No time like the present

NO TIME LIKE THE PRESENT…. I’ve spent an inordinate amount of time lately trying to ascertain/understand/guess what happens next on health care reform. Over the last week or so, there have been some encouraging signs and discouraging signs, but at this point, there are really only two things that are perfectly clear: (1) the relevant players really do seem to want to get this done; and (2) they haven’t the foggiest idea when or how.

Last night, President Obama defended the Democratic reform plan during the State of the Union, and urged lawmakers not to give up. At an event in Tampa today, the president repeated a similar sentiment:

“[W]e will not stop fighting for a health care system that works for the American people, not just for the insurance industry. We won’t stop.

“We want a system where you can’t be denied care if you have a pre-existing condition. You can’t get thrown off your insurance right at the time when you get seriously ill.

“We want a system where small businesses can get insurance at a price they can afford. Nobody pays more than small businesses and individuals who are self-employed in the insurance market, because they’ve got no leverage. We want to change that by allowing them to be able to set up a pool.

“We want to make sure that people who don’t have coverage can find an affordable choice in a competitive marketplace.

“We want a system in which seniors don’t have these huge gaps in their Medicare prescription drug coverage. And where Medicare itself is on a sounder financial footing.

‘Those are the things that we’re fighting for. And I’m not going to stop on this, because it’s the right thing to do.”

Sounds great. So, what’s next? No one knows.

Senate Majority leader Harry Reid (D-Nev.) told reporters today, “We’re going to do health care reform this year. The question at this stage is procedurally how do we need to get where we need to go.” Senate Majority Whip Dick Durbin (D-Ill.) added that Democrats are “thinking about it and how to move on it.” What does that tell us? Not much.

Conservative members of the Senate caucus still aren’t helping. Sen. Mary Landrieu (D-La.) said reform is “on life support,” and she’s “hoping that in the next week or two” the president will give lawmakers marching orders.

My biggest fear isn’t that reform will come down to a life-or-death moment, where it either succeeds or fails. What’s more likely is that this once-in-a-generation opportunity will simply fade away — winter talks will be put on the backburner so policymakers can work on other things, which will lead to spring and a series of votes on those other issues. Spring will turn to summer, which is when leaders start telling reform proponents, “Well, we wanted to do something, but members don’t want to vote on controversial issues so soon before the midterm elections.”

If this is going to succeed, the way to make it happen is to get it done very soon. As a practical matter, that means working out a plan, literally, over the next week or two. The longer it takes, the more likely failure becomes. And if it fails, the consequences — for the country, the economy, the Democratic Party, the Obama presidency — would surely be severe.

Also, I’ve been pushing the line pretty hard that congressional Democrats can/should realize what needs to be done, and not rely excessively on the White House to deliver marching orders. I still believe that, but it’s also becoming clearer to me that expecting Congress to make these realizations is probably unrealistic — the House and Senate are at odds, they don’t seem to be getting anywhere, and without some presidential hand-holding, a way forward will likely never materialize.

The fate of reform, in other words, shouldn’t necessarily fall on the president’s shoulders, but it may anyway.