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Health-Care Overhaul 2010

Tracking the national health-care debate | More »

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Like Sausage-Making, Reforming Health Care Is a Messy Business

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The liberals caucused. The Congressional Black Caucus voiced objections. President Obama made calls to keep people on board. What is unclear at week's end, with members about to go home, is whether the middle ground is spacious enough to hold a majority of the House.

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"There's nothing orderly about this process. It's chaos that sometimes is managed, sometimes is not. But it's the way the legislative process works," said Rep. Peter Welch (D-Vt.), who sits on the Energy and Commerce Committee.

It's the perfect environment for turf battles.

"We did not spend 60 hours, 300 amendments, 23 sessions, to roll over," Sen. Christopher J. Dodd (D-Conn.) said Wednesday. He was not talking about some Republican political gambit, but rather about a compromise being negotiated by a fellow Democrat, Senate Finance Committee Chairman Max Baucus (Mont.).

Baucus, two other Democrats and three Republicans spent much of the week huddled in Baucus's office, trying to figure out what it would take to bring a few Republican votes into the fold. But a health-care bill had already been approved by Dodd and his fellow Democrats on the Senate Health, Education, Labor and Pension Committee, led by the ailing Sen. Edward M. Kennedy (D-Mass.). Dodd, in effect, was telling Baucus not to assume that Finance was calling the shots.

Much of the drama the past few days has centered on the House side, and particularly on the Energy and Commerce Committee led by Rep. Henry A. Waxman (D-Calif.). At one point, Rep. Charles B. Rangel (D-N.Y.), chairman of the Ways and Means Committee, which passed its version of the bill, popped into Waxman's "mark-up" of H.R. 3200, taking a prominent seat in the audience, as if to remind everyone of the high stakes.

"If they don't function, then the two legs of the three-legged stool can't stand on their own," Rangel said outside the room, referring to the three House committees.

In recent months, there has been much GOP criticism of Democrats for passing legislation that some lawmakers have not read. But the bills are not exactly beach reading. They are legal documents crammed with legislative coding, sentence fragments and assorted gibberish that modifies laws already on the books somewhere. To really understand what a bill says, you'd need to have the existing laws memorized.

Here's a fairly typical passage from H.R. 3200:

Section 1834(a)(7)(A)(iii) of the Social Security Act (42 U.S.C. 1395m(a)(7)(A)(iii)) is amended

(1) in the heading, by inserting 'CERTAIN COMPLEX REHABILITATIVE' after 'OPTION FOR'; and

(2) by striking 'power-driven wheelchair' and inserting 'complex rehabilitative power-driven wheelchair recognized by the Secretary as classified within group 3 or higher.'

And that goes on for a thousand pages.

The frenetic nature of the Capitol this week was the result of a strategic decision by the Obama administration to let lawmakers do most of the heavy lifting on health-care reform. Obama did not want a repeat of "Hillarycare," the ill-fated proposal during the first term of President Clinton. Then-first lady Hillary Rodham Clinton put together that plan and presented it to Congress for essentially an up-or-down vote.

"I've never seen anything like this. Hillarycare, we got one very long and impressive lecture by Hillary," said Rep. Peter A. Defazio (D-Ore.).

Before either chamber can vote on a bill, the committee chairmen, along with congressional leaders, will have to merge the disparate versions into a single bill to bring to the floor. Whatever is passed by the two chambers must then be reconciled again in "conference."

The conference committee would then produce a final bill that would have to be voted on by each chamber. If passed, the bill would go to the president. If he found it acceptable, he would sign it.

And, simple as that, it would be the law of the land.


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