A knowledgeable reader from up on the Hill chimes in (the references are to this post from this morning) …
Pivot Point #1 is all but a done deal: the bill may pass the House before the August recess, but not the Senate. It probably passes the Senate Finance Committee, then the Finance and HELP committees will work out their differences over August, putting the bill on the floor in September.
Pivot Point #2 may come down to a question of how well Reid can hold his caucus. Some Democratic senators would vote against a health care bill with a full-on public option — but would they filibuster it? The HELP bill has a public option, Finance will probably have a co-op option. Which prevails?
I think Pivot Point #3 isn’t quite what you describe; it’s what Robert Reich puts his finger on, the question of cost containment. Taxing Cadillac health plans would help contain costs, but that’s off the table. Obama has proposed “MedPAC on steroids” — reviewing the rates at which Medicare reimburses care providers — and that will help. But some of the deals the Administration has cut to win support do erode the ability to contain runaway health care costs. If we’re expanding coverage but not also delivering care more efficiently, have we succeeded?
Bottom line, Congress needs to thread a fine policy and political needle: delivering care more efficiently to more people without running up larger deficits. It’s tough work, and the bills out there now are at best a starting point. It probably happens by the end of the year, but there’s a lot of hard slogging still to come.
