by Roger Stark, MD
The much anticipated health care summit was held recently in Washington, D.C. President Obama controlled the microphone and served as moderator, timekeeper, and chief negotiator with the Republicans. It became clear by hour two of the almost seven hour meeting that very little compromise was possible.

Both Democrats and Republicans held firm to their respective beliefs and the entire process devolved into presentations of talking points rather than actual negotiations. So what happens now? There are really only four possibilities - A through D.

Possibility A would be passage of the existing legislation. To do this, the House and Senate would need to agree on a compromise that combines both of their respective bills. The House and Senate versions of health care reform are just different enough that both Houses would need to make major concessions. This is not likely. Even if one bill could be fashioned out of the existing legislation, it has no chance of passing the Senate with sixty votes. After the election of Senator Scott Brown in Massachusetts, the Democrats lost their super majority of sixty votes in the Senate.

Possibility B would be to use a parliamentary process called reconciliation to pass the existing Senate bill. There are a number of steps to make this work, however. First, the House would need to accept the Senate bill as written. This is problematic since the House and Senate bills have significant differences, particularly with regard to abortion and the public option. Also, the House passed its bill last November, in spite of the major outrage the country has shown toward this massive reform legislation. Congressmen now understand the nation's serious concerns and all 435 of the members are up for re-election this November.

If the House passes the Senate bill as written, the bill would still need to be amended. Reconciliation is used only for budget legislation and the benefit parts of the Senate bill would need to be passed in an amendment form. Only fifty-one votes are needed for this passage in the Senate, but getting a majority of votes in the House is problematic - again because of the concerns of Americans today. Passage of major health care reform using reconciliation would be strictly partisan and enacting a major entitlement program this way is unprecedented in this country. It would show that the Democrats dont care what the American public thinks and dont want to work in a bipartisan fashion.

Possibility C would be to abandon both the House and Senate bills and start over. This is what the majority of Americans want (53-61% in the last three polls). Republicans have offered well over 200 amendments and over thirty of their own health care bills in the past year - none of which received any consideration by the Democrats. The American public demands bipartisanship to reform 17% of our economy and starting with a clean slate would be the most logical choice at this point.

Possibility D is the most likely outcome. This would be some combination of health insurance reform (i.e. more regulation for the insurance industry), an expansion of Medicaid, and an expansion of the children's' health insurance program, S-CHIP. These programs are already in place and broadening their scope would require much less political controversy. Both parties have supported these programs in the past and both sides could claim victory in the health care debate.

Possibility D would expand the government's role in our health care, but only in an incremental fashion. Rather than real reform that curtailed costs and gave patients more control over their health care dollars and decisions, an expansion of existing government programs such as outlined in D would be yet another step in the wrong direction.

It would place more people under the control of government bureaucrats and would further burden already-unsustainable entitlement programs. Dr. Roger Stark is a retired surgeon and a health care policy analyst with Washington Policy Center, a non-partisan independent policy research organization in Washington state.

For more information contact WPC at 206-937-9691 or washingtonpolicy.org.