During yesterday’s interview with ABC News, President Obama admitted that the process of passing health care reform had not been as transparent as he would have liked. “Part of what I had campaigned on was changing how Washington works, opening up transparency and I think it is — I think the health care debate as it unfolded legitimately raised concerns not just among my opponents, but also amongst supporters that we just don’t know what’s going on,” Obama said. “And it’s an ugly process and it looks like there are a bunch of back room deals”:

OBAMA: Now I think it’s my responsibility and I’ll be speaking to this at the State of the Union, to own up to the fact that the process didn’t run the way I ideally would like it to and that we have to move forward in a way that recaptures that sense of opening things up more.
SAWYER: A lot of people think you must say at the end of the day, this is not who I was in 2008, these deals with Nebraska, with Florida…
OBAMA: Let’s hold on a second, Diane. I mean, I think that this gets into a big mush. So let’s just clarify. I didn’t make a bunch of deals. There is a legislative process that is taking place in Congress and I am happy to own up to the fact that I have not changed Congress and how it operates the way I would have liked. So that’s point number one.

Obama is right to recognize that the process of forcing 60 Democrats to support something as ambitious as comprehensive health care reform required some serious arm twisting. But Washington deal-making isn’t the only factor behind the popular dissatisfaction with the “process”; Republican obstructionism and repeated Democratic concessions deserve at least some of the credit.

In the Senate, Democrats wasted a lot of time reaching out to the GOP and conservative Democrats. They watered down their legislation — removed the most popular elements of reform — and when Republican support still failed to materialize, they found themselves at the mercy of the Democratic hold-outs. Members like Ben Nelson, could not be convinced to vote for reform for reform’s sake and were brought on board with extra Medicaid funding. This drawn out process of missed deadlines and back room negotiations in the majority leader’s office tugged on the public’s patience and did more to dilute reform than improve it.

The process wasn’t pretty, but it was a far cry from the kind of arm twisting the GOP engaged in during their push to pass Medicare Part D in 2003. Democrats held months of committee mark-ups and debate. They provided Republicans with ample opportunity to contribute to the legislation, allowed Max Baucus to hold nine months of bipartisan negotiations and included Republican-friendly provisions in their bills. But Republicans undermined this process. House Republicans shouted down Democrats as they tried to introduce the measure for debate, Republican Senators tried to prevent health care reform from reaching the Senate floor, forced the clerk to read thousands of pages of legislative language, routinely lied about the bills, and introduced a stream of message amendments designed to derail reform.

On the whole, the process produced a fairly conservative piece of legislation in a moderately transparent manner. The GOP’s success in painting the bill and the debate as a left-wing power grab while they got away with talking about ‘death panels’ and successfully obstructing “the legislative process” every step of the way, says more about the GOP’s communication efforts than it does about Ben Nelson’s Cornhusker kickback.

Earlier today, The Plum Line’s Greg Sargent reported that “[t]he GOP Senate leadership has privately settled on a strategy to derail health reform if Dems try to pass the Senate bill with a fix through reconciliation.” Republicans are promising to “[u]nleash an endless stream of amendments designed to stall for time and to force Dems to take untenable votes.” “There is no way to limit the number of amendments that are voted on. You can’t close debate. Democrats will have to vote on every politically perilous amendment that you can possibly think of,” the aid said.

But at least one former Senate parliamentarian is calling the strategy “patently absurd.” According to Robert Dove, who served as Senate parliamentarian until 2001, “In the Senate, the motion to go to that [reconciliation] bill is not debatable, and the bill itself is only debatable for 20 hours. All amendments must be germane.” “If there are differences between the two houses in their reconciliation bills, then you would either work out those differences through a conference, or through amendments as they bounce back and forth,” Dove told Lester Feder, who has been covering health care policy for The Nation and the O’Neill institute’s health law blog.

Dove also revealed that Vice President Joe Biden, not the Senate parliamentarian, is “the ultimate decider” of “what can stay in under the rules“:

But no vice president has tried to play that role in reconciliation. We haven’t had vice presidents that have tried to play important procedural roles for a very long time. The last one was Nelson Rockefeller, in 1975, and before him Hubert Humphrey, in the 1960’s. But no vice president has ever tried to play a role in reconciliation. Basically, since Walter Mondale was vice president, they have kind of been co-opted by the president and given an office down in the West Wing. Their interest in playing Senate politics has become attenuated. That has left the Senate parliamentarian in an extremely powerful position.

Dove stressed that “reconciliation was never designed for something like health care” and pointed out that “It’s designed for deficit reduction, and therefore everything in a reconciliation bill must contribute to deficit reduction.” Of course, in 2001, Republicans broke from tradition and used the reconciliation process to pass President Bush’s budget busting tax cuts for the rich. As a new report from the Center on Budget and Policy Priorities points out, reconciliation has been used to pass major pieces of legislation in the past and, “[s]ince rising health costs are the single largest reason for projected long-run deficits, it is appropriate that health reform be considered through the reconciliation process.”

Reports are suggesting that Senate and House negotiators are rallying behind a strategy that would require the House to pass the Senate health care bill alongside a reconciliation package of fixes that would improve the bill and satisfy progressive lawmakers. The reconciliation package would originate in the House and require just 51 votes to pass the Senate. Congressional aides are hoping to use the measure as a vehicle to remove the “Cornhusker Kickback” from the Senate bill, close the Medicare Part D doughnut hole, include higher subsidies, cut deeper into Medicare Advantage, and preserve the deal with labor unions to delay a tax on expensive insurance plans and increase the thresholds for the tax.

But speaking at the National Press Club today, House Majority Leader Steny Hoyer (D-MD) reiterated that Congress has not settled on a course of action and said that it would be possible to pass a scaled-down health care reform bill. Hoyer suggested that Congress could offer a “more limited exchange,” encourage small businesses to pool risk, enact insurance reform, eliminate the insurer exemption from anti-trust laws and institute “smaller” affordability measures:

Much of the bill is an integrated whole. That is to say, to accomplish the objectives you need to both include many more people in coverage under insurance, spread the risk, bring costs down for individuals. At the same time that you affect reforms…That is an integrated whole that works as a whole. It’s more difficult when you take out individual items. However clearly an exchange could be created, a more limited exchange. There is I think broad based belief that we need to empower small businesses to come together to create larger markets, not small groups but large groups so they’ll get better prices and bring them down…There are obviously within affordability smaller things you can do, but I think there are somethings we can work together on…It is difficult to take small pieces and accomplish the objective that you want to accomplish. But it is not impossible and insurance reforms are popular…

Watch it:

Meanwhile, TPMDC is reporting that “House and Senate leaders will huddle today at 4 p.m., House Democratic leadership will meet at 5 p.m. and then House leadership will hold a caucus meeting with rank-and-file members at 7 p.m.” to “get a sense of where members stand after spending three days sounding out constituents.” “Nothing is certain; rank-and-file Democrats are all over the map with some members opposing comprehensive reform outright, and others resistant to passing the Senate bill and having lost faith that the Senate will be able to pass a separate bill. A House leadership aide tells TPMDC that members will be presented with “three ways forward and that’s it. And none of them are really that good.”

“The overwhelming majority of our caucus wants to pass a health care bill,” the aide told TPMDC. “They can’t make a decision yet because they are still trying to work through the parliamentary procedures that are at our disposal.”

This morning, Sen. Evan Bayh (D-IN) appeared on MSNBC’s Morning Joe to endorse President Obama’s new proposal to institute a discretionary spending freeze for two years. “The freeze would affect $447 billion in spending, or 17% of the total federal budget,” but it would “exempt security-related budgets for the Pentagon, foreign aid, the Veterans Administration and homeland security, as well as the entitlement programs that make up the biggest and fastest-growing part of the federal budget: Medicare, Medicaid and Social Security.”

Bayh supported Obama’s new approach but criticized him for spending too much time on health care reform. “We can have progressive government in this country, but you’ve got to take it a step at a time. You’ve got to be in touch with the times you’re in,” he said:

And going with the large bill in the middle of the worst recession since the 1930s and a major new expenditure at a time we were running a $30 trillion deficit just didn’t resonate real well. Monday morning quarterbacking is not something I’m into, but you’ve gt to learn from these sorts of things, and going forward let’s do what we can in a common sense way.

Watch it:

Bayh is wrong to suggest that health care reform is antithetical to reducing the nation’s $1.4 trillion deficit. After all, according to the Congressional Budget Office (CBO) the Senate health care bill would reduce the deficit by $132 billion over 10 years (or up to $409 billion over 10 years according to a Commonwealth study) and lower Medicare spending per beneficiary from 8% growth rate to 6% growth rate. As Christina Romer, chairwoman of the Council of Economic Advisers, explained in December, reform would slow the growth rate of cost by 1 percentage point per year” and have “a dramatic impact on where we are relative to otherwise we would have been.”

Health care reform would compliment the administration’s new focus on deficit reduction by slowing the fastest growing part of the deficit. In yesterday’s interview with Diane Sawyer, Obama reiterated his commitment to “keep on pushing” “on the big issues” and said, “We are going to have to be serious about the deficit in ways that we haven’t been before.” Obama didn’t say if he would urge Congress to pass comprehensive health care reform as party of his effort “to be serious about the deficit,” but taking a strong position on reform certainly demonstrate that he is “not backing off the need for us to tackle these big problems in a serious way.” As he told Congress during his address in February, “Put simply, our health care problem is our deficit problem. Nothing else even comes close. Nothing else.”