While headlines talk about a "fight" over the confirmation of Judge Sonia Sotomayor for the Supreme Court that may never develop, a much bigger battle is about to break out over President Obama's No. 1 domestic priority, health care.
Sotomayor is a cinch to win approval for the bench, but no one can tell you with any certainty what form the promised overhaul of the health-care system will take — or whether it will pass. We're soon going to find out.
House Majority Leader Steny Hoyer announced last week that the Democrats' goal is to get both the energy-climate control bill and health-care reform through the House before the summer recess begins in early August.
That is an incredibly ambitious schedule. The energy bill has at least been through its parent committee and has been available for examination for several weeks. But there is no health-care bill as of yet, and it is almost mind-boggling to imagine that a measure that would restructure one-sixth of the American economy and alter the relations among patients, doctors, hospitals, insurers and businesses could be whipped into shape and passed in two months.
But Hoyer said that the staffs of the three House committees that share jurisdiction over health issues have been working for months on the project. And he notes that Obama is eager to exploit his current popularity to build momentum.
The interest groups on all sides of this fight are taking the accelerated timetable seriously. On Thursday, a group calling itself Conservatives for Patients' Rights began a $1.2 million cable TV ad campaign, warning that "some in Congress" seek a "massive government-run insurance plan" that would leave "government in control of your health care."
This weekend, an offshoot of the Democratic National Committee called Organizing for America is sponsoring local gatherings aimed at building grass-roots support for the still-unfinished Obama plan.
Because Congress has passed bill after bill on Obama's wish list and because Democrats hold overwhelming majorities in both the House and Senate, some may think there can be no repetition of the fiasco of 1993-94, when Bill and Hillary Clinton saw their effort at health-care reform die without a whimper.
Insiders know better. Last week, I went to see the four top officials of the National Coalition on Health Care, perhaps the broadest consortium in the field, including labor, religious, professional and medical groups and a smattering of businesses. It has long advocated the kind of comprehensive overhaul of health care that Obama aims to achieve.
These advocates applaud administration efforts to engage the players in the insurance, hospital and pharmaceutical industries in their talks — and the willingness of those groups to "stay at the table."
But once there is specific legislation, they say, each of these groups will start bargaining hard to protect its own interests. And some of them — local hospitals, for example — have real clout with members of Congress.
Moreover, they point out, the Democratic majorities will almost certainly splinter over the provisions of any health-care plan. Many Democrats are frustrated that Obama has ruled out a single-payer, Medicare-for-all approach, and they are insisting that a full-fledged government-sponsored plan be on the menu for those getting insurance for the first time.
But last week, the Blue Dogs, the caucus of conservative House Democrats, declared its opposition to any such government plan unless private insurers fail to offer the options needed by the currently uninsured.
The Blue Dogs claim 51 members, and by some calculations Obama would need the votes of two-thirds of them to pass a bill in the House without Republican support. And so far, there has been little outreach to the GOP.
To win over the Blue Dogs and any possible Republicans, Obama will have to convince them that his cost-cutting measures are realistic. But the arbiter of that will be the independent Congressional Budget Office, which historically has cast a skeptical eye on claims of long-term savings from any changes in the health-care system.
Obama will have to carry much of the burden of advocacy himself — if outside events don't intrude, as they did on Bill Clinton. The president has shown his willingness to bargain, signaling, for example, that he would now consider taxing some employer-provided benefits, an approach he denounced when John McCain endorsed it during the campaign.
But it will take much more than that to win what promises to be an epic struggle.
