I'm disappointed by this post from Steve B, who, understandably, is angry that I don't pay more attention to HR-676, the single-payer health care bill in Congress, but decides to chalk that up to "of inside-the-beltway corporate tunnel vision" and the sort of ideological capture that comes from reporting on the occasional insurance industry conference. Call it creeping Sirota-ism. The problem is, it also obscures the actual obstacles to health reform. There's a very simple reason I spend more time reporting on the Wyden bill and the presidential offerings than HR-676: HR-676 isn't going to pass. Not in any set of circumstances we can currently imagine, or any congressional make-up we can currently expect. Steve talks a lot about how it's got broad cosponsorship from progressives in the House, but health care lives or dies in the Senate. Which is why the problem that animates my work has changed. It used to be why the French health care system was better than the American incarnation, because frankly, I feel most sure of myself on that ground, and it's something I enjoy writing about. But over time, I realized that though that sort of commentary was fun for me, it was beside the point when it came to health reform. There, exactly one question matters: How do you get to 60 in the Senate? The reason I don't spend much time on HR-676 is that one has ever explained to me how you do it with that bill. Forget the 4-6 Republicans you'd need even in the unlikely case of full Democratic unanimity after an election in which Democrats gain 3-5 Senate seats. First tell me how you get 16 of the following 16 Democratic moderate-to-conservative politicians onto a single payer health care plan: Mark Pryor, Blanche Lincoln, Dianne Feinstein, Ken Salazar, Joe Lieberman, Tom Carper, Max Baucus, Bill Nelson, Ben Nelson, Evan Bayh, Mary Landrieu, Jeff Bingaman, Kent Conrad, Robert Byrd, Tim Johnson, and probably Mark Warner. Then, after you do that, tell me how you get three of the following three "dealmaker" Republicans: Olympia Snowe, Susan Collins, and Arlen Specter. And then tell me how you get two or so of the following five dealmaker economic conservatives (cause you're not going to get the straight party hacks): Bob Bennett, Chuck Grassley, Lamar Alexander, John Sununu, and George Voinovich.
