The Healthcare Bill in the Senate

The healthcare debate has entered a crucial new phase, with the Senate now officially considering the plan put together by Democratic Majority Leader Harry Reid of Nevada. Most observers expect the debate to be lengthy, running at least until Christmas and possibly into the new year.

While Senator Reid was able to garner sixty votes to proceed to his bill before Thanksgiving, it is much less clear that he has the votes locked up to pass it. He will need sixty senators at several more steps along the way to provide their assent, and some who voted with him to proceed to the legislation have publicly stated they would not now vote to stop debate unless significant revisions are made to the bill.

Senator Joe Lieberman of Connecticut is among the holdouts, and he should be the least likely among them to be persuaded by appeals to party loyalty. In 2006, he was successfully challenged in a Democratic primary, and several prominent national Democrats sided with his opponent. He won reelection anyway, running as an independent. He continues to caucus with his Democratic colleagues in the Senate, but he owes them very little at this point. He has said that he will not vote to end debate on the Reid bill so long as it includes a new government-run insurance option so coveted by the left, even if states can opt out, as the Reid plan would allow.

Democratic senators Mary Landrieu of Louisiana, Blanche Lincoln of Arkansas, and Ben Nelson of Nebraska are also said to be in various degrees of discomfort over the Reid plan. Of course, that might be related to the strong and intense opposition to the plan among voters in their states. Despite a year-long campaign to convince the public of the virtues of near-total governmental control of U.S. health care, most Americans are rightly dubious of the notion that the federal government can be given so much power over the organization and financing of American medical care without harming its quality.

And then there is the issue of abortion coverage. As matters stand, the Reid bill would allow taxpayer subsidies to flow to insurance plans covering elective abortions. If enacted, it would overturn the longstanding policy, upheld by Congresses under the control of both parties, that taxpayers should not be forced to finance abortion procedures they find morally abhorrent. House Democrats originally pushed provisions similar to those in the Reid bill, but pro-life Democrats balked. To secure enough votes for passage, Speaker Nancy Pelosi was forced to allow a vote on an amendment offered by Michigan Rep. Bart Stupak. It passed convincingly, much like the Hyde amendment has many times over the years.

Still, it is not at all clear that a Stupak-like amendment could prevail in today’s very liberal Senate. In the aftermath of the 2008 Democratic landslide, there are fifty-eight Democratic senators, two independents, and a handful of pro-choice Republicans. There probably is not majority support for an amendment to add strong pro-life language to the health-care bill. But that doesn’t mean Stupak-like language is dead. Senator Ben Nelson considers himself to be pro-life, and, as of now, Senator Reid needs his vote. If he wanted to, Senator Nelson could probably force other Senate Democrats to accept something like the Stupak language in a revised Reid bill. But it’s not clear that’s what Senator Nelson wants at this point. In mid-November, in response to a question, he said he would not support the Reid bill unless it had abortion restrictions at least as strenuous as those in the Stupak amendment. Some days later, however, he said he misunderstood the earlier question, and gave a more ambiguous response. Pro-life Nebraskans might respond to this waffling by asking their senior senator if he isn’t going to stand up for life now, then when will he?

Of course, even if the Reid bill is amended to prevent funding of elective abortions, it is still seriously flawed. The Democratic plans would require Americans to enroll in government-approved insurance. If something like that passes, voters will very quickly turn the question around on politicians: What are they doing to make sure this requirement is affordable? The federal government will inevitably become the choke point for all of the important resource allocation decisions in the health sector. That’s a recipe for clumsy cost-control efforts which always erode quality, discourage innovation and new breakthroughs, and lead to queues and waiting lists.

The Senate was always going to be the highest hurdle for Democratic healthcare ambitions. Senator Reid may yet prevail, but it is not a foregone conclusion. Now is the time to pull out all of the stops to convince at least forty-one senators that the chamber known for its lengthy debates should continue debating this bill for a very long time.

James C. Capretta is a fellow at the Ethics and Public Policy Center .