Health care reform: Tuesday and beyond (updated)

Kari Chisholm FacebookTwitterWebsite

Tuesday's the day (finally? finally!) for the Senate Finance Committee vote on health care reform. They're scheduled to meet at 7 a.m. Pacific, though it's unclear how long they'll talk before there's a vote. (Watch live here.)

It's unclear what, exactly, is going to happen. Our own Senator Ron Wyden is considered one of just a handful of critical undecided votes. Heading into the weekend, Wyden told the AP:

"I am not going to characterize where I am (on the bill) in any way," Wyden said Friday as he headed to the airport for a trip back to his state.

If Wyden votes against the bill, and is joined by Senator Jay Rockefeller (D-WV) and Senator Olympia Snowe (R-ME) - generally considered the three undecideds - the entire process may be derailed. Most observers don't expect that outcome, notes The Hill:

If more than one of those three senators joins the panel’s Republicans and votes against the bill, healthcare reform would suffer a tough blow on Tuesday and might not recover.

It’s likely Baucus will have the votes. Committee chairmen generally don’t schedule a vote they won’t win, and at least two of the three senators are likely to make a leap Tuesday in the hope the bill will improve as it moves forward.

If the bill survives the Finance Committee vote, that's when some serious backroom politics takes the stage as majority leader Senator Harry Reid (D-NV) fashions the "floor bill" by grafting parts of the HELP Committee bill (and whatever else he wants) onto the Finance Committee bill.

The Washington Post's Ezra Klein explains:

The floor bill will not be the Finance Bill, exactly. And it will not be the HELP Committee's bill. Instead, it will be a blend of the two. The merger will be overseen by Harry Reid's office, and Hill sources expect the room to be fairly small beyond that: Max Baucus, officially representing the Finance Committee, but unofficially representing Senate moderates. Chris Dodd, representing the HELP Committee, but unofficially representing Senate liberals. A few White House staffers (Peter Orszag's name comes up frequently). Finally, Tom Harkin, the actual chairman of the HELP Committee, will have some involvement but isn't expected to be a key player. ...

What emerges from this process is expected to look a lot like the final compromise. As a smart Hill source explained to me, the final legislation is hard to change. It won't take anything but the agreement of the members in that room to add something to the bill. But after the bill leaves that room and goes to the floor, it will be very different to make any changes. Harder even than in the committee process, where a bare majority of committee members could add an amendment.

On the floor, you'll need 60 votes to add anything. You also need 60 votes to remove anything. If some group of senators dislikes one of the features, they'll need to beat a filibuster to reform it. ...

The flip side of that, of course, is that you need the entire Democratic caucus to break the final filibuster on the bill. You can't have anyone angry enough that they're willing to scuttle the final legislation. That means the compromise coming out of the merger has to be basically acceptable to all Democrats, and then a core of 41 Democrats needs to be ready to defend every major element from attack (even as some Democrats vote for those attacks). It's not going to be easy. But that's the next step.

Update, 10:57 a.m.: Senator Wyden just spoke. He said that when the vote happens, he intends to vote for the bill - in order to move the process forward.

Update, 11:57 a.m.: The bill has passed the committee by a vote of 14 to 9. Wyden and Rockefeller voted yes. More surprisingly, Snowe voted yes as well.

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    [Full disclosure: My firm built Ron Wyden's campaign website. I speak only for myself.]

  • theresa Kohlhoff (unverified)
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    And just when Reid is saying that he needs to be convinced that the public option has sufficient agreement to be included in his bill. Note the HE needs to be convinced, personally. And having Mr. Insurance Lackey, Baucus, in the same room as Reid! I can only imagine. Now I see how precarious this whole thing is.

  • backbeat (unverified)
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    If you can't watch the hearing, TPM is liveblogging it here: http://tpmdc.talkingpointsmemo.com/2009/10/senate-finance-committee-votes-on-health-care-reform-bill.php?ref=fpblg

  • backbeat (unverified)
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    Firedoglake is also liveblogging it here: http://campaignsilo.firedoglake.com/2009/10/13/senate-finance-committee-vote-live-blog/

  • Bill Bodden (unverified)
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    I caught a brief piece this morning that suggests this hearing is complete BS. Senator Bingaman (D-NM) complimented Baucus on the fair way that he managed the hearings. Baucus (and the majority, if not all, of the committee) denied single-payer advocates a hearing. Kind of like the way Dodd and Frank and their committees denied witnesses opposed to the bailout a hearing.

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    Baucus (and the majority, if not all, of the committee) denied single-payer advocates a hearing.

    They also denied the supporters of unicorns a hearing.

  • bradley (unverified)
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    Cheap shot, Kari. Certainly there was something the esteemed Senate Finance Committee could have learned by getting beyond the politics and bumper sticker explanation of single payer. Like it or not, single payer is real reform. Can you say the same about the Senate Finance bill?

  • Bill Bodden (unverified)
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    "Baucus (and the majority, if not all, of the committee) denied single-payer advocates a hearing.

    "They also denied the supporters of unicorns a hearing. "

    Very likely because they didn't bribe the committee members with campaign donations.

  • Mike (unverified)
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    Senate Finance Committee Chairman Max Baucus, wants to include a version of a government option called a co-op owned by insured members. What a wonderful idea says Mike Oliphant whom manages Utah health insurance plans for www.benefitsmanager.net/utah-group-health-insurance.htm . This may encourage competition from private health insurance carriers. But I fear it will fail ultimately if there is no TORT reform because the same liability costs that plague medical professionals and health insurance carriers will be like a fast cancer growth within the co-op plan. A government option wouldn’t allow legal suite against the plan but will with medical providers. Doesn’t anyone see that we need TORT reform to protect the cost outcome? See what Utah has done with health care reform www.ahealthinsurancequote.com/reform.html.

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    Just updated the post...

    Senator Wyden just spoke. He said that when the vote happens, he intends to vote for the bill - in order to move the process forward.

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    As for the unicorns comment, OK, that was pure snark. My deepest and humblest apologies.

    For those who support single-payer, can you name ten Senators that have said they'd vote for a single payer bill?

    Didn't think so. I support single payer too, but without a path to a majority vote, debating a bill is a waste of time.

    As for whether something could have been learned by having a hearing on a concept that has no support, sure... we could all learn more about all kinds of topics. But that's a different thing than having a hearing on legislation that's going nowhere.

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    Baucus (and the majority, if not all, of the committee) denied single-payer advocates a hearing. Kind of like the way Dodd and Frank and their committees denied witnesses opposed to the bailout a hearing.

    I'm constantly amazed at the extent to which people actually believe that hearings are the only way (or even the primary way) that member of Congress learn about issues.

    Many of those same people are convinced that if they just had 15 minutes with their elected representative, they could bring him or heer some new piece of information about a single-payer system (or bank bailouts or whatever) that would lift the scales from the eyes of the official and change history.

    Whether you agree with these folks or not, they really didn't get there because they are dummies nor are they unmindful of the arguments on both sides of most of the issues that come before them.

    Kari is right; having testimony before the Senate Finance Committee on a single-payer system would have been just as productive as having people testify about unicorns; not that there might not be some new or novel information about both, but that the Senators had already decided that neither was going to be in this bill.

    Personally, I wish all of them would talk less and vote more, and in the process limit the dog-and-pony-show public hearings which tend to the be the legislative equivalent of, "Does the defendant have anything he wishes to say before I pronounce sentence?"

  • Bill Bodden (unverified)
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    "As for the unicorns comment, OK, that was pure snark. My deepest and humblest apologies."

    Apology accepted

    "For those who support single-payer, can you name ten Senators that have said they'd vote for a single payer bill? "

    This says more about the senate (and all of Congress) than it does about single-payer. History is replete with examples of voices in the wilderness who got it right and were vindicated after the wrong path was taken and the damage done.

    On the WHO report for 2000 the United States was ranked 37th for health care attainment and delivery. Several nations with single-payer plans or versions thereof were in the top 30 with France and Italy first and second, respectively, and Canada at 30th. Per capita expenses for health care in these other countries were about half of what we paid in the United States. Given the prospect that costs will continue to escalate under our non-single-payer system would anyone care to guess where the United States would rank if another analysis were made in, say, 2013? Or, even today?

  • Bill Bodden (unverified)
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    "Very likely because they didn't bribe the committee members with campaign donations."

    Marie Cocco on Bribe, Vote, Repeat

  • Bill R. (unverified)
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    Olympia Snowe joins the forces of Satan and votes for a health care bill. Now she will lose her chairmanship for sure. (And maybe leave the GOP) They hate her anyway.

  • Kurt Chapman (unverified)
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    Ok, so the finance COmmittee has a watered down bill they are"proud" of. the bill will cost about 1 Trillion bucks and only cover 25 million of the 45 million currently uninsured. They actually think that this is reform?

    I would not blame Wyden if he were to vote this out of committee in order to exoriate it on the Senate floor and then vote NO.

  • alcatross (unverified)
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    Bill Bodden wrote: History is replete with examples of voices in the wilderness who got it right and were vindicated after the wrong path was taken and the damage done.

    True, but more often than not voices in the wilderness are just that... Not all voices in the wilderness are necessarily prophetic.

    Several nations with single-payer plans or versions thereof were in the top 30 with France and Italy first and second, respectively, and Canada at 30th. Per capita expenses for health care in these other countries were about half of what we paid in the United States. Given the prospect that costs will continue to escalate under our non-single-payer system would anyone care to guess where the United States would rank if another analysis were made in, say, 2013? Or, even today?

    Actually, you may be surprised - ...nearly all developed countries are now struggling with rapidly rising health-care costs, including those with single-payer systems. From 2000 to 2005, per capita health-care spending in Canada grew by 33 percent, in France by 37 percent, in the U.K. by 47 percent—all comparable to the 40 percent growth experienced by the U.S. in that period.

    I (along with about everyone) agree health care in US needs to be reformed. I don't support single-payer or any additional movement towards such a system.

  • juicing recipes (unverified)
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    This all smells of Roosevelt to me. Its one thing to try and pass something, but its another thing to force it ahead of time, especially when there is still going to end up being years left over. History repeats itself.

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    There is actually just about zero evidence that any member of Congress is "bribed."

    Note what "bribe" implies--you vote for a bill that you would have otherwise voted against (or vice versa) without the campaign donation.

    And, as Jack R. points out, most members of Congress have amazing reservoirs of information and analysis at their disposal, much partisan (on both sides of an issue), some less partisan (e.g. CBO, CRS).

    It's all too easy, but not accurate, to assume members of Congress are bought and paid for. In actuality, and not surprisingly, most lobbyists give money to members that already agree with them.

    Progressives should celebrate this victory and move on to the floor.

  • Bill Bodden (unverified)
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    "- ...nearly all developed countries are now struggling with rapidly rising health-care costs, including those with single-payer systems. From 2000 to 2005, per capita health-care spending in Canada grew by 33 percent, in France by 37 percent, in the U.K. by 47 percent—all comparable to the 40 percent growth experienced by the U.S. in that period."

    If their health care costs rise at the same rate as ours won't the end result remain the same; that is, that they will still be paying something like half of what we pay? Given the fact that the insurance industry owns many key players in Congress we should consider the probability that our health care costs are at risk of rising at a higher rate than the other nations referred to above.

    "in the U.K. by 47 percent"

    I recall a blogger (presumably a Brit) on this site some time ago who indicated the rise in U.K. costs was, to a great extent, attributable to a heavy influx of immigrants from the European Union who had never before contributed to the funding of the National Health Service.

    "I don't support single-payer or any additional movement towards such a system."

    I don't know how it could be achieved, but I would like to see two systems develop here that would be open to all. One would be the same as we have today with people buying, if they can, commercial health insurance policies and another that would provide a chance to opt into a properly funded Medicare system. Those who decline either of these options would be on their own at the mercy of luck or the medical system.

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    Here's Bill Moyers' take on corruption and the US $enate.

  • Bill Bodden (unverified)
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    "There is actually just about zero evidence that any member of Congress is "bribed.""

    Some wise person once said that if someone gives another a gift and that gift changes their relationship, then that gift is a bribe.

    Representative Steve Buyer-Linked Foundation: Who Gave, And Where Did The Money Go?

    Some people may consider that it was just a coincidence that Rep. Buyer happened to agree with what his campaign donors wanted, but others consider skepticism, at a minimum, is called for. Try reading Greg Palast's "The Best Democracy Money Can Buy."

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    Out of the Baucus tar pit and onto the Senate--nice!

    Given everything that has transpired in this epic battle, it's remarkable how healthy and intact the possibility of a public option remains. It's not a sure thing by any means, but it's been hammered for months by the GOP, FOX News, and industry lobbyists--and if anything, it's more likely now than in July.

    Strange times.

    (Incidentally, I claim "Baucus tar pit" as my own.)

  • chris #12 (unverified)
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    Kari: "They also denied the supporters of unicorns a hearing."

    Thanks for clearing that up for us, Kari, you glib, condescending, snarky, expert on all things possible.

    This is one of the main reasons I think that progressives should give up on the Democratic party, and start organizing at the (non-electoral) grassroots. If you're so committed to electoral politics, how about working on building a third party, or some other way to get folks elected who aren't so beholden to their corporate funders. (Heck, a second party would be nice at this point).

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    I’m guessing that it’s touch and go on getting enough votes to pass any version of health care reform. Getting to 60 and holding 60 in the Senate is difficult. No Republican, unless Snowe, will vote for the final bill on the floor. Votes are still fluid, and deals outside health care reform will be involved. But I don’t think the public option is even close. I doubt if Carper’s idea is either. Nor do I think Wyden’s Free Choice amendment will make it. I think, my theory, that Wyden had enough votes in the Finance Committee including some Republicans, but Baucus couldn’t let it pass because it did not have enough votes on the floor, given opposition from business and labor. I’m for a public option and the free choice amendment but neither is going to be in the final bill. Makes me sad.

    But I think a final bill is worth passing without either. So on to other issues in it.

    I am mostly concerned about the financing aspects, especially Medicare. The current financing of Medicare is not sustainable. There are future savings in Medicare costs in most of the bills, but those savings seemed to be used for other subsidies not for making Medicare financially sound. Or don’t I understand the Medicare part?

  • Jonathan Radmacher (unverified)
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    Bill Bodden: "Some wise person once said that if someone gives another a gift and that gift changes their relationship, then that gift is a bribe."

    I'm not sure who this "wise person" is, but s/he would seem pretty outcome-bound. For example, engagement and wedding rings explicitly change the relationship. That doesn't mean that the gift is only given in order to change the relationship; it's just an express recognition of the mutual position of the people. As previously pointed out above, most political money is given because of existing policies and positions, not desired changes in those policies and positions. If it were otherwise, Ds would be getting red money, and Rs would be getting blue money.

  • backbeat (unverified)
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    So did you see the pathetic list of Senators that get to go behind closed doors to blend the Senate plans? Baucus, Snowe, Reid and banker-Dodd. No Democratic women, no left coast Senators, and a big F YOU to Ron Wyden.

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    Thanks for clearing that up for us, Kari, you glib, condescending, snarky, expert on all things possible.

    Nah, not an expert. That's why I keep asking if any single-payer absolutists can identify even 10 votes for their bill? If not, there's no point in going on and on about it.

    This is similar to the long-running philosophical battle (usually started in freshman dorms) between those who prefer to work for change by standing outside federal buildings and yelling at people and those who prefer to work for change by getting jobs inside the federal buildings.

    Both strategies have their place, but you can count me among those who believe in changing things from the inside - through persistent change, even when incremental change is the only thing possible.

  • Bill R. (unverified)
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    Looks like Wyden got a commitment to get a version of his "choice" amendment on the final bill: http://voices.washingtonpost.com/ezra-klein/2009/10/how_the_senate_finance_committ.html

  • Bill R. (unverified)
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    For those of you who keep touting the necessity of 60 votes. The 60 votes are required to get cloture, not to pass a bill. Reportedly those who are considering filibustering with the Rs have been told they will lose their chairmanships if they cross that line. I don't think Lieberman or Lincoln want to lose their chairmanships and spend their remaining senate careers in the outer darkness where there is the weeping and gnashing of teeth. They can vote no, just have to vote yes on cloture. And if they want to play sabotage and lose their chairmanships, the Senate is prepared to go budget reconciliation.

  • chris #12 (unverified)
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    "That's why I keep asking if any single-payer absolutists can identify even 10 votes for their bill? If not, there's no point in going on and on about it."

    I'm glad you weren't running a blog when the civil rights movement was getting started. "I'm sorry, Rosa, we don't have the votes in the Senate, there's no point in going on and on about the whole bus thing."

  • Bill Bodden (unverified)
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    "If it were otherwise, Ds would be getting red money, and Rs would be getting blue money."

    The "money" doesn't care about Ds and Rs. Just results.

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    I'm glad you weren't running a blog when the civil rights movement was getting started. "I'm sorry, Rosa, we don't have the votes in the Senate, there's no point in going on and on about the whole bus thing."

    But that's just the point. Rosa Parks wasn't asking for a hearing on a bus integration bill in 1955, when it didn't have a chance. She wasn't expecting legislation at all, Instead, she helped start a movement that created the legal, political and moral climate that led to small steps like the Civil Right Acts of 1957 and 1960 which finally led to the Big Three: the Civil Rights Act of 1964, the Voting Rights Act of 1965 and Fair Housing Act of 1968.

    The more apt analogy here would for the single-payer-types of that day saying to Rosa Parks, "Why are you fooling around trying to integrate one lousy municipal bus system when the real answer is comprehensive legislation banning all forms of discrimination? Let's go to Congress and demand a hearing on that right now!"

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    Notice how, in Jack's analogy, there were Civil Rights Acts in 1957, 1960, and 1964. And even then, Voting Rights and Fair Housing in later years.

    There's no reason why there can't be health reform acts in 2011, 2013, and 2016. In fact, having finally broken the seal and done something meaningful, it'll be easier to make further reforms down the road.

  • Bill Bodden (unverified)
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    "Let's go to Congress and demand a hearing on that right now!""

    But there wouldn't be much point in going to the Senate Finance Committee with its policy of debating only what the insurance corporations wanted and rejecting other options such as single-payer and a public option. Some people tried to demand a hearing on single-payer and were ejected.

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    There's no reason why there can't be health reform acts in 2011, 2013, and 2016. In fact, having finally broken the seal and done something meaningful, it'll be easier to make further reforms down the road.

    In fact, after the Social Security Act was passed in 1935, there was a major overhaul of the system just four years later, and it is the Social Security Reform Act of 1939 that basically created the system we basically still have today.

    But if people had insisted on the 1939 system back in 1935, it might never have passed.

  • RyanLeo (unverified)
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    Gosh damn, I have to clear the air once more.

    Q1: Why do Democrats need 60 votes?

    A1: Filibuster. A filibuster is a procedural move by the minority party when the bill is up for a vote on the floor of the US Senate that kills the bill on the floor. It works like this:

    1. Minority party does not like the Final version of the bill.

    2. Minority leader organizes party (Dem or Rep) to ENDLESSLY speak on the bill at hand.

    3. With 30+ member speaking on the bill, they can ostensibly kill it by delaying the vote for a month or more. Think each Republican speaking on the floor for a day along with a few Democrats such as Mary Landrieu from Louisiana, Kent Conrad from North Dakota, and Blance Lincoln from Arkansas.

    4. To bring the filibuster to an end (cloture), the majority party needs 60 votes out of the 100 votes in the US Senate.

    Q2: Why not use the Vice President as the 60th Senate vote?

    A2: The VP has been very reluctant to be the 101st, unelected US Senator. Remember, they are elected as a member of the Executive Branch. ONLY on matter regarding a 50-50 vote regarding the US Budget, only has the VP voted as the President of the Senate.

    Furthermore, the majority party at the time (Democrats will not be a majority forever) is hesitant to set the precedent of the VP being a Senate vote knowing the the opposition party will follow the same precedent when they have the White House.

    Q3: Why not use Budget Reconciliation?

    A3: Reconciliation is a procedure used only in regards to passing a Federal Budget.

    Again, Democrats would set a bad precedent that would be used against them once Republicans have majorities in the US Congress. Imagine the vote for DOMA (Defense of Marriage Act) only requiring a simple 50 vote majority as required under Budget Reconciliation...Yes, beware of what actions you undertake when you are in power.

  • RyanLeo (unverified)
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    As for my view of healthcare reform (not that anyone cares), I believe that the Baucus Bill as it stands fresh out of committee could and would pass as the Final version of Obama's healthcare reform. The Baucus Bill is as good as it gets.

    As it stands, Judd Gregg and Senate Republicans will entirely gut a healthcare reform bill with the public option via parliamentary procedure if Senate Democrats use Budget Reconciliation. I have very good sources to confirm this. Sources that Democrats and "Progressives" do not normally like to read.

    I do not believe that the HELP Bill has any chance to pass. It will only get about 55 Democrat votes with Baucus, Landrieu, Lincoln, Conrad, Nelson and potentially more Democratic Senators voting against it.

    Remember, you need an absolute 60 votes to bring cloture to a filibuster.

    The earliest I can see a vote on healthcare reform is early November. Expected mid to Thanksgiving. If the Public Option is snuck in by Harry "soon to be retired" Reid, then Christmas/New Years.

    In all, I expect single payer advocates and right wing free market types to be crying over different things regarding health care reform.

    If the extremes are crying, then the resulting legislation has hit it's intended mark.

    On the other hand, if the bill is filibustered due to liberal Democrats pushing a Public Option, then no one wins except the health care industry.

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    I have very good sources to confirm this. Sources that Democrats and "Progressives" do not normally like to read.

    Gonna share? Some of us might like to read your sources.

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    Also, RyanLeo, the big question of the year - which no one knows the answer to - is this: Will 60 Senators agree to cloture, even if only 51 will agree to the bill?

    Will there be Senators willing to move forward to an up-or-down vote even if their plan is to vote no?

  • Bill Bodden (unverified)
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    "Bill Bodden: "Some wise person once said that if someone gives another a gift and that gift changes their relationship, then that gift is a bribe."

    I'm not sure who this "wise person" is, but s/he would seem pretty outcome-bound. For example, engagement and wedding rings explicitly change the relationship. "

    Radmacher: It appears you didn't pay enough attention to the "IF" in the saying above.

  • Bill Bodden (unverified)
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    Cancel the preceding. My turn to be too quick on the draw.

  • Lisa (unverified)
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    The insurance companies are greedy but I hope this reform will help people that can not affod health care.

  • Emmit Goldman (unverified)
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    Re: "Name me ten Senators..."

    What a cynical deceit. You guys obstuct any progressive messages. You control the range of acceptable debate and marginalize everyone to your left. You lie and obfuscate to the point where no one knows what's even being debated.

    The Reich is right about you: You are elitists who couldn't give two shits about the welfare of ordinary people, only about how you're going to fool the suckers in the next election.

    The piece of shit bill that's going to be passed and called "progressive" by the DP and "socialist" by the RP is not going to lead to single payer any more than it will lead to unicornworld.

    1. The large majority of people, who receive their insurance from their employer, will see no benefit whatsoever from the Plan. Most will, in fact, find their premiums rising as new requirements imposed by the Plan (e.g., the elimination of lifetime limits) raise the cost of insurance. And, of course, to their undoubted surprise, most of them will not have access to the public option, even if there is one.

    1. Most provisions of the Plan will not become effective until 2013. This gives four years for Republicans to criticize the Plan, including (1) its use of cuts in Medicare reimbursements and Medicare Advantage premiums as principal sources of funding, (2) its lack of any real or believable mechanism for containing costs, and (3) its bureaucratic complexity.

    2. The taxes on high-cost insurance plans, the other principal source of funding, will cause those who now have good insurance (called, pejoratively, “Cadillac” plans) to find these plans heavily taxed and their employers given a strong incentive to cut back on their benefits. Instead of reducing underinsurance, this part of the Plan will increase it! (And the rest of the plan does little about underinsurance at all.)

    3. During the four years of waiting for the Plan to take effect, costs will continue to rise. By the time the Plan takes effect, costs are likely to be at least 25% greater than now. Even more people will find insurance and health care unaffordable. People will ask “What was health reform about?” The disillusionment will be great.

    4. The complexity of the plan, including (1) federal rules regarding what kinds of employer-based insurance plans are “qualified,” (2) new income tax forms that will be needed to implement the individual mandate, and (3) the process of determining income eligibility for everyone, will all lend themselves to criticism and even ridicule.

    (Leonard Rodberg , Chair, Urban Studies Department, Queens College/CUNY, http://pnhp.org/blog/2009/10/09/rodberg-is-there-any-way-out-for-obama/)

  • Lord Beaverbrook (unverified)
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    Amen, Emmit. At least one person has their eye on the ball!

  • hank mccurdy (unverified)
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    <h2>Single payer presents a 5th Amendment taking/just compensation problem. To implement single payer now rewards the health insurance carriers for gouging the American public. Instead, let them die slowly through the pathway to single payer- the public option. March with us Sunday, Oct. 18 in Portland. See http://pdxpublicoption.com.</h2>

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