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Too big to fail is the tagline that health lobbyist Fred Graefe applies to the health care reform effort, and hes got it dead right.
The failure of an overwhelmingly Democratic Congress to pass President Barack Obamas No. 1 priority would be a political disaster for the president and his party.
It would also be a disaster for the country to continue with mounting numbers of uninsured people soon to top 50 million and mounting, unconstrained costs that employers, premium-payers and government cant afford.
So Graefe, a Democrat who represents hospitals, pharmaceutical and related companies, and device manufacturers, bravely predicts that President Obama will sign a health care reform bill by Christmas.
Lets hope. But producing a bill in the current superheated ideological and special interest environment is going to require a lot of heavy lifting by the president and a willingness to compromise by a lot of Democrats and at least a handful of Senate Republicans.
The likeliest vehicle for legislative success though far from an ideal policy outcome is the bill being developed by six bipartisan negotiators on the Senate Finance Committee.
That measure is designed to cost less than $1 trillion over 10 years, have a phased-in individual mandate, foist considerable costs of covering lower-income workers onto the states by expanding Medicaid and the State Childrens Health Insurance Program, and pay for itself through a combination of Medicare provider cuts and taxes on high-end insurance plans.
It will contain stiff new regulation of the insurance industry but no government-run public plan of the kind that liberals are insisting upon, which is why heavy lifting will be required to pass it.
The Senate Finance bill assuming Chairman Max Baucus (D-Mont.) can reach an agreement with Republican Sens. Chuck Grassley (Iowa), Mike Enzi (Wyo.) and Olympia Snowe (Maine) conceivably could garner 65 votes on the Senate floor.
That is, Democrats some of whom, mainly liberals, will have to swallow hard would vote for it, plus Republicans Grassley, Enzi, Snowe, Sen. Susan Collins (Maine) and, possibly, retiring Sen. George Voinovich (Ohio).
In the Senate, heavy pressure is being applied to Grassley and Enzi by fellow Republicans to stop cooperating with Baucus. And fellow Democrats are mad at Baucus for consorting with Republicans.
In a different environment which Obama might have established were he truly a post-partisan figure health reform could have had broad support if it included GOP-sponsored elements like medical malpractice reform, consumer choice and competition to lower costs, and options to buy insurance across state lines.
But thats not happening. Nor is Congress likely to turn to other worthy bipartisan proposals like the Healthy Americans Act sponsored by Sens. Ron Wyden (D-Ore.) and Bob Bennett (R-Utah) or the Bipartisan Policy Center plan of former Sens. Tom Daschle (D-S.D.), Bob Dole (R-Kan.) and Howard Baker (R-Tenn.).
At this late date, the Senate Finance bill if it emerges likely will be the only viable vehicle with bipartisan support.