The Corner

The Doc-Fix Vote

Conversations on the Hill this afternoon suggest Harry Reid has done himself some damage with the failed vote on the fix to the Medicare doctor payment formula. He lost significantly more Democrats than he expected, and seemed to lose control of what was in essence the first health care reform vote on the Senate floor.

The Democrats are now arguing that they knew they would lose this vote (though not even Reid is arguing he knew he would lose this badly) but wanted to bring it up so that Republicans could not use the doc-fix issue as a killer amendment on the actual health-care bill later this year — forcing the Democrats to either vote against it or lose their deficit-neutral CBO score. The idea is that anyone who voted against this bill wouldn’t vote for an amendment later to do the same thing, so this takes such an amendment off the table. If they really believe this, then the Democrats are clearly not prepared for the floor fight to come on health-care reform, but I suspect it’s just cover for an embarrassing surprise on the floor.

The problem for Reid is more than substantive — more than unhappy doctors and an unhappy AMA. The biggest problem is the danger of losing the confidence of his Democratic senators. Passing health-care reform remains an extremely difficult challenge: There are two Senate bills, with very significant substantive differences between them, which need to be combined, voted on, then merged with an even more different House bill, and voted on again. Each of these votes would require the support of just about every (if not indeed every single) Senate Democrat, and each would be a very tough vote for one or another group in their caucus. It is an exercise in serial needle-threading that will call for an extraordinary degree of discipline by the Senate Democrats — a group not known for discipline. To work, it will require Reid to pressure nervous members, strike multiple precarious compromises, and hold it all together, which will require him to command a great deal of authority and confidence among his members. None of them wants to be left out in the cold having taken a tough vote on a very unpopular bill that still ends up going nowhere. Today’s vote showed these senators a leader unsure of himself, lacking an accurate vote count, and surprised by developments on the Senate floor — embarrassed and embarrassing. This is not what the Democrats need in the buildup to a very tense and complicated legislative maneuver.

This is a big part of why many on the Hill remain unpersuaded that the Democrats can pass something like Obamacare this year. Maybe Lyndon Johnson could pull off what they need to pull off in the next month or so. But Harry Reid is no Lyndon Johnson.

Yuval Levin is the director of social, cultural, and constitutional studies at the American Enterprise Institute and the editor of National Affairs.

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