As the healthcare debate continues unfold and legislative resolutions continue to take longer to produce, I can’t help but wonder what the Obama administration and Congressional Democrats are going to view as constituting success. The Senate HELP Committee has extended markup on their legislation and they now won’t be considering the coverage parts of legislation, which include the public health insurance option, until after the July 4th recess. The Finance Committee seems to have moved completely beyond the public option and is now fiddling with various ideas of regional insurance co-ops, which are in no way a substitute for a national public health insurance option. The House, on the other hand, has aggressively pushed meaningful reform that includes strong employer responsibility provisions and a robust public option.

In my eyes, the House efforts are both leading towards the sort of legislation that I think would constitute meaningful reform and being done in a way that will likely maximize the positive impact through strong, principled engagement of the legislative process.  Somewhere along the line, the House and Senate will have to get together to figure out what this legislation will really look like. Either on body will have to accept the others’ work, or it will have to be hammered out (read: rewritten from scratch) in conference committee. There are, as I see it, five possible procedural outcomes:

• The Senate considers and passes/modifies the House bill
• The Senate considers the HELP Committee bill and sends it on to the House
• The Senate considers the Finance Committee bill and sends it on to the House
•  A conference committee reports a merger of the House legislation and whatever comes out of the Senate
• Nothing passes

Only the first option, where the Senate makes the House legislation their underlying bill and then Democrats try to fight off damaging amendments from Republicans to water it down, is really likely to produce successful reform. I hope the second option, where the Senate makes a strong HELP Committee bill underlying and passes it without being watered down, is also possible, but we don’t yet know how good the HELP legislation will be. I have no faith in the Finance Committee or the outcome of a conference committee at this point in time.

It all comes down to how is the White House and Democratic leaders in Congress thinking about what constitutes success. If they really want to cover a larger majority of uninsured Americans and get the economy back on track, I don’t see how they can look at anything that fails to include a public health insurance option as a success. If passing anything and calling it “landmark healthcare reform” regardless of what it actually does is enough of a success, then I worry that there will not be pressure by leadership to ensure that what I think of as a high quality bill passes. We’re reaching the point where President Obama, Senator Baucus, Reid, Dodd, Speaker Pelosi, and Rep. Hoyer (to name a few) need to decide what is more important: creating compelling ad scripts for the 2010 and 2012 elections or really helping working Americans have affordable, high quality healthcare. That’s the choice – politics or policy. Judging by the quality of the bill that eventually gets pushed forward to a final vote, we will see which won out.