Summer's biggest battle will be over health care reform

While headlines talk about a fight over confirming Judge Sonia Sotomayor for the Supreme Court that may never develop, a much bigger battle is about to break out over President Obama's No. 1 domestic priority, health care.

Sotomayor is a cinch to win approval for the bench, but no one can tell you with any certainty what form the promised overhaul of the health care system will take - or whether it will pass. We're soon going to find out.

House Majority Leader Steny Hoyer announced last week that the Democrats' goal is to get both the energy-climate control bill and health-care reform through the House before the summer recess begins on Aug. 7.

That is an incredibly ambitious schedule. The energy bill has at least been through its parent committee. But there is no health-care bill yet, and it is almost mind-boggling that a measure which would restructure one-sixth of the American economy and alter the relations among patients, doctors, hospitals, insurers and businesses could be whipped into shape and passed in two months.

But Hoyer said staffs of three House committees have been working for months. And he notes that Obama is eager to exploit his current popularity to build momentum.

Interest groups on all sides are taking the accelerated timetable seriously. Last Thursday, a group calling itself Conservatives for Patients' Rights began a $1.2 million cable TV ad campaign, warning that "some in Congress" seek a "massive government-run insurance plan" that would leave "government in control of your health care."

This weekend, an offshoot of the Democratic National Committee, called Organizing for America, will sponsor local gatherings aimed at building grass-roots support.

Because Congress has passed bill after bill on Obama's wish list and because Democrats hold overwhelming majorities in both the House and Senate, some may think there can be no repetition of the fiasco of 1993-94, when Bill and Hillary Clinton saw their effort die without a whimper.

Insiders know better. Last week, I went to see the four top officials of the National Coalition on Health Care. It has long advocated the kind of overhaul that Obama seeks.

These advocates applaud efforts to engage the insurance, hospital and pharmaceutical industries in their talks - and the willingness of those groups to "stay at the table."

But once there is specific legislation, they say, each will start bargaining hard. And some - local hospitals, for example - have real clout with members of Congress.

Moreover, they point out, the Democratic majorities will almost certainly splinter. Many are frustrated that Obama ruled out a single-payer, Medicare-for-all approach, and insist that a full-fledged government-sponsored plan be on the menu for those getting insurance for the first time.

But last week, the "Blue Dogs," the caucus of conservative House Democrats, declared its opposition to such a plan.

The Blue Dogs claim 51 members and by some calculations, Obama would need the votes of two-thirds of them to pass a bill in the House without Republican support.

To win over the Blue Dogs and any Republicans, Obama will have to show his cost-cutting measures are realistic. The arbiter of that will be the independent Congressional Budget Office, which has cast a skeptical eye on claims of long-term savings from changes in the health-care system.

Obama will have to carry much of the burden of advocacy himself. The president has shown his willingness to bargain, signaling, for example, that he would consider taxing some employer-provided benefits, an approach he denounced when John McCain endorsed it. But it will take much more than that to win what promises to be an epic struggle.

© 2009, Washington Post Writers Group