Health care autopsies?

"#HealthCareFAIL: How The Dems Botched Their Signature Legislation" (TPM):

Talk about fits and starts.

A year ago Democrats committed to passing comprehensive health care legislation; six months ago, it became clear that their project wouldn't go smoothly; one month ago it was full speed ahead; and a week and a half ago it all fell apart.

Health care reform is now on life support. To mix metaphors, it's on life support and the back burner at the same time. How the Democrats' signature agenda item went from a foregone conclusion to a prospect in peril is a tale of missteps and bad luck. No single player or event brought us to where we are today. But if any of the below episodes had gone...more smoothly, this might've been a done deal.

You know how the saying goes: Success has a thousand fathers, but failure is an orphan. And you can be sure that if health care reform fails, the people below will make like John Edwards--quick-like.

“1. Let's Do This The Hard Way...Just For Fun
It was a move that baffled and outraged reformers and Democratic members of Congress: Back in the early days of summer, while the House and the Senate Health Committee adhered to a standard legislative framework for drafting a reform bill, Senate Finance Committee Chairman Max Baucus (D-MT) went in a completely different direction. Convinced, against all evidence, that the GOP would play nice on major social policy, Baucus decided to huddle with a motley crue of Democrats and Republicans, culled from his committee. It started in June as the "coalition of the willing"--Baucus, along with Sens. Kent Conrad (D-ND), Jeff Bingaman (D-NM), Chuck Grassley (R-IA), Olympia Snowe (R-ME), Mike Enzi (R-WY), and Orrin Hatch (R-UT)--but Hatch soon bolted, leaving the Gang of Six. Their meetings dragged on through the August health care flame wars into September, ultimately yielding...nothing. Baucus introduced a bill on his own, with the aim of winning over Snowe, and put it through the normal committee process. It wasn't approved until October 13.

2. Rumblings In Massachusetts Sen. Ted Kennedy (D-MA) died on August 25, and because of his illness, he could not play a major role in the health care debate. The impact he might have had can't be known, but his passing ultimately deprived Dems of a 60th vote. At the time of his death, Massachusetts law required the seat to be filled by special election after 145-160 days. But at his request, the state government changed the law to allow the governor to appoint an interim senator to fill the vacancy. That change allowed Sen. Paul Kirk (D-MA) to cast the 60th vote for health care to get it through the Senate the first time. But it set the stage for the blow that put Kennedy's own lifetime cause into a coma.

3. Math Math Math
Three words Democrats are tired of hearing at this point: Congressional Budget Office. At about a zillion different stages in the legislative process, Democrats had to wait for the CBO to "score" the cost and budgetary impact of the reform proposals on the table. But if Democrats could go back to 2009 to get some of that time back, they'd probably nix a four week back-and-forth between Senate Majority Leader Harry Reid (D-NV) and CBO-chief Doug Elmendorf, which dragged a process that was supposed to be over in August, then October, into November.

4. Snake, Meet Tail
There's no getting around it. As SEIU President Andy Stern said recently, Senate Democrats "had a chance, a gift, from the American people--60 votes, so they could, for the first time in their life, debate any single issue they chose to debate. And they squandered it." With Republicans out of the equation, Democrats needed to stand united--and they didn't. On October 26, after canvasing his caucus, Reid declared that he would include a public option in his health care bill. The next day, Sen. Joe Lieberman (I-CT) announced his intent to filibuster. Reid unveiled his bill on November 18, and managed to get it on to the floor. But he couldn't get it off the floor--passed--until he rounded up 60. For weeks, liberals and Democrats huddled to find common ground on the public option. At the last possible moment, after they thought they'd come to an agreement, Lieberman rose again: No public option; no compromise; either it goes, or I go. He won.

5. It's The Republicans!!
Thusfar, this has largely been a story about Senate Democrats. With 60 votes, why didn't they charge ahead? But the Senate is the Senate, and even a 40 vote minority can cause pointless delay. And delay they did. Republicans filibustered the move to debate the health care bill (30 hours); and through separate filibusters, delayed final passage of the Senate bill--December 24, 2009--by about a week.

6. No! It's The Democrats!!
But as soon as the bill passed, Democrats skipped town. For weeks. Reid went to Nevada--"I'm just going to sit back and watch my rabbits eat my cactus"--and other key players took time off. Exhaustion had clearly set in. But they needed those weeks.

7. #CoakleyFAIL
Why did they need those weeks? Because they'd soon lose a Senate seat. Kennedy's seat. The Democrats had planned to use the Senate bill as a baseline--send it over to the House for some changes, then back to the Senate for (truly) final passage. Another 60 vote hurdle. But after running a lethargic, gaffe-ridden campaign, Democrat Martha Coakley lost to surging challenger Scott Brown, who ran on a vow to be the 41st vote against health care. Suddenly Democrats needed a Plan B.

8. #ObamaFAIL
Democrats are settling on a Plan B. Whether it will work or not remains to be seen. But they came to the last-ditch strategy in the heat of a panic. It wasn't a pre-cooked contingency. Because Democrats never thought they'd need one. They took it for granted. And as a result, as Sen. Mary Landrieu (D-LA) said, health care reform is on life support.

"Dems' missteps led to health breakdown" (AP):

Democrats say they never saw it coming, but the breakdown of President Barack Obama's health care overhaul was abetted by their own mistakes.

It wasn't just a political fluke brought on by the surprise election of a Republican senator in true-blue Massachusetts.

Looking back, Obama and his congressional allies failed to appreciate the depth of frustration with Washington - people's desire for health care legislation that would respond to their anxieties, not the clamor of interest groups.

Former President Bill Clinton was criticized for dictating to lawmakers when his health care plan imploded in the 1990s. But Obama may have swung too far in the opposite direction, giving free rein to Capitol Hill's culture of insider dealmaking.

Democrats bowed to ideology over pragmatism. They allowed a dispute within the party over a government insurance option pursued by liberals to drag on last year, even when it was clear the Senate wasn't going to pass it and Obama was unwilling to save it.

As Republicans closed ranks against the sweeping remake sought by Obama, Democrats lost more time last summer waiting to see if bipartisan talks in the Senate would produce a compromise bill.

But GOP negotiators came under relentless pressure from their own party, and the three-month exercise yielded nothing. Many Democrats felt it was an elaborate game of political rope-a-dope. Early on, Sen. Jim DeMint, R-S.C., had captured the defiant mood among Republicans when he said health care would be Obama's Waterloo. "It will break him," he said.

Maybe not.

Unlike the 1990s, Democratic congressional leaders are working overtime to salvage the health care overhaul that consumed them for a year. The House and Senate bills would cover more than 30 million uninsured people, yet neither side seems ready to yield on differences over important details. Even if leaders can agree, lawmakers worried about their re-election prospects this year may not go along with a complex rescue plan requiring a series of controversial votes.

Obama, at a pivotal moment in his presidency, has turned introspective. In his State of the Union speech, he accepted responsibility for failing to communicate the benefits of the legislation to the public. With more workers in jobs that lack health insurance, the Democrats' plan for government to subsidize affordable coverage for millions had inherent appeal.

Instead, the legislation was defined by the activists who turned out at town hall meetings last summer riding a current of populist anger over the government's expanding role in a time of economic crisis. Obama was forced to relaunch health care with a September speech to Congress that calmed Democrats and got them back on track.

But the deals lawmakers cut to get votes fired up the critics again, and Obama belatedly has joined in pointing the finger at Congress.

"The health care debate as it unfolded legitimately raised concerns not just among my opponents, but also amongst supporters, that we just don't know what's going on," Obama said in a recent ABC News interview. "It's an ugly process and it looks like there are a bunch of backroom deals."

Ugly process. For Democrats in Congress, that stings. Administration officials cut deals, too - with drug companies, hospitals and others. Sen. Mary Landrieu, D-La., said she thought Obama endorsed the legislative strategy: one big bill in the House, two in the Senate.

"As far as I thought, the president thought it was a good idea to have three separate bills debated," said Landrieu, calling the strategy "a tough plan."

Sen. Tom Carper, D-Del., said Obama could have moved more quickly to settle differences between the House and Senate to get a final bill. The president jumped in the week before the Massachusetts election and drove them close to a deal.

"The president's role in health care reform initially is to steer the boat," said Carper. "At some point in time, the president needs to start rowing." Should Obama have done that sooner? "Probably so," said Carper, "but I wouldn't fault him."

Now Obama is standing back again. He's refrained from telling Congress how to move ahead. Administration aides have explored options that include ramming the Senate bill through the House and opening a dialogue with Republicans. What Obama wants is unclear.

It was like that much of last year on one of the central issues in the debate, whether the government should offer its own insurance plan to compete with private carriers. Liberals pursued the public option as a pathway to Medicare-for-all, and Obama was unwilling to settle the dispute raging in his own party.

As a result, the slim chances for a bipartisan solution disappeared, and the public plan overshadowed almost everything else.

"The public option was a bright line for Republicans, and one we would not cross," said Michigan Rep. Dave Camp, author of the House GOP health care bill.

Drew Altman, president of the nonpartisan Kaiser Family Foundation, said the focus on the public option "diverted attention from core consumer issues such as affordability" and added to the delay.

Time is running out now. Obama, in his prime-time speech Wednesday, challenged Republicans to come up with a better health care plan if they don't like his. That's not likely, not when Republicans have the Democrats just where they want them.

Carper says his party fumbled the football a couple of yards short of scoring a touchdown. "The ball was bouncing around, and we fell on it and recovered it," said Carper.

The question now for Democrats is if Obama will call in a winning play.

Howie P.S.: Booman wonders "What's Going On?"