NV-03: Dina's Choice

So what will it be? We now have more details on the costs and benefits of the health care bill.

The bill would reduce the deficit by $130 billion in the first ten years, and potentially by $1.2 trillion in the second ten years (though CBO always warns that projections into the second decade are extremely unpredictable).

According to the source, CBO finds that the bill reduces annual growth in Medicare expenditures by 1.4 percentage points per year, extending Medicare's solvency by at least 9 years.

And, in a small, but significant improvement over the Senate bill, the combined package will expand health insurance coverage to 32 million Americans, as opposed to the Senate bill's 31 million.

The one difference Republicans will point to? The bill's about $100 billion more expensive than its predecessor. The price tag is fully covered, but will cost $940 billion over a decade. That's likely a reflection of changes to the bill, such as enhanced subsidies and closing the Medicare Part D donut hole. But it does exceed President Obama's arbitrary price of "around $900 billion", which he issued back in September, and which Congress treated as a hard ceiling.

OK, so the bill costs $940 billion over the next decade. However, it will ultimately reduce the deficit by $130 billion in the next decade and extend coverage to 32 million more Americans while making health care more affordable to more people. What's not to like?

Well, we still have to ask Dina Titus that.

As Democratic Rep. Dina Titus faces a challenging health care vote, how she eventually sells her position to voters could be as important to her political future as whether she votes yes or no.

House Democrats are nervous about voting for a bill that polls show majorities of Americans do not support. Yet Democrats are equally worried about heading into re-election campaigns without accomplishing health care reform after a year spent debating the issue.

For Titus, the internal debate could be heard last week during a tele-town hall meeting with more than 3,000 voters in her Henderson district.

To one caller, Ken, who supports health care reform, saying he is a small-business owner who recently had to discontinue coverage for his workers because of rising premiums, Titus assured him, “I support reform.”

To another, Frank, who was concerned about the costs of the bill, Titus insisted that she wanted to see Congress “tightening their belts” too and was not about to greenlight the bill until she had fully reviewed it. (The final version has yet to be presented to members of Congress.)

“I just don’t believe it’s responsible to commit until you see the bill in front of you,” Titus told him.

Well, now she can have the bill and the CBO score in front of her. She needs to make a decision and make it soon. Even though The New York Times suggests Dina has already made her decision, she herself is not saying anything yet. But if we were to assume that "The Grey Lady of Journalism" is correct and Dina ultimately votes for health care reform one more time, what can she do to defend herself against "the angry mob" of teabaggers out to call her "SOCIALIST!"? Here's a helpful hint: Explain what health care reform does.

The challenge for Titus and other Democrats, if they choose to vote yes, will be articulating their reasons for supporting the legislation in a 30-second sound bite that can withstand the attacks expected from the opposition: ObamaCare. Government takeover. Rationing.

Last week, former Rep. Marjorie Margolies Mezvinsky, who as a freshman from Pennsylvania cast a deciding vote in 1994 on Clinton’s budget package, offered a cautionary tale. She told The New York Times that she had distilled an explanation of her support into a four-minute sound bite. But her opponents could explain their criticisms in 30 seconds. She lost.

White House Communications Director Dan Pfeiffer said the reason Democrats “didn’t have a 30-second answer in ’94 is they failed to pass health care.” He said he could imagine a candidate making “a very compelling case in 30 seconds or less of all the benefits they delivered and the fact that they took on the insurers to do it.”

Titus knows the difference between having to explain oneself and lobbing attacks. She has been on both sides of that equation — as a veteran state senator who had to answer for past votes and as a challenger in 2008 to the incumbent Republican lawmaker she eventually ousted.

A vote for health care would allow her, while on the campaign trail, to take a page from Obama’s book, reaching for the human faces that can tell the story of health care reform — Nevadans who have been dropped by their insurance companies or had their insurance premiums raised to unaffordable levels.

[Cook Political Report Analyst David] Wasserman believes that if the bill is passed, Democrats will enjoy a brief victory lap then immediately “pivot to the economy” — the top issue on voters’ minds.

This is quite true. As I said back in January when things were really looking bleak, Democrats need not be afraid of doing the right thing... And explaining it as such.

Look, most Nevadans want health care reform. We're not afraid of "the r word". We would have liked a public option in the package, but hopefully it won't be long before this is revisited. We obviously don't like the current state of affairs and want a health care system that works.

This is what Dina Titus needs to remember. She needs to remember how she won in 2008. She needs to remember why her supporters (us!) worked so hard for her back then. She needs to remember that voters like elected officials who get stuff done, not ones who sit around and do nothing.

Thankfully, Dina's not one to sit around and do nothing. And she's someone who knows Nevada politics forward and back. And she understands the costs of inaction on health care.

This is all she needs to remember. This bill may not be perfect, but it makes plenty of progress in making health care more affordable and more accessible to more people. And by voting for it and explaining it well, she won't really be taking the kind of risk that the Republicans claim she would.

After all, if health care reform were really as "toxic" as the GOP claims it is, why are they working so hard to block it?