As U.S. Sen. Harry Reid tries to corral enough Democratic votes for his $848 billion health care reform bill, the Democrat from Nevada may find solace in the words of Mark Twain. When the writer was once asked if he belonged to an organized political party in the United States, he replied "I don't belong to any organized political party. I'm a Democrat."

But holding together the diverse, cantankerous and seemingly new-health-care-idea-a-day Senate Democratic caucus to pass the bill isn't the Senate Majority Leader's only challenge. Reid will probably have to recruit one or two Republicans to achieve his goal. The U.S. House of Representatives narrowly approved (220-215) its own version of a health reform bill last month.
Solution Agreeable to a Republican, or Two

Gaining one or two Republican votes is now arguably Reid's No. 1 task. He'll have to devise a solution that's appealing to Republicans concerned about an expansion of the role of government, but one that's still attractive to Democrats who want every citizen to be able to obtain health insurance at an affordable price.

Reid's best chance may be to incorporate a variant of Sen. Olympia Snowe's "trigger option." The Republican from Maine has proposed that a so-called public option would only take effect if private insurers did not achieve the goal of universal health care insurance by a given year.

One possible variant of Snowe's trigger: a public agency or possibly a private, non-profit organization, funded by Congress, that would enter health insurance markets in those states whose private insurers fail to cover nearly everyone after 2012 or 2014.

For example, if State A has three insurance companies and they failed to implement reforms that resulted in 95% coverage by 2012 or 2014, the agency would be allowed to offer low-cost coverage in the state. There would be federal subsidies to help lower-income individuals and families pay for health care premiums charged by the agency. Such a program may be receptive to Snowe without losing the support of key, liberal Democratic senators essential to heath care reform's passage.

Give Up on Lieberman?


A second, key Reid tactic? Abandon all efforts to recruit Sen. Joe Lieberman, I-Connecticut, a former Democrat who frequently votes with the Democrats. Frequently, that is, but not on this breakthrough public policy legislation, if it contains a public option. The reason? Lieberman's home state contains the city of Hartford, which, as most investors know, is the insurance capital of the world.

The insurance industry doesn't want a public option, and Lieberman, who's received campaign contributions from the insurance lobby, doesn't either -- surprise, surprise. Lieberman said he will oppose any public option, so nix one Senate vote from the Democrats' "Sweet 60." Reid can more efficiently deploy his political capital by trying to recruit another Republican or two in addition to Snowe.

Preferably, they should be Republicans not up for election in 2010 or 2012, because Rush Limbaugh and Glenn Beck will portray any Republican who votes for health care reform as making a pact with Stalin. And it will most assuredly lower each senator's public approval rating.

Offering Incentives for Support


Finally, Reid should be able to recruit the support of three other uncommitted senators on the Democratic side, U.S. Senators Ben Nelson, D-Nebraska; Mary Landrieu, D-Louisiana; and Blanche Lincoln, D-Arkansas. Senate health care bill language that lets insurance companies cover abortions but that also requires officials to segregate public and private funds, with only private funds used for abortions, should be acceptable to Nelson.

Landrieu has a bigger stake in the bill now that Reid has added $300 million in Medicaid funding for Louisiana to the proposed legislation. And Lincoln? Reid will have to offer more incentives to cultivate her support, given that she faces a difficult election in 2010 -- in a two-party competitive state. The calculation here is that Lincoln will ultimately support the bill.

Provided Reid is successful regarding all of the above, he'll have at least the 60-vote minimum needed to avoid a filibuster, and a Senate vote on the bill could occur later this month, although it may not occur until after the new year.

A passed bill would then go to a House-Senate conference committee to work out differences with the House's legislation. Talk about horse-trading and meetings of consequence: in that room about $2.2 trillion will be at stake.

Financial Editor Joseph Lazzaro is writing a book on the U.S. Presidency and the U.S. economy.

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