Health Center Federal Policy

Legislative Sausage-Making in Action

By John Sawyer

Two quotes come to mind as the legislative wrangling over health care reform hits a fever pitch this week:

  • the first, from a wise friend of mine: “happiness is about getting 80% of what you want, and life is about understanding which 20% is negotiable.”
  • the second, from Otto Von Bismarck, is that “Laws are like sausages. It’s better not to see them being made.”

As they continue negotiating the myriad complexities of health care reform legislation this week, President Obama and Congressional leaders are learning both of these lessons the hard way.

While there’s little doubt that these negotiations are some of the most intense in years, for those of us who spend our time in regular, close-up examination of the legislative process, it’s not an unfamiliar sight.  The gut feeling that “everything’s coming apart at the seams” is a frequent, some would say necessary, precursor to “everything’s coming together.”  Legislating is about backroom deals among hard-working people representing very different interests.  The difference this time, in addition to historically high stakes, is that the world has started paying attention.

Very close attention.  CNN reporters with cameras are staking out hearing rooms in the Dirksen building, and startled-looking Senators emerge, make an offhand comment, and the prevailing story changes three or four times a day.  No fewer than five “insider” publications (Roll Call, CQ and the like) publish dozens of stories a day on the process alone.  The truth is Congressional deliberation was not designed to fit into the 24-hour cable news/internet cycle, and rather than negotiate with each other, Members are now negotiating with the public on a minute-by-minute basis.  Bismarck would’ve been appalled at the transparency.

The other realization as this week of slow-downs and bet-hedging comes to an end is that legislating is difficult.  One of hundreds of cases in point:  rural conservative “Blue Dog” House members want Congress to iron-out the disparity between rural and urban Medicare reimbursements.  Sounds fine, right?  Raise rural rates, get the reluctant members on board, go have a celebratory drink at the House bar.  Not so fast.  Raising rural rates means cutting other Medicare payments, and urban members are bristling at the idea of cuts – to hospital payments in particular – since in many cases, hospitals and the health care industry are the largest source of jobs in their districts.  Suddenly you’re gaining votes on one side, but losing them on the other.  Which 20% is negotiable?

These kinds of dilemmas play themselves out over and over again in even the smallest legislative negotiations – add in the high-profile nature of this debate, and all of a sudden the tiniest detail is dissected with a microscope and amplified with a megaphone.  Will health care reform get done this year?  It’ll be tough.  But one thing is clear: those who aren’t making their voices heard, every day and in a strategic way, will be left on the sidelines if and when legislative sausage is served.

1 Comment

  1. Great article John, I like the section on rural vs urban Medicare reimbursement since I brought that up with our Blue Dog Rep. Stephanie Herseth-Sandlin the first of this month in a public meeting she invited me to attend. You are right, which 20% is negotiable?? Not mine…somebody elses!

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