I have heard a dangerous mantra being repeated by the Senate bill apologists in many different forms. The goal of the consistently uttered mantra seems to be to trick those inside the Washington bubble that the Senate health care bill is, in fact, secretly popular, but the American people are too dumb to realize it. The message in defense of the legislation basically boils down to, “when people hear that X is in the bill, they like the bill more.” Usually the X is some very popular element like tax credits for small businesses, or banning coverage denial based on pre-existing conditions.

Yes, the Senate bill does contain some popular provisions and good ideas. Democrats should not take too much comfort in the fact that they wrote a 2,000 page bill and some how managed not to make every single page terribly unpopular. The problem is that legislation is normally not judged by a handful of its most popular sections, but is often judged by its most egregious. This is especially true when the onset of the bill is delayed so people can’t actually feel the good stuff, but can still hear about the bad stuff. Legislation is like a chain, only as strong as its weakest link.

It is true that when people hear about how the Senate bill will ban rescission, ban discrimination based on pre-existing conditions, expand Medicaid, help close the Medicare Part D donut hole, and/or provide small businesses with tax credits, they tend to be more supportive of the bill. But it is equally true that when people hear about the mandate forcing people to buy private health insurance, the excise tax on employer-provided health insurance benefits, special money for Nebraska, the secret deal with PhRMA to stop drug re-importation, or the delay of benefits till 2014, they become dramatically less supportive of the bill.

Democrats can try to run on the popular stuff–which will not kick in until 2014–but the Republicans will be able to run against the unpopular stuff. Plus, the Republicans will probably say, “We would have happily voted for those popular provisions if the Democrats did not put them in a bill with so many corrupt deals.” While I think this will be dishonest on the part of Republicans, it will still make for a great campaign talking point.

Doubling down on an awful bet by simply passing the Senate bill in the House as is would be a terrible idea. That bill already cost Democrats a Senate seat in Massachusetts. Chris Van Hollen, the head of the DCCC, knows voting for the bill as is would be toxic for House members in 2010.

Cold Political Calculation

Democratic House members should ignore this insane mantra for the bill apologists and make a cold political calculation. Democrats wasted all year working on health care reform so they need to deliver something big to prove they can govern. Equally important the Senate bill as it currently stands is pure poison filled with terrible provisions. The bill is unpopular and House members need to at least pretend they are responding to the anger. So, Democratic House members have only two solutions:

  1. Quickly pass a simple, clean, and easy to explain expansion of Medicaid/SCHIP/Medicare using reconciliation. Tell voters you’ve heard them and made the bill simpler while still helping 30 million Americans.
  2. Create a sugary sweet reconciliation sidecar measure with as many popular ideas as possible to fix the Senate bill (include a public option, Medicare buy-in, and drug re-importation, eliminate Nebraska’s special deal, and fix or eliminate the excise tax). Pass both bills on the same day. Finally, run against Joe Lieberman and the Senate for messing things up, while pointing to how you did everything you could to stand up to the evil insurance companies, and managed, with hard work, to salvage a very decent health care reform package.

Either strategy should work. Policy-wise, both routes could produce a decent health care reform package if Democrats choose to use reconciliation smartly. For pure political reasons, I lean towards very expansive reconciliation sidecar strategy because the Senate Democrats already voted on their bill.

House Democrats can prove they are relevant, take credit for the very popular provisions in the reconciliation measures, and blame all the problems on the broken Senate. Conservative Senate Democrats can blame whoever they want. I recommend trying to make an argument that uncompromising Republicans just force the Democrats to go it alone, and only moderate Democrats can move things to the center.

Ignore The Mantra

The Senate bill is unpopular and full of easy political targets for Republicans. It will not magically get more popular by just passing it now. Passing it “as is” in the House will prove that House Democrats are a worthless rubber-stamp, and make them look deaf to the will of the people. It is a death sentence.

House Democrats need to show they are listening by demanding some popular changes, like including a public option. The public option is popular, makes the individual mandate more tolerable, and is a sign that Democrats stood up to the unpopular insurance companies. Even if the changes are relatively small, House members need something to point to so they can say, “we heard you.”