Health Care Reform on the Mend?

It looks there is yet another delay in the unveiling of sweeping health care reform.

The drive to remake the nation's health care system suffered yet another setback in Congress on Thursday when a pivotal group of House Democrats demanded numerous changes in legislation the leadership was drafting on a fast track.

The emerging bill "lacks a number of elements essential to preserving what works and fixing what is broken," 40 members of the Blue Dog Coalition of moderate to conservative Democrats wrote in a letter to party leaders.

To win their support, they said, any legislation would need to be much more aggressive in reining in the growth of health care.

The letter addressed to House Speaker Nancy Pelosi and Majority Leader Steny Hoyer also called for greater protections for small businesses and rural health care providers. It did not specify how much additional time the group wanted, but Rep. Mike Ross, D-Ark., said he believes no vote should take place until September.

There are several things playing out here that I've written about often. First, the Blue Dog Democrats are asserting their power as Congressional rainmakers. Second, it once again shows the problems the Democrats have in governing. There are simply far too many factions and each has its own agenda. Those agendas are difficult to bring together to create legislation. Third, and most importantly, it shows the difficulty in trying to enact the kind of sweeping health care reform the president wants.

The Blue Dogs:

On some issues, you can't tell the difference between a Blue Dog Democrat and a Conservative. They favor pay go. They're not necessarily for big government or the tax and spend policies of the leadership. The Blue Dogs, about 40 of them, can form a bloc that, voting with the Republicans, can stop any and all legislation they don't like. They all come from moderate or Conservative districts. As such, supporting big government policies is not something that voters in their districts normally go for. Since the Pelosi wing and Obama himself often agree, it is the Blue Dogs that would need to be wooed to craft all legislation. That's what's happening in this case, and they are flexing their political muscles.

The Democrat's Governance Problem:

Try and imagine the philosophical differences between Nancy Pelosi, a San Francisco liberal, and the Blue Dogs, themselves moderates. Crafting legislation in such an environment is nearly impossible. Giving way to one group means you turn another group off entirely. You are either left with no legislation, or the legislation is so watered down that it's rendered worthless a la cap and trade.

Health care will NOT pass:

This latest news is yet another sign of how difficult it will be to get health care to pass. This is one of the most complicated pieces of legislation to every be attempted. On top of this, the Democrats are loose knit coalition of members with varying agendas. The agenda for the Pelosi wing is a lot different than the agenda for the Blue Dogs. Yet, Pelosi needs almost all of her coalition to pass it. Trying to navigate through all of this is nearly impossible.