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The Nation

Timetable for Health Bill Passage (w/o Public Option) Locks In

The debate about health care reform is finally getting serious.

How serious?

President Obama, who rarely if ever allows anything to get in the way of his international sojourning, is delaying his trip to Guam.

At the same time, House Speaker Nancy Pelosi, D-California, is saying finally -- and presumably definitionally -- that there will be no public option in the legislative package that reshapes the American health-care system.

These are both pieces of the broader puzzle that gets to the passage of what will be declared "reform." They come as the folks at Organizing for America are busy highlighting scenes from around the country where supporters of reform are now rallying in bigger numbers than Tea Partisan foes. And my friends at Reason magazine, where sincere libertarian objections to the legislation have been raised, are already sending "alerts" that talk about what comes after passage of a bill.

The health-care debate that has for so long been so open-ended is coming finally to a conclusion.

How do we know?

Let's go first to Obama's decision, which effectively sets the timetable for the key votes.

Obama, whose travel plans for next week include not just the sojourn on Guam but a too-long delayed stop in Australia and a nostalgic visit to his childhood home of Indonesia, was to set off on March 18.

Now, he'll leave March 21.

What's the big deal about the 18th?

That's the day when, despite deliberate vagueness on the part of many key players, seems to have been settled upon as the due date for a health-care reform bill. And, with the Senate parliamentarian saying that Obama must sign an initial bill before the complicated process of reconciliation (which is essential to getting the House and Senate on the same page) can move forward, the president's presence becomes essential to getting the House and the Senate on the same page.

Here's why: The old plan was for the House to pass the Senate health care reform bill at roughly the same moment that the Senate would pass companion legislation adopting changes to the Senate bill that had been negotiated by House Speaker Nancy Pelosi, D-California, and Senate Majority Leader Harry Reid, D-Nevada.

House members, especially liberals, are demanding the companion bill be moved quickly through the Senate in order to address concerns regarding a Senate bill that they think is far too compromised and dysfunctional in its approach. In particularly, they propose to limit taxes on the health plans of middle-class families (so-called "Cadillac plans") and to provide more subsidies for low-income Americans to buy health insurance.

Before the parliamentarian's intervention, negotiators had imagined that the president might sign the core bill and the companion measure at the same time, effectively packaging everything together in what would be referred to as "health care reform."


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The parliamentarian's ruling shakes things up, raising concerns among House members who frankly do not trust the Senate to quickly enact the companion bill. As Congressman Mike Capuano, D-Massachusetts, says of the whole reconciliation route: "There is great risk in this course of action. If one or both parties refuse to commit to this approach, the Senate bill could be signed by the president as the final bill."

So the negotiations will continue. Pelosi is already telling concerned members of her caucus that she will get Senate commitments before they vote. "There are certain assurances that we want and that we will get from them before we take a vote," says the Speaker.

Reid, prodded by Obama, will give those assurances.

When all is said and done, the best bet is that Pelosi and Reid will agree on an approach that calms the fears of most House Democrats.

Pelosi will have her votes in order.

Reid will have his votes in order.

And there will be no big surprises that might upset the process.

That's why Pelosi spent Friday taking issues off the table. In particular, Pelosi rejected efforts by progressives to renew the public option as a tool for competing with and regulating health-insurance companies. "We had it, we wanted it (but) it's not in the reconciliation," the speaker said Friday. "It isn't in there because [the Senate doesn't] have the votes to have it in there."

That's blunt talk. It's disappointing, especially to those of us who saw the public option not as a radical initiative but as a compromise that fell far short of the desired goal: a "Medicare for All" system designed to provide quality health care to all Americans at a significantly reduced cost to society.

But this is the sort of bluntness that is heard from a Speaker when the time for talk is ending and the time for voting of a historic nature is near.

So the final form of reform is coming into view. It will be based on the Senate bill, with significant House tinkers but no public option.

Watch for negotiations to continue through the weekend.

On or near the 18th - perhaps sooner if the pieces fall in place -- there will be House and Senate votes. There may be a White House bill signing, or two.

Obama will be central to the process, an essential player holding things together and taking decisive action at necessary points in what promises to be a remarkably intense week when we will be reminded frequently of the old comparison between legislating and sausage making.

Then he will go to Guam, a territorial possession of a country that will (if the next week goes as Obama, Pelosi and Reid expect) have taken a significant step toward establishing something akin to a national health care system.

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