And, the Ides of March Are Upon Us!

As we approach yet another week in the drawn-out battle known as healthcare reform, the middle of March has historically been an interesting point in literature.  As we all recall from our high school English class of reading Shakespeare’s Julius Caesar, Caesar himself was warned to “beware of the ides of March” right before he was killed by Brutus. The “Ides” were a yearly festival in Ancient Rome dedicated to celebrating the Roman God of War – Mars – on March 15.  As the Ides of March 2010 loom on the horizon, we consider whether healthcare reform will ever pass or if we are seeing a tragic Shakespearean ending.

While it seems that healthcare reform is at last entering the grand finale with the Senate’s decision to proceed with the use of reconciliation to pass their bill, we must remember that we’ve been here before.  In the last eight months, we’ve had at least seven times when the light at the end of the tunnel was declared, including the following moments: 

• July 28:“Healthcare endgame on Capitol Hill” (Reuters)
• Aug. 21:“Analysis: Health care endgame near but uncertain” (AP)
• Oct. 14:“Senate, administration begin healthcare endgame as Dem

leaders express unity” (The Hill)

• Oct. 25:“Senators say health care bill endgame is in sight” (Politico)
• Oct. 30:“Health reform inches closer to endgame” (The Washington Post)
• Nov. 23:“The Health Care Endgame” (NPR)

Is healthcare reform the great mirage of our generation?  Many have worked tirelessly to achieve it and while it has been within our grasp, it still eludes us. Although the Senate will likely pass a health package through reconciliation, it is going to be a very rough battle in the House to gain passage of a reconciliation bill. 

Though the House of Representatives passed their original healthcare bill by a narrow 220-215 vote in November, much has changed in the last four months.  The lone Republican (Rep. Joseph Cao – R-LA) is now a “no” vote, one supporting Democrat has passed away (Rep. John Murtha – D-PA), and three Democrats have resigned (Rep. Robert Wexler – D-FL; Rep. Neal Abercrombie – D-HA; and Rep. Eric Massa – D-NY). After taking into consideration the changes in membership that occurred in recent weeks, the current vote tally would be 216-215, and that is IF AND ONLY IF all the other Democrats vote the same way they did in November. After considering shifting political tides during the last four months – illustrated by Senator Scott Brown’s (R-MA) shocking Senate victory – it is clear that other Democrats may be more hesitant to follow Nancy Pelosi’s lead.

So, what does this mean?  Yet another healthcare stalemate, but this time in the House? Making matters more complicated for the Dems are the key differences the Senate’s bill contains related to abortion. While the House bill contained a special provision - known as the “Stupak Amendment” after Representative Bart Stupak (D-MI), which prohibited funding abortions with federal aid, the Senate bill did not include such language.  As a result, the more conservative Stupak and ten other Congressmen have vowed to vote against any bill that does not restrict federal abortion coverage.  But, do they have the votes? 

We should not forget the powerful force of Speaker Pelosi who will likely cash in any political capitol she has been saving up to garner votes along the way.  She cannot argue with the arithmetic going against her.  And, complicating Pelosi’s situation is the 2010 midterm elections. While Democrats easily hold the majority in the House, it should be noted that more than 40 House Democrats hail from districts that John McCain won during the 2008 election and another 32 are from areas Barack Obama barely carried. With 176 members from districts that could be considered “pro-Obama,” that still leaves Pelosi behind the 216 votes she will need to pass a healthcare bill.  But, we will all wait and see…

I have no doubt the House will create a deal with the Senate and pass a bill that will be sent back to the Senate for a reconciliation vote.  Obama’s cancellation of his Asia trip for next week is a sure sign that a “collaboration” between the House and Senate is in the works.  Who knows what back office mechanics contributed to the final deal?  Perhaps we can all read about it in the history lessons of the future.  But for now, watch and learn…

So, we should take a page from Shakespeare and remind ourselves of the Ides of March?  Like Julius Caesar, healthcare reform could see a demise, but then again, maybe not… 

Kevin Fickenscher, MD

The views and opinions expressed herein are my own and do not necessarily represent the views and opinions of Dell Services or its affiliates.