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The Art of the Deal: Lawmakers Hone Skills in Sweetening Health Bill

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House Speaker Nancy Pelosi gestures at a news conference with Capitol Hill reporters in Washington March 19. (Reuters Photo)

Dealmaking is a delicate dance on Capitol Hill. But if the health care debate is any gauge, lawmakers are getting pretty good at doing the "twist." 

With several Democratic holdouts having been persuaded to cross over and support the health care bill in the past week -- and over the past year -- the public is getting a glimpse at the backroom arm-twisting that is muscling the legislation over the finish line. 

"There is a lot of dealmaking going on, as though some deal could actually cover up a vote for one of the worst bills I have ever seen," House Republican Leader John Boehner told Fox News on Friday. 

Though Republicans are making hay over the deals, they know full well that back scratching and palm greasing are just a fact of life in Washington. 

Sen. Ben Nelson, D-Neb., got the so-called "Cornhusker Kickback," a $100 million Medicaid benefit for his state, around the time he signed on as a supporter. That provision has been stripped out of the package of changes unveiled Thursday, but guess what.... The bill now includes millions for Tennessee hospitals, a deal that was completed just as Tennessee Rep. Bart Gordon announced his support for the bill. (Gordon's spokeswoman told The Associated Press that the congressman's support was not tied to the hospital money.) And several other sweeteners are sprinkled throughout the bill for various districts. 

Sometimes, these deals have to be stripped, because of the political backlash. Other times, they stay in. 

Here are some rules lawmakers often keep in mind when it's time to play Let's Make a Deal: 

-- Remember the four "R's." They are: re-election, riches, reputation and rehabilitation. In exchange for a vote, influential officials may be able to help a wavering lawmaker on any of these four concerns. Members are always thinking about getting re-elected; they need riches -- a.k.a. campaign contributions -- to do that; a good reputation certainly doesn't hurt; and if all goes to pot, rehabilitation becomes essential. If the leadership can't rehabilitate a campaign, maybe it can provide the loser with a cushy job when it's over. 

-- Focus on the middle. Those looking to strike a deal and twist some arms know that the left will support the left and the right will support the right; it's the middle that's always up for grabs. This is why so many of the lawmakers at the center of controversies over sweetheart deals are from moderate districts or states. 

-- The sweetener must equal the risk. "Look, every vote is a vote you have to answer to your constituents," Rep. Dennis Kucinich, D-Ohio, explained. 

The cost-benefit analysis is pretty simple. If the backlash for a vote is too strong and the value of the payoff too little, don't make the deal. But if a member of Congress is going to take heat back home for a controversial vote, he might be able to make the argument that he held his nose, voted for the bill and got something really good in return. 

With those as the ground rules, Republicans are on the hunt. 

"If you think you can cut a deal now, and it will not come out until after the election, I want to tell you that isn't going to happen," Sen. Tom Coburn, R-Okla., warned Thursday. "And be prepared to defend selling your vote in the House." 

Some lawmakers have found out the hard way that the payoffs they were seeking in the health bill were a little too conspicuous. 

For Nelson, it meant calling off the Cornhusker deal. And Sen. Kent Conrad, D-N.D., urged the House to remove an item in the latest draft that would have helped the state-owned Bank of North Dakota, because he feared it would be exploited for "partisan" purposes. 

Boehner, who called the North Dakota provision the "North Dakota bank heist," suggested that no deal is worth it at this point in the health care debate. 

"I think it's pretty hard to cut a deal for a bridge that's going to cover up the fact that you've voted against your constituents," he said. 

Fox News' Brian Wilson contributed to this report.