Reid's recipe for getting health care deal done

WASHINGTON - Of the Democratic senators who have set out to transform the nation's health care system, one of the least likely is Majority Leader Harry Reid, whose legislative priorities typically fall more toward protecting the interests of his native Nevada.

Despite the prospect of a potentially tough 2010 reelection fight, the combative Democratic leader has assumed full ownership of a 2,074-page bill that would cost $848 billion over 10 years and institute the most far-reaching changes to the system in generations. As the Senate debate unfolds on the chamber floor, Reid has remained burrowed in his office, looking past the daily political drama playing out and, as he said recently, "getting my deals done."

When the debate over the economic stimulus program entered its final stretch earlier this year, Reid called on President Obama to act as salesman in chief for the legislation, closing every deal with high-voltage White House charm. Ten months later, as the president juggles a full slate of challenges, Reid has opted to confine health care negotiations largely to the Senate chamber and his adjoining suite of offices, urging colleagues to negotiate compromises among themselves and to bring their concerns directly to him.

For Reid, success means emerging from the marathon debate with a bill backed by the 60 senators needed for final passage, something he hopes will come to pass as soon as late next week. Democrats' concerns will be addressed in individual amendments, but many others will be crowded into an omnibus "manager's amendment," a package Reid is expected to offer at the end of the process that will include many of the perks and fixes that members of his caucus are requesting.

As a longtime member of the Senate Appropriations Committee, where crafting bills is done one favor at a time, Reid is hardly a stranger to deal-making. But he has been slow to tip his hand as he confronts uprisings from the left and right on major flashpoints such as abortion coverage and a controversial public insurance plan.

"We're going to do our very utmost to complete health care before the end of the year," Reid, whose talents run more to vote-counting than oratory, told reporters on Thursday. The end is coming "soon," he said, whenever "we work out all the problems we have in the legislation."

Reid's wait-and-see approach has frustrated some liberal Democrats, who have grown impatient with the idea that the debate over a potentially historic health care overhaul has essentially been hijacked by a handful of moderates and fear that Reid is leaving too much to chance. But it appears to be yielding results on the public option, for months the major issue dividing moderate and progressive Democrats.

Four Democrats have announced that they would oppose the Senate bill as currently written, objecting to the inclusion of a public option. Reid had initially resisted including a government plan in the bill, but reversed himself after a revolt by his liberal colleagues, although with an opt-out clause for states that would not want to participate.

At Reid's urging, various senators have begun exploring alternatives for a public plan that could pass muster with the centrists, and some lawmakers are starting to examine other ways to achieve the same goals of greater competition, better coverage and lower prices. But as the negotiations unfold, liberal Democrats say they are growing increasingly realistic in their expectations.

The essence of Reid's calculus is to make sure that the cost of locking in one vote is not driving away another. Almost every Democratic senator has requested a special favor or exemption of one form or another, senior Senate aides said.

And Reid already has established a dangerous precedent, by dangling $300 million in Medicaid funding for Louisiana to win Landrieu's support for bringing the bill to the Senate floor. Months earlier, Reid had carved out his own Medicaid exemption for Nevada. One addition he made to the Senate bill, an increase in the Medicare payroll tax for high earners, has raised concerns with Sen. Olympia Snowe of Maine, the only Republican who has been at least somewhat supportive of Democratic reform efforts, who cited its potential to harm small businesses.

Two pending amendments related to Medicare drug benefits are potentially worrisome to Democratic leaders. A package of small-business incentives and protections that Lincoln and Landrieu are expected to offer could secure their votes for the legislation - but may come with a high cost.

"I'd have to say the odds are, if you want to improve this package, a manager's amendment is gaining ground," said Sen. Kent Conrad, D-N.D. "Clearly, Republicans are trying to slow-walk this thing right over the cliff."