It's 'do or die' week for health care reform - how did we get here?

It's 'do or die' week for health care reform - how did we get here?

It's another "do or die" week for health care reform in America. While it may feel like déjà vu all over again, Democrats actually are closer than ever to passing health care reform. That doesn't mean that the process will be completed this week, practically speaking it means that the vote (currently expected on Saturday) is a key to make final passage of health care reform fairly inevitable. But is it a win for Democrats? As you watch the back and forth, here's a breakdown of what's really going on. Let's re-cap how we got here. After a brutal summer, the House passed its version of health care reform in November 2009, which included a public option, and the unpopular Stupak amendment. (An insult to American women that says we can't use our own money for a legal procedure). The Senate took the House bill, made changes like excluding the Stupak language on the grounds that current law already says that public funds cannot be used for abortion, and striping out the public option, (despite the overwhelming support by the American people for it). Then in order to secure a few hold out Democrats, special side deals like the "Louisiana Purchase", or the "Corn Husker" deal, were added. Now that 60 democrats were on board (because, of course, the Republicans made it clear from the start they had no intention of working on reform), the Senate passed their version of health care reform in another 'do or die' moment on Christmas Eve 2009. It seemed like all that was left to be done was to merge the House and Senate versions, vote on the merged bill and send it to President Obama's desk before the State of the Union speech at the end of January 2010. Not so fast. Then came the surprise election of republican Scott Brown in Massachusetts, which changed the math and the vote count - now at 59 - Senate Democrats no longer had the votes needed to stand against threats of a filibuster from the Senate Republicans which would basically kill reform. After several more weeks of negotiating, here we finally are. Some are saying that this is all procedural wrangling at this point - but I say it's the Democrats finally standing up to the Republican party of "no" and making it happen for the American people. Its about time rules started working in favor of -not against - the American people. In the House, a number of democrats have made it clear that they do not want to vote for the senate version of health care and want to make a set of "fixes". Moderate Democrats don't want to vote for a bill with side deals in it, and progressive Democrats don't want to vote for a bill with no public option, while conservative Democrats want the stricter Stupak language reinstated, despite current law which already prevents federal money being used for an abortion. Yes, it is hard to be a "big tent" party. So this week the House is working on this set of "fixes", but what exactly is fixed and how it gets fixed is still being debated. Once a deal is reached, these changes can be voted on and passed as a separate reconciliation measure. Now comes yet another term of Washington jargon - the "self-executing rule". According to this rule, also known as "deem and pass" once the reconciliation measure passes, the House leadership can deem that in effect, the House has agreed to the Senate version of the health care bill -- without having to vote on it. So the House members who don't want to vote for the Senate bill, technically don't have to (remember they already voted for their own reform package last November). At the point reconciliation passes the House, it will be near impossible to stop health care reform. Why? Because Senate Majority Leader Harry Reid has said he has the 50 votes he needs to pass reconciliation. Senate Republicans can't filibuster a reconciliation measure. They can use a stall tactic of proposing an endless stream of amendments but at some point the president of the senate - aka Vice President Joe Biden - can cut them off and call for a vote. Reconciliation passes. Health care reform passes and President Obama signs it into law. In political terms, Saturday's vote means that Democrats will be able to campaign on the accomplishment of having brought change to our health care system, and republicans can campaign on having opposed the Democrats. For most Americans not much will really change until after the 2010 elections. While some people will be relieved to find that the crazy lies about "death panels" were completely false, images of the deal making and bickering we've seen throughout this process have further eroded the American people's belief that Washington can accomplish anything that has a real, positive impact on their lives. Ultimately whether or not this is a "win" is in part a test of whether or note Democrats in Congress recognize that this week's vote is a 'do or die' step on the road to making our case to the American people about why we deserve their trust and the opportunity to continue to lead.