Health care's last battle

After months of debate and demagoguery by the president, it all comes down to next week.

What's going on? The final push for Obamacare is about to begin. It starts on Monday, when the House Budget Committee will insert reconciliation instructions into the November House health care bill. By late Monday/early Tuesday, Budget will pass this bill and send it to the House Rules Committee, where Pelosi will change the language so that it matches the Senate bill. This is the final compromise legislation that may come to a vote on the House floor within weeks. "They're creating the shell," says Rep. Paul Ryan of Wisconsin.

Why move ahead when the votes aren't there? Pelosi hopes that launching the process will create enough momentum to flip Democrats her way. The clock is ticking. The speaker has two weeks before Congress breaks for Easter Recess. And the recess could kill off health care reform, since many of the wavering Democrats will get an earful from their constituents when they return home. Republicans expect Democrats to lose votes over the break.

This is health care harakiri and Pelosi has to know it. Yesterday the Senate parliamentarian ruled that the president must sign the Senate bill before any changes can be made. With their reconciliation sidecar derailed, dozens of Blue Dog House Democrats will have to vote on a bill larded up with wildly unpopular deals like the Cornhusker Kickback. The latest whip count by the progressive blog FireDogLake has 189 aye votes, 202 nay votes, and the rest undecided. With the public as outraged as they are, it's unlikely very many, if any, of those reps will swing yes. Pelosi is already facing an unlikely alliance of pro-choice Democrats, Hispanic Democrats, a couple of progressives, Blue Dogs, and unified Republicans. The only other solution is if Pelosi has one last procedural trick up her sleeve, but at this point it's hard to imagine what she could do.

Meanwhile Obama is barnstorming around the country trying to close the deal, but it isn't working. Last week Obama gave speeches in Pennsylvania and Missouri, but vulnerable Democratic congressmen refused to show up. This debate has raged for a year and the expenditure of political capital has been great. Next week the President will discover whether it was capital well spent.