Analysis: More fighting could doom health care

WASHINGTON - The patient isn't dead yet.

A few more months of wrangling and indecision, and health care legislation to remedy America's coverage and costs problem could be drawing its last gasps.

As Congress returns to work this week, President Barack Obama and lawmakers have three broad options — competing treatment plans for a patient whose vital signs are growing weak. It's not clear which one, if any, will work.

Democrats — and liberals in particular — want heroic measures and large scale intervention. They think the legislation needs big new ideas such as a public insurance plan that would have government offering coverage to middle-class workers and their families.

Republicans want a conservative treatment to relieve the worst symptoms of America's health care malaise. They're proposing help for small business owners and the self-employed, and some GOP lawmakers probably could go along with expanding current programs that cover the poorest of the poor. But no new government plan and no guarantees that everyone would be covered.

Obama to address Congress Wednesday
A third group, including moderates from both parties, supports a holistic approach that would put the country firmly on track to coverage for all. They believe government should help some middle-class people through subsidies for private coverage, but that a federal insurance plan isn't needed. Some are willing to include malpractice changes that appeal to conservatives.

Obama will say which way he wants to go when he addresses a joint session of Congress on Wednesday night.

Above all, the president wants to avoid failure. But an argument on the merits may fail to persuade lawmakers polarized by the town hall brawls of August.

If nothing gets done, "it's a disaster politically" for the Democrats, said Gerald Shea, the AFL-CIO's top health care policy expert. "Unfortunately, I think that's what's behind a lot of the Republican opposition."

The action will speed up once Congress is back.

The chairman of the Senate Finance Committee, Sen. Max Baucus, says he's ready to march ahead. For months, Baucus, D-Mont., has tried to reach a compromise within a small but influential group of senators from both parties. He faces a Sept. 15 deadline, and has signaled he'll move with or without a deal.

His committee would be the last one to consider health care legislation before the full House and Senate take over. Deliberations in the Finance Committee are seen as a critical test because it reflects the composition of the Senate as a whole.

No vote until the end of September
In the House, Democratic leaders have indicated they will not schedule a vote until the end of September. Many House members don't want to stick their necks out if it looks like the Senate is hopelessly deadlocked. Still, once House Democrats decide to go forward, they should be able to pass their bill.

There won't be any guarantees in the Senate, where 60 votes are needed to pass legislation of any consequence. It doesn't look like Democrats have them right now.

Senate Majority Leader Harry Reid, D-Nev., will try to meld the Finance Committee's bill with legislation written by liberals on the Senate Health, Education, Labor and Pensions Committee before he takes something to the full Senate. Debate could last for weeks, with hundreds of amendments.

Reid's most important decision will be whether to use a maneuver that allows the Senate to pass the financing elements of the bill with just a simple majority. Even so, he'd probably still need 60 votes to pass companion legislation with other essential elements — such as how people would buy their health insurance.

Strategy could backfire politically
The shortcut strategy could backfire politically. Sen. Ben Nelson, D-Neb., said Sunday his constituents are already concerned that Congress is rushing things. "If we went to some sort of a parliamentary shortcut, I think they would be even more alarmed than they are right now," Nelson told CNN's "State of the Union."

Even if the legislation clears every hurdle, it could be Christmas before it reaches Obama's desk.

Republicans say Congress should scrap what's been done so far and start over, without deadlines.

"There don't seem to be any checks and balances on a runaway government in Washington, D.C.," said Sen. Lamar Alexander, R-Tenn. An immigration overhaul fell under its own weight during the last administration, and "health reform seems to be doing the same."

For all the disagreements, the core elements of the congressional bills are similar.

They would set up a new purchasing pool to make it easier for individuals and small businesses to buy insurance, and offer government subsidies to make premiums more affordable. People would be required to get health coverage, through an employer, a government program, or on their own. Businesses that don't offer coverage would have to contribute in some way.

The changes are complicated, and it would take the better part of a decade to phase them all in. The cost — offset by spending cuts and tax increases — is about $1 trillion over 10 years.

As the scope of the legislation has gotten clearer, more voters seem to be having second thoughts. Polls show that support for action this year plunged over the summer, from 61 percent in June to 53 percent in August, according to a Kaiser Family Foundation survey.

Obama is hoping he can turn that around. If he doesn't, lawmakers worried about getting re-elected next year will have another option to consider:

Should they pull the plug?

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EDITOR'S NOTE — Ricardo Alonso-Zaldivar covers health care for The Associated Press.

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