will rein in runaway costs…  [P]eople are starting to lose faith in the president.”

I’m glad the Times is finally starting to see the light on Obama’s executive inexperience and his disastrous agenda.  Maybe now millions of Middle Americans who hang on Krugman and Herbert’s every word will develop more confidence in expressing their opposition at all those town hall meetings I keep hearing about.