Going forth on health care reform

After its narrow passage in the House, health care reform moves to the Senate, where the battle will get harder. Harry Reid, the majority leader, is holding onto a filibuster-proof alliance of Democrats and independents. Once the CBO releases its report on the projected costs of the Senate plan, expect much debate after Thanksgiving.

For now, four issues characterize health reform as it moves to the Senate:

1) Principles or Pragmatism - Two Democrats, Martha Coakley and Michael Capuano, have stated ultimata that they would not vote for any bills that prohibit abortion funding. While they ought to be applauded for standing by their principles, they should consider the impact of their decisions on the passage of the bill as a whole. The abortion question might be the biggest issue dividing Democrats, but how many will stand by their beliefs while jeopardizing the passage of a health reform bill?

2) Beware the Filibuster - Joe Lieberman's filibuster threat should not be taken lightly. His personal background and ties to industry will impact his decision, but the Democrats still may convince him to vote for reform. He, like many other independents, is wavering between support for and opposition to the health reform bill. The Democrats' support from independents like Lieberman will be the key to success.

3) The Specter of Cost - Cost, not access, will drive the debate. Many, including Democrats, are justifiably questioning the costs of health reform, especially adding new programs while failing to reform existing ones. Republicans and opponents are using cost as their principal weapon in defeating reform. Whatever bill proposed will provide access and everyone agrees that increasing access is desirable, but whichever bill potentially controls costs will win over constituencies.

4) The Lure of Time - Congress goes to holiday in late December, and midterm elections loom next November. Hence, health reform needs to be completed by the end of this year. Once 2010 begins, the representatives will have heard opposition from town meetings and incumbents will be thinking about reelection. Now is the time to get it done, although waiting for the Senate to produce a bill and reconciling it with the House's will take much time. Wait till next year?