“We Get By With A Little Help from Our Friends”

As a child of the 60s, is it any question that I’m a Beatles fan?  So, the message of the week is without friends, it’s hard to make things happen.  Following months of wrangling in Congress and debating the final healthcare reform package, a vote was finally cast.  While the Senate took a nap on Saturday afternoon, the House took a rare Saturday vote, following a last minute call to the Hill by President Obama, by a squeaker margin of 220-215 in favor of the healthcare reform package.  Speaker Nancy Pelosi (D-CA) successfully guided the chamber through the final vote.  But, while Speaker Pelosi and the Democratic leadership deserve much credit in passing the reform package, without friends , it would not have happened.

Both Obama  in an impromptu appearance before the White House press corps and Pelosi  in her weekly press briefing acknowledged the support of major organizations that supported the reform initiative.  The American Association of Retired Persons (AARP), the American Medical Association (AMA), as well as the associations for the family physicians, pediatricians and surgeons – the American Nurses Association, the American Cancer Society, and other healthcare provider and advocacy groups – stepped forward to endorse the House healthcare plan. Picking up the support from these many influential organizations represented a significant endorsement to “go forward.” 

While many over the last few weeks have been speculating whether Speaker Pelosi had enough votes to pass her bill, in the end, she was able to bring together the needed number of 218 Democratic colleagues by a margin of two votes to give the 220 – 215 vote.  Only a single Republican voted in the affirmative for the measure, Rep Anh “Joseph” Cao (R-LA).  As the lone GOP nod for the bill, Cao said, “I have always said that I would put aside partisan wrangling to do the business of the people. My vote…was based on my priority of doing what is best for my constituents." But, the core strength of the vote came after Pelosi harnessed the diverse moderate and liberal Democrats to a plan that expands coverage to more Americans while keeping costs down. A critical element that boosted support of the bill was the inclusion of a more tempered public option. Rather than tying the public option to Medicare rates, the bill created a coverage plan based on negotiated rates and voluntary provider participation.  The approach appeased many conservative Democrats and created the platform for support from their friends, which I believe made the critical difference. 

Furthering the Speaker’s ability to convince her fellow Democrats to vote for the House’s plan, President Obama made a last minute pre-vote trip to Capitol Hill on Saturday morning to meet with leaders and drum up a final wave of support for healthcare reform. Obama, who had been notably quiet  in the debate since addressing a joint session of Congress on the issue in September, re-emerged as the major player in guiding the bill through the House. The last minute visit by Obama sent a clear message that yes, healthcare reform is the Administration’s highest domestic policy goal.

But, while the Saturday vote was a crucial move for creating forward momentum, the White House did not move into celebration mode.  All attention now turns to the Senate where replicating the House’s success will be even more difficult. This past week, Majority Leader Harry Reid (D-NV) intimated that passage in the Senate could slip past the holidays.  While he quickly recanted on the comment after the White House intervened (they were purported to be “apoplectic”), in conversations with members of the Senate staff, it is clear that many believe the discussions will not be completed until January rather than before the Holiday recess.  The question remains – will Obama make a similar lobbying effort by directly addressing the Senate like he did in the House?  It’s likely and could change the dynamics of Senate discussions which are increasingly unclear.  Again, the middle seems to be in control so we should anticipate a moderate course of action.

The work for creating the final package is clearly not done at it relates to the healthcare reform debate, and many observers – both inside and outside the Administration – know the wheels could still fall off the reform effort. As President Obama noted in his Rose Garden comments on healthcare reform early Sunday afternoon, “Now it falls on the United States Senate and taking the baton…”  So, anticipate Majority Leader Reid and the Senate will be under the microscope of attention and under intense scrutiny in the coming weeks. 

Kevin Fickenscher, MD

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