In November 2008, the Senator Max Baucus (D-MT) ,chair of the Senate Finance Committee, released a 98 page white paper. This was a crucial precursor to what eventually became the ACA. Some of the white paper made it into the bill. But that was not why this white paper was important. Instead, it was the last major Democratic choke-point holder laying out what he was willing to do and not do with healthcare reform. With this white paper, all the major Democratic Party actors who held explicit or implicit veto positions were at least onboard with a rigorous exploration of passing an individual market, subsidized and standardized and a major expansion of Medicaid eligibility. There was a pathway forward.
Fast forward to this week. Senator Warren released a Medicare for All plan. It is a plan that won’t get sixty votes in the Senate. It is a plan that will need the approval of Senators Manchin and Sinema. It is a plan that will need 218 votes in the House. In addition to the 218 votes it needs in the House, it also needs a floor slot and committee time. That is problematic.
We talk some about how difficult it would be get a maximalist left-wing agenda through a narrowly divided Senate.
We haven’t talked at all about how difficult it would be to get it through the House, especially with a not especially cooperative Speaker. https://t.co/zPLwuFss58
— Bill Scher (@billscher) November 2, 2019
Significant elements of the critical pathway to enactment are screaming that they are not interested in another run up the hill of health finance and delivery system transformation. Senators Manchine and Sinema are veto players. Speaker Pelosi is a veto player. They aren’t onboard with the vision that Senator Warren is outlining. This is a major problem if you support Senator Warren (and/or Senator Sander) and her health care plans. Even if she wins, enactment will be extremely unlikely if the rest of the veto players are indifferent at best to it.