An unnoticed statement by a Democrat at the health care summit indicating that reconciliation will not happen
(Note: Sen. Conrad on TV this morning made much more definitive statements on reconciliation than the ones I discuss in the initial entry. So my effort to tease out the meaning of his indirect statement at the summit is no longer necessary. See Dale F.’s comment below.)
We know that Obama and the Democratic leaders are going to go for reconciliation. Obama himself more or less said so in his concluding statement at the end of the summit. We know that all kinds of opinionators and cheerleaders on the left are urging the Democrats to “ram it through,” and that these commentators believe that the Democrats can ram it through. (See,, e.g., Robert Shrum’s disturbing column, a specimen of leftist mania in and of itself.)
However, statements made last week by Senate Budget Committee chairman Kent Conrad of North Dakota, both before the summit and at the summit, suggest that the path of reconciliation is not politically viable.
On February 23, according to Politico, Senate Budget Committee chairman Kent Conrad
fired another warning shot Tuesday about the limits of reconciliation, saying a narrow bill might pass muster with the Senate parliamentarian, but not a measure nearly as broad as the proposal put forth by Obama.
Writing at VFR, I
took that to mean that Conrad will not help the health care bill pass by reconciliation and therefore it could not be passed.
Conrad was at the summit on Thursday, February 25. When I saw him there in a photo or video afterward, I wondered, did he repeat his statement of Tuesday saying that reconciliation could not be used to pass Obamacare? Or did he switch positions and back up the president and the Democratic leadership?
Here is Conrad’s statement at the summit, which concerned Medicare. The whole statement is deeply interesting. I am bolding just the parts that are relevant to my present point.
CONRAD: Well, thank you, Mr. President. Thank you for allowing us to come and visit about what really is the 800-pound gorilla facing the federal budget, and that is the health care accounts of the United States, Medicare, Medicaid and the rest.
What we all know that is true is the biggest unfunded liability of the United States is Medicare. What we all know is true is the trustees have told us Medicare is going to go broke in eight years.
So the idea that we don’t have to do anything about Medicare is utterly disconnected from reality. The idea that we don’t have to find savings in Medicare is an admission that we are headed for a fiscal cliff that we’re going to go right over.
CONRAD: And if we really want to endanger the benefits to people who are getting Medicare, the best way to do that is to do nothing. Because if we do nothing, we will guarantee that Medicare goes broke.
So, together, we can either do this together or we can have this imposed on us. I very much hope we do it together.
Senator Coburn, and I’m sorry—did he leave? I’m sorry that he’s not here, because he said something that was one of the most important comments made here today, and something that I think has gotten way too little attention. And that’s the question of those who are chronically ill.
As we analyzed Medicare, we found a startling statistic: 5 percent of Medicare beneficiaries, 5 percent, use half of all of the money. I think Paul knows this well. Five percent use 50 percent of the money. Who are they? They’re the chronically ill. People who have multiple serious conditions.
And I think Dr. Coburn was really referencing that when he talked about the need to better coordinate their care, because we are wasting massive amounts of money and getting worse health care outcomes than we could if we better coordinated their care.
What do we mean by that? A study was done with 20,000 patients. They put a care coordinator on each one of them. These are chronically ill patients. And what they found was by coordinating their care—and the first thing they did, by the way, was go into their kitchen tables, sit down, get out all their prescription drugs.
On average, they found they were taking 16. They found that by looking at them, they could eliminate eight. The result was hundreds of thousands of dollars of saving per patient and better health care outcomes.
You know, I did this with my own—my own father-in-law in his final illness. Went to his kitchen table. Didn’t know it was the final illness. Got out all his prescription drugs. Sure enough, he was taking 16.
I get on the phone to the doctor. I go down the list—and Dr. Coburn, you were out of the room. I referenced you, because you said something that really triggered a thought in my mind that I think is important—went down the list of what my father-in-law was taking, 16 prescription drugs. And I get in the line to the doctor, and he says, “Well, Kent”—and I get down to about the third one—“He shouldn’t be taking that. He shouldn’t have been taking that the last five years.”
I get a little further down the list, two drugs, and he says, “Well, Kent, he shouldn’t be taking those two drugs, they work against each other.”
I said, “Doc, how does this happen?”
He said, “Kent, it’s very simple. He’s got a heart condition. He’s got a serious lung condition. He’s got orthopedic issues. He’s got doctors for each one of those. He’s getting prescription drugs mail order; he’s getting them at the hospital pharmacy; he’s getting them down at the beach. He’s sick and confused. His wife’s sick and confused. We’ve got chaos.”
And my conclusion, after all of these hundreds of hours of hearings and meetings that Senator Grassley and Senator Baucus were part of and Senator Enzi was that indeed we do. We have a system that is characterized, especially for those people, by chaos. We can do better.
And we really don’t have a choice, because we’ve got a debt now grossed at 100 percent of the GDP, headed for 400 percent, that nobody believes is sustainable.
So I—I just pray that we find a way to come together and deal with these things seriously, because if we don’t, we will rue the day.
Here I boil down Conrad’s statement about Medicare to its essence:
What we all know is true is … Medicare is going to go broke in eight years…. Because if we do nothing, we will guarantee that Medicare goes broke.
We can either do this together or we can have this imposed on us. I very much hope we do it together.
I just pray that we find a way to come together and deal with these things seriously, because if we don’t, we will rue the day.
What is Conrad saying? He is saying that EITHER we “do it together,” meaning we do it in a bi-partisan fashion, Republicans and Democrats together, OR we will do
nothing and Medicare will go broke in eight years. EITHER bi-partisanship to pass a bill and save Medicare, OR nothing. What is missing from Conrad’s list of possibilities? Ramming through the bill by reconciliation. So, without mentioning reconciliation or attacking it, he’s saying that reconciliation is not going to happen.
And Conrad as the chairman of the Senate Budget Committee presumably would have a big say in any reconciliation effort, given that reconciliation is a method for modifying budget items.
Can anyone tell me how reconciliation can happen—on what basis do the gung-ho Democrats and liberals think reconciliation is going to happen—given Conrad’s two statements last week to the contrary?
Also, I just did a search for the key phrases in Conrad’s summit statement that I’ve discussed here. His phrases only appear in transcripts of his statement at the summit. No reporter or commentator has quoted Conrad’s statement, let alone discussed its significance.
(The Washington Post has transcripts of all the statements at the summit.)
I had sent a draft of this post to Andrew McCarthy, and he replied:
Very interesting, Larry. I want to think about this some more, because, as you say, there is a lot of interesting stuff in Conrad’s remarks. But if this were a legal case, I would say you were inferring too much from silence. I’m not saying you’re necessarily wrong about the trajectory of his thinking. But I don’t take his failure to address reconciliation one way or the other as a statement that it is not going to happen.
- end of initial entry -
Dale F. writes:
Kent Conrad has said explicitly that reconciliation can’t be used to pass health care reform. The relevant quote below is from today’s Face the Nation. Full transcript here.
CONRAD: On the question of reconciliation, I have said all year as chairman of the Budget Committee, reconciliation cannot be used to pass comprehensive health care reform. It won’t work. It won’t work because it was never designed for that kind of significant legislation. It was designed for deficit reduction. So let’s be clear.
On the major Medicare or health care reform legislation, that can’t move through reconciliation. The role for reconciliation would be very limited. It would be on side-car issues designed to improve what passed the Senate and what would have to pass the House for health care reform to move forward. So using reconciliation would not be for the main package at all.
LA replies:
Dale, thanks for this.
However, there is an ambiguity in his statements. Does he mean that there is some rule against using reconciliation for this purpose, and he must obey that rule regardless of how he feels? Does he mean that there is something inherent about reconciliation that makes it impossible to use it for that purpose? Does he mean that it could be used for this purpose, but he himself would oppose that?
Dale F. writes:
Later in the transcript he says that it will be impossible to use reconciliation, because the central provisions of the Democratic bill fail the tests of the “Byrd rule” (which I hadn’t heard of until now). Here’s the exchange in which he makes this point:
SCHIEFFER: Let me just throw this in because I’m not sure the White House has the same understanding of this that you do. Because the woman, Nancy DeParle, who is, kind of, in charge of Medicare over there at the White House—I mean, health care, over there at the White House, said this morning on “Meet the Press” she thought that an up-or-down vote would be the way to go on this.
So, obviously, she’s talking about trying to do it through reconciliation, Senator.
CONRAD: I’d say this to you, Bob. I have said all year, I am chairman of the committee in the Senate; I think I understand how reconciliation works and how it can’t work. The major package of health care reform cannot move through the reconciliation process. It will not work.
SCHIEFFER: It will not work?
CONRAD: It will not work because of the Byrd rule which says anything that doesn’t score for budget purposes has to be eliminated. That would eliminate all the delivery system reform, all the insurance market reform, all of those things the experts tell us are really the most important parts of this bill.
The only possible role that I can see for reconciliation would be make modest changes in the major package to improve affordability, to deal with what share of Medicaid expansion the federal government pays, those kinds of issues, which is the traditional role for reconciliation in health care.
LA replies:
Ok, so he’s saying that this is a rule and that they cannot get around that rule, period. But hey, the Democrats have 59 votes, they could change the rule. But probably they would need to achieve cloture to change the rule, so we (or rather the Democrats) are back where we started.
It sure seems that for all the many trial balloons that the Democrats have floated in the first 40 days of the Brownian Era, about how they had agreed on a plan and were ready to move forward, they haven’t actually sat in a room together and thrashed out a plan that they were in agreement on. Maybe, prior to meeting with the Republicans last week, Bambi should have had a Democratic summit see if it was possible to get the Democrats on the same page. Because I think they don’t know what the hell they are doing.
I feel a parody coming on:
In the second month of the Brownian era, the empire of Obama comprehended the most confused part of the earth, and the most distracted portion of mankind.
That’s from the first sentence of Gibbon’s The Decline and Fall of the Roman Empire:
In the second century of the Christian era, the empire of Rome comprehended the fairest part of the earth, and the most civilized portion of mankind.
March 1
Dale F. writes:
I did a little looking around on the web; here are some things about Kent Conrad:
Born in Bismarck, North Dakota in 1948. Orphaned at age 5 when his parents were killed in an automobile accident, raised by his grandparents. Educated at Phillips Exeter Academy, Stanford, GWU (MBA). Elected state tax commissioner at the age of 32; six years later elected to the Senate, where he has served for 24 years. Meticulous, well-organized, hard working, one of the Senate’s experts on the budget, and chairman of the powerful Budget Committee.
And then there’s Barack Obama—one of the Senate’s least experienced and least qualified members, improbably elected President, presiding over one of the most disorganized, amateurish White House operations in memory.
Now read that exchange with Bob Schieffer again:
SCHIEFFER: Let me just throw this in because I’m not sure the White House has the same understanding of this that you do. Because the woman, Nancy DeParle, who is, kind of, in charge of Medicare over there at the White House—I mean, health care, over there at the White House, said this morning on “Meet the Press” she thought that an up-or-down vote would be the way to go on this.
So, obviously, she’s talking about trying to do it through reconciliation, Senator.
CONRAD: I’d say this to you, Bob. I have said all year [the year during which my former junior colleague has been in charge at the White House], I am chairman of the committee in the Senate; I think I understand how reconciliation works and how it can’t work. The major package of health care reform cannot move through the reconciliation process. It will not work.
LA replies:
Well, perhaps you’ve provided the explanation for the Democrats’ schizophrenia on this issue. Conrad has been saying all year that reconciliation can’t be used for this purpose, while the fanatics, both inside and outside Congress, have simply been refusing to listen to him.
Which shows how appropriate is the title of this entry. Whether Conrad’s statements on the matter have been loud and clear, as on Face the Nation, or indirect and implied, as at the summit, they have gone unnoticed. The fact that reconciliation is impossible for this purpose, period, does not fit the “dominant narrative,” so it simply doesn’t register. Conrad speaks the words, the words get written down and recorded and broadcast, but it’s as if he hadn’t said them at all.
Dale F. replies:
Excellent point. There are probably a lot of smart, experienced people in DC just like Senator Conrad who are feeling a maddening sense of frustration as they try to explain to the Yes-We-Can crowd that, no, actually you can’t. “Huge dreams” (as you point out in another post) are not enough; wishing will not make it so.
Posted by Lawrence Auster at February 28, 2010 02:12 PM | Send