If there’s one area in which the House health care reform bill is obviously superior to the Senate version, it’s coverage and affordability.
There’s more financial assistance for buying insurance and much stronger protection against out-of-pocket medical costs. That means more people getting coverage and fewer people struggling with expenses.
Speaker Nancy Pelosi and her allies, both on and off Capitol Hill, have made clear this is one of their top priorities for the coming negotiations over how to merge the two pieces of legislation. And it would seem, at first blush, like one of the rare points on which the House might actually get its way.
After all, who wouldn’t want to offer people more financial assistance and security? It’s not just good policy. It’s good politics.
Or is it? The reason the House bill does more is that it costs more: Over ten years, it would spend an additional $166 billion on expanding and improving coverage. The House was willing to do this because it was willing, and able, to pay for the extra cost through additional revenue and savings.
But the Senate couldn't come up with as many "offsets," as they're called in congressional parlance. Partly that was because centrists, like Budget Committee Chairman Kent Conrad, kept pushing to shrink the bill out of sheer principle. And partly that was because the Democratic leadership struggled to find a combination of offsets that sixty members would accept.
Virtually every idea raised objections from some member or group of members. Usually it was the same set of senators who wanted to keep the bill small--that is, the centrists. But on some occasions it was more liberal members responding to parochial or moneyed interests.
By all accounts, these same obstacles remain today. Centrists in the Senate still don't want the bill to get bigger. Ben Nelson has indicated he'd jump ship, and support a Republican filibuster, if the final package comes back with a substantially larger price tag. Conrad and Joe Lieberman have made similar noises.
And while the centrists may tolerate slightly higher spending--at the very least, it could go from the Senate's $871 billion to at or just above $900 billion, the infamous figure President Obama used in his September speech--the task of finding new offsets that won't lose at least one member of the caucus remains difficult.
What makes this all so regrettable is that the House offsets actually make a lot of sense, purely on their own terms. Consider the three basic approaches on the table:
Passing health care is going to require convincing Representative Bart Stupak, or at least his would-be allies, to vote for the bill despite their concerns that it is tantamount to federal funding of abortion services. 
