I don't think it matters much, because this bill does not in any fundamental way address the fundamental issue, which is the rising cost of health care in the U.S. I can't decide whether scrapping the bill and starting over (which most likely means, at minimum, several more years of the status quo) or plunging ahead with the bill as is and attempting incremental change would get us closer to confronting the real problems more quickly. I guess it depends upon what emerges from the reconciliation process, presuming the Senate does get this passed shortly.

Until we figure out how to bring health care costs down to manageable, affordable levels, nothing much will change. We will continue on the path to greater inequity in health care delivery, and we will continue going broke doing it -- bill or no bill.

The house should try to improve it as best they can and then they should pass it......as long as it doesn't further restrict women's reproductive rights.

After it passes, they should open up medicare to everyone via reconciliation and tell Lieberman, Nelson, and the Republicans to well.............fill in the blank.

I'm one hundred percent with Joshua Welch on this. Fix the current bill as much as possible and pass it. THEN introduce a short, simple, clean, revenue-neutral bill in the House to let every American under 65 BUY into Medicare. Design it as a measure that can pass the Senate through reconciliation.

I think this would be a politically necessary move for the Democrats at this point, given the degree to which they've pissed off their base by offering capitulation after capitulation in an effort to appease Lieberman and Nelson. If they can't show us a stronger performance next year, it's gonna be harder for a lot of them to get contributions and volunteers, and a lot of less-engaged Deomcratic voters are likely to stay home in November.

"There will not be another chance for years. The Democrats will probably not have 60 votes in the next Senate."

This has been one of the main arguments made in favor of supporting this bill. The Dems arguing in favor of the bill seem to make this argument as if they don't have control both houses of congress and the WH for the next year. My question is: since the Dems control the house, the senate, and the WH for at least the next year, how is this a now or never scenario?

I am confident that passing this bill - with no price controls and an individual mandate, is political suicide for the Dems. As much as I hate this bill, I tip my hat to the Dems who are apparently willing to forfeit control of Congress and the White House for the next few election cycles in order to do whatever it is they think they are doing.

Do any of our constitutional scholars have a simple explanation as to how the individual mandate will pass the inevitable constitutional scrutiny? Will they be amending the tax code to add the penalty, which can be avoided by proof of insurance? I slept quietly through constitutional law classes, but I am honestly curious about how this will work. Police power? Seems like a stretch.

The individual mandate is probably not constitutional. The civil rights/commerce clause cases were all about regulating people who had voluntarily engaged in commerce (i.e. if you open a restaurant you can't discriminate). The mandate impacts people who are not engaged in any form of commerce.

The individual mandate is not enforceable through the tax code. The tax code allows the taxation of income. The individual mandate supposedly applies to people who don't make any income.

The fact that subsidies are available doesn't change the analysis. If the government doesn't have the power to enforce the individual mandate through the commerce clause or the tax code, it can't compel people to apply for subsidies.

As of yet, the federal government has never compelled people to buy a product.

The analogy to auto insurance is a strawman. People can chose to drive and the mandatory auto insurance rules only apply to liability towards others. Sure, the government can make rules about the products insurance companies sell, but the government can't compel people to buy the products.

I have never liked the personal insurance mandate. It is authoritarian. It is coercive. It will piss off many Americans. And, no, it it is not equivalent to mandatory auto insurance. I can choose not to own a car and not pay for insurance. In this case my choices will be to leave the country or die.

If the bill contained a robust and affordable public option, or, at least, allowed a sizable population to opt for Medicare, and made significant efforts to containing total spending on healthcare [meaning that we would spend no greater percentage of GDP than most other developed nations], then I could swallow the personal mandate as a necessary bridge to single-payer.

Fix it or kill it.

Carla, You know what I appreciate about you? You show some of the pain and frustration we've all experienced watching this last year of "hope and change." It makes it so much more vivid when a person retains some individuality within an institution like the Dems. I wish someone would explain to me what mechanism is really at work here. I mean everyone seems to think this will lead to a decline in the Democratic seats in power so why don't they do something that would have assured their reelection? My only theories are that they must be convinced with the right campaign contributions they can sell anything. Or the lobbyists get though to them on a social level. Could it be that they are doing the bidding of the big corporations over the People, because they view Congress as a job interview? That's it, right? They know if they kiss the right ass now they are set for life in the private sector. Or their family members are paid huge salaries. It just turns out that Joe Lieberman's wife has the skills that the healthcare companies are looking for. Right. If that isn't blatant corruption what is? Still to answer your question I'd have to say pass this - hold our noses and pass this. There's got to be some good in it. I refuse to believe universal healthcare is going to degenerate into mandatory health insurance, where they force you to pay for it or become criminals. Good luck with that. Maybe that's just what we need to get the American People to rise up. But it does scare me reading that Howard Dean and Matt Taibbi say don't pass this. I don't know what to do. What a fucking mess. Politicians are the worst.

That's our Al! Great speech! (good remarks by S. Brown, as well!). Thanks for posting the video.

I like what Dave Porter said. Christmas Eve will be a monumental vote. It will have passed the Senate.

No Congress can obligate future Congresses. Pass the bill in whatever form necessary, take it to the midterms, and try to get more friendly Congress next time. (I'm wondering if all Stupak's constitutents agree with him on abortion, for instance.)

Those of us old enough to have lived through the days of civil rights bills (there was more than one---and a Republican vote on the 1968 bill came from a Republican who was a former Evangelical Layman of the Year and cast the yes vote as a tribute after MLK was shot) know that bills which bring major change are not easy. And maybe that is not a bad thing.

BTW, I loved the exchange between Alexrod and Dean on Meet the Press. No name calling, just respectful disagreement.

For whoever it was who doubted I had really worked on all the campaigns I said I worked on, THAT showed the Democratic Party I was proud to be involved with in the 1970s and 1980s. Respectful tone (most if not all the time) but clash of ideas---and out of that clash sometimes comes better ideas. So much better than the doctrinaire Republicans who want everyone to think alike!

Maybe I am wrong, but it seems the Nelson Senate abortion language may not be as bad as Stupak--evidence being how Stupak dislikes it.

Maybe leave that Nelson language in (Right to Life also dislikes that language apparently), and get the bill out of conference in whatever form possible.

There is an old saying that if everyone hates something, it is probably pretty good.

In the 1980s, the Wisconsin legislature passed a bill with a title like ABORTION PREVENTION AND FAMILY RESPONSIBILITY ACT.

Ever noticed how many anti-abortion types don't like details? Wisc. bill was 9 pages of details. For example, rather than all the paperwork and (in Oregon's case, creating a cause of action to sue for "failure to adequately notify" which turned out to be one of the reasons the bill died in the House due in part to a powerful pro-choice Republican state rep.) regarding parental notification, it did things differently.

There was a new kind of advocate created, sort of person who might have CASA or rape victim advocate training. This type of advocate was available to go with the teen girl to notify her parents. I always thought that was a great idea---good way for an adult set of eyes to spot potential for child abuse or whatever if the parents were upset.

It is time we started talking more about details and less about labels. That's what we did in the 1970s and 1980s. Outside of whether a person had worked on a particular campaign (esp. contested primary) or a particular issue, it was all about accomplishing goals (campaign win, getting legislation passed, etc.)

And I did love Sen. Paul Kirk's statement to Dean in a floor speech, "Well as one former DNC chair to another, I AM a Senator and I will be voting for this bill!"

When is Thune up for re-election? Maybe he should be a target. He never was very bright about issues, and after all, he's the guy who defeated Daschle.

All those of you who don't think it matters if a Democrat you don't totally agree with is defeated, look at S. Dakota. Is Thune really better than Daschle on his worst day in office?

The whole point of healthcare reform was to cover more people and reign in the out of control costs. Before it was done the healthcare companies would have experienced a stable but much less lucrative future. Instead it was turned into the opposite. It is a bonanza for corporations and the proof is healthcare industry stocks are soaring. Heck of a job, Congress. So now it's time to listen to how historic it all was.

This bill, if I understand it correctly, further enthralls us to the tender loving hands of large corporations. That is the problem. That is why Bernie Sanders should have killed this bill.

I do not demand that we get single payer right away. We should have. It is the only logical, moral thing to do. But let that pass.

I only ask that we don't go backwards and further entangle ourselves into the grip of corporations who, by their very nature, only want to take as much money as they can while we are healthy and then drop the level of care by any means necessary when we are sick. That is their essential nature, they cannot change it, no one can. There is no "reforming" it; the instant an organization veers from this trajectory it ceases to be a corporation and so violates the law and invokes the furies (its stockholders and directors).

The Senate bill does NOTHING about this essential problem except make it much worse than ever. The mud is deeper from which we are inevitably going to have to extract ourselves.

Moreover, Greg D. is right. The Democrats are writing their political epitaph. Poll after poll after poll says: SINGLE PAYER GODDAMMIT NOW. Children get it. Hell, I think I could make my dog understand this. Only shills like Wyden (and some of the commentators above) think its possible to fool people about this over the next two election cycles.

It's a recurring theme in American studies . . . the moment of change that passes away unfulfilled. Populism. Reconstruction. The Great Depression. The 1960s. And now this.

Sanders should indeed have killed this turkey. But wait. Maybe his no vote would not even be counted. Remember, he put a "hold" on Big Bad Ben's nomination to the Fed Chair. And yet it seems to be full speed ahead.

Look. Sanders is Hartmans friend. How sweet. But if he has anything to be remembered for it should be a no vote on this monstrosity. It is clearly too late for Wyden and Blue Oregon. Dirty Deeds. Done Dirt Cheap.

Considering this is the most dysfunctioanl group of people ever (can hardly wait to see teh bounce in Obama and Congress' ratings) - Yes.

Issues: - No one know what exactly is in it (including Reid's last minute 400-page add-in) - Obama/Reid/Pelosi are driving this with no other goal than to get a "bill" shoved thru - The amount of pork doled out to get votes (Nelson anti-abortion stuff, Landrieu's several $100M for LA, Dodd's $100M for a hospital, etc.) staggers a mind just getting used to a $1T deficit now.

It did get one yea vote, though. Health care stocks had a huge rally once the Senate approved this piece of sausage.

Finally, equal-opportunity screwing over regardless of poilitical persuasion. Yet nothing is probably changed.

These people in Congress and Obama's admin are geniuses.

One more thing - It does absolutley nothing to reign in costs (at least according to the CBO) which is really the root of a lot of the problems I thought we were trying to address.

Back up one second. You're going to follow Howard Dean's lead after telling us for 2 years that he's too radical?

Is this a change of heart, or strategic positioning?

"No one know what exactly is in it (including Reid's last minute 400-page add-in)"

Not necessarily so. According to Howard Dean, investors boosted shares for health(?) insurance industry stocks last Friday to their highest level in years, which suggests they knew something. Probably that the senate would vote for the bill the lobbyists wrote.

As for the option of taking what is offered now and hope to work to improve it later, lots of luck on that. If a sizable majority are satisfied with this bill (until maybe they read the fine print) then very few will give a damn about those who are still left on the gurney outside the emergency room and they'll stay there until they die.

There's another option: Tell Congress they made a start, but it isn't good enough. Now get your butts back in there, return your bribes to the insurance industry lobbyists, and don't come back until you have it right.

If that doesn't work, then the next option in November 2010 is to let those who sold out know that they are fired.

Al Franken just made my $100.00 campaign contirbution pay off again. The next time he smacks down another Republican liar like Thune, I'll send him another hundred. Way to go Al!

Ditto Pedro! It was worth all that time waiting for the recount to decide Al was elected!

For those who want to "reign in" costs, this from dictionary.com

reign
n.
Exercise of sovereign power, as by a monarch.

The period during which a monarch rules.

Dominance or widespread influence: the reign of reason.

intr.v. reigned, reign·ing, reigns

To exercise sovereign power.

To hold the title of monarch, but with limited authority.

rein –noun 1. Often, reins. a leather strap, fastened to each end of the bit of a bridle, by which the rider or driver controls a horse or other animal by pulling so as to exert pressure on the bit.
2. any of certain other straps or thongs forming part of a harness, as a checkrein. 3. any means of curbing, controlling, or directing; check; restraint. 4. reins, the controlling or directing power: the reins of government.

–verb (used with object) 5. to check or guide (a horse or other animal) by exerting pressure on a bridle bit by means of the reins. 6. to curb; restrain; control.

Dan Petegorsky smugly posted this bit of idiocy on the other thread:

Anger, frustration and disappointment about the Senate bill are understandable and warranted. But they don't necessarily guide us towards effective next steps. For what it's worth, here's a piece ("Why I Still Believe In This Bill") from Jacob Hacker, often dubbed the father of the public option.

Hacker, and Dan, might have some credibility had Hacker not posted this ("You Call This a Compromise?") just two weeks earlier when it was known that all of the essential of the Senate bill he mentions would be in the bill.

This includes President Obama. He made the public plan part of his promise of change in 2008. Now he needs to put his weight and influence behind the public plan and its essential goals, rather than allow them to be gutted. This is in our nation’s interest. It is also in his and his party’s political interest. A bill that forces people to take private insurance but doesn’t create competition or a public benchmark is a prescription for unaffordable coverage, runaway costs, and political backlash. The “middle ground” is nowhere to stand if it’s going to crumble beneath you.

The fact is Hacker is NOT the father of THE public option, he is just a self-promoting egotist of A public option. The idea had been around for a LONG time, in much better forms this his questionable version. The evidence certainly suggests that by the time he wrote what Dan got all smug about he must have felt he had to do something to assert he was still relevant. Pretty good example of what it means to be an arrogant, elitist, too, who thinks we of the great unwashed masses are too stupid to have notice.

I just thought of something: You have the GOP - traditionally the pro-business party at every turn - and nobody voted for the bill. Then you have the bill - pro-business as it turns out at every turn - and the Dems vote for it 100%. Sort of lends credence to the argument that the 2-party system is just a charade to distract us while the fascists who are really in charge slowly squeeze the life out of America.

"A bill that forces people to take private insurance but doesn’t create competition or a public benchmark is a prescription for unaffordable coverage, runaway costs, and political backlash."

When the British tried to force taxes and customs duties on the American colonists, the latter regarded this as tyranny and eventually rose in rebellion against the follies of King George III and his government. The question now is, "Will the current crop of Americans accept another form of tyranny in being forced to buy insurance to increase corporate profits?" Could be. However, taxes seem to be about the only thing that motivates enough Americans to influence the government. It's okay to start illegal wars, violate the Geneva conventions, shred the Constitution, and reward corporations with taxpayer money in exchange for campaign donations, but tapping ciizens' wallets directly is pushing the button that might wake them up.

Hard to understand the political calculation behind this bill and how the Dems think it helps them.

Mandated insurance purchase, no tort reform, insurance companies not allowed to sell across state lines, no buying prescription drugs from Canada, and all the “benefits” fail to kick in for years. And that’s just for starters.

On top of that it was passed on a strictly party-line vote, nothing bipartisan about it. They should call this mess what it is, the Health Insurance Company Stimulus Bill.

Do the Dems really think voters are going to smile politely and eat this feces sandwich?

If this Frankenstein’s Monster of a bill is not killed on the operating table of Congress the Dems may be handing both the House and Senate to the Repubs in ‘10.

Dan Petegorsky, what is your point? Except to provide an object lesson in just how little too many who call themselves "progressives" have to offer.

Are you arguing in support of what Dayen terms Hacker's "conciliatory" approach in which Hacker argues for passage of the Senate bill as a starting point, or in support of Dean's "aggressive" approach in which Dean argues for killing the bill because it is a bad starting point? Because Dayen is definitely arguing in favor of Dean's intelligent, tough, politically saavy approach, (Dean was a governor, you know), and savaging Hacker's cowardly, smarmy, "advocacy", (Hacker has been an ivory tower academic all of his professional career.)

Dayen's point is that those who adapt Hacker's weak-willed position criticize Dean actually have no valid argument on the substance to criticize Dean as they shamefully have. If they believe what they actually claim the believe. They are shamefully wrong in their cowardly criticism of Dean and those agree with him because "what we have seen over the past several months of this debate is that the aggressive voices get heard."

Politics in a representative democracy is a vicious, adversarial process with legitimate risk. What do you think the whole "sausage making" metaphor is about? It is right that it is that way, because no one is entitled to have their legitimate desires honored ahead of anybody else's. All too often the obnoxious, lazy, childish, whiners we see in the Democratic Party, and particularly in the NW and DPO, are either resentful everybody is just not acceding to their elitist sense of privilege and entitlement, or just really are selfishly out for themselves and so don't feel any particular moral obligation to stand for anything that isn't directly of benefit to themselves. My observation is that frequently both are the case.

What Dayen is actually arguing quite effectively is how Hacker and those who share his viewpoint lack the required courage of their professed convictions and certainly demonstrate little integrity of character. And he's right. It's a tough world out there Dan, so crawl in hole and get out of the way if you're not capable of dealing with it.

"For those who want to "reign in" costs, this from dictionary.com"

And your point is?

I thought that was the central issue, not whether we have quality medical care, but how do we pay for it - which this 2400-page (I think, that may increase by the minute with Harry Reid) doesn't address. At worst cass, the CBO says it wil even increase costs faster.

This thing stinks more each time you smell it.

IT MAY NOT BE THE BILL I WOULD HAVE WANTED. BUT I'TS SURE A LOT BETTER THEN NOTHING. THE GOP SAID NOTHING BUT NO FROM DAY ONE BECAUSE THEY HAVE NO INTEREST IN HELPING THE CONSUMER

Posted by: Bill McDonald | Dec 21, 2009 8:22:18 PM

I just thought of something: You have the GOP - traditionally the pro-business party at every turn - and nobody voted for the bill. Then you have the bill - pro-business as it turns out at every turn - and the Dems vote for it 100%. Sort of lends credence to the argument that the 2-party system is just a charade to distract us while the fascists who are really in charge slowly squeeze the life out of America.

I've been calling it the two-faced, one party system on here for 4 years. Good that we're gaining so many Dems over this, but not a word of this is news to real, experienced progressives. They stand out here because they ask direct questions that undercut the spin assumptions, but never get a word of response. Let's see...yup, there's one now. "Undomesticator".

What really surprises me is that the average progressive is not nearly as silly as the pundits are.I am so tired of the all the whining from Huffington Post to Schultz.I am a lifelong and proud liberal.But I am also a American.Is it really fair for the minority view to run total ramshod over the majority?No it is not!We the liberal and progressives are less than 25% of the total electorate.That we can even talk about health care and other issue that are dear to our hearts says alot about our power.We worked to get President Obama elected.Now are we are working twice as hard to make sure that he is 1 term President.Please,he cannot and should not give us everything that we want.It is not his job to enact legislation.It is the congress job.He can only lead.You all have missed the point.Before Obama no one since Clinton has even talked about Health reform.Now after less than 12 months we are on the cusps of doing something that has not been done in 100 years.Is it perfect?nothing is.Will it make a positive difference?Yes it will.Will it be made better in future?I truly hope so.To kill it now will surly mean Republican takeover in 2010.If that happens then what?Arainna Huffington and Ed Schults are already rich.They can afford 20 more years of Republican mis rule.We the average working class cannot.Please let not kill the goose just right now.I will close with one question.Were you better off politically 4 years ago than you are now?

When the health care reform effort began, I had great hopes for very comprehensive reform. Unfortunately, we didn't achieve that. That said, I still think the bill going forward will provide us with some of the reforms we desired and it should stay alive.

Does that mean that we quit advocating for comprehensive reform? No. We continue our fight in the next Congress and we spend the coming election year getting rid of some of the creeps that stood in the way of true reform. We also use the coming election to support those great Democrats who stood up for comprehensive reform and almost succeeded in delivering something meaningful.

Were you better off politically 4 years ago than you are now?

So it's better when unresponsive jerks that don't represent you kind of do what you want, than when unrepsonsive jerks that don't represent you blatantly do what they want?

I'm simple minded. It's a representative gov and they don't represent us. Nothing after that point is worth thinking about.

The population and reps are staring to sound like the kind of woman that concludes her BF is a complete jerk...then calls you ever other day to tell you what he's done now. Punctuated, of course, by days when "he wasn't a total jerk today". It gets old real fast because you accepted day one that he was a jerk. Why continue adding data?

Both want to believe what they know is not true. Can anyone cite me an example where the behavior leads to a good relationship? In every case I know, she eventually accepts what she said herself, day one. and her BF is the only one better for the delay.

How long are you going to dissect what the Dems did today, before you realize that they don't represent you, never will, and kick them to the curb?

Point 1: How can this bill change the primary problem with healthcare, which is costs, when there are so many pork-bellied buy offs in it.

Point 2: Why does the abortion issue need to even figure into this? Other than when it is medically necessary for the safety of the mother, reproductive issues are a matter of individual choice and lifestyle and not really a health matter. We should not be paying for abortions or vasectomies, as they tend to be as much a choice as plastic surgery.

I'd truly would like a reply on both of these as you will.

Re: "The individual mandate is probably not constitutional."

How about Obama's slaughter in Pakistan, Yemen and Somalia (without Congressional approval)? How about His continuing support for Bush Administration torturers? How about His support for illegal corporate surveillance?

Isn't it obvious that we no longer are a Constitutional republic? The Constitutional Scholar-in-chief doesn't think so, and his acolytes don't care.

Proportional.Representation.

Don't make everything depend on 50%+1 magic vote and then complain about the tyranny of the majority!

We should not be paying for abortions or vasectomies, as they tend to be as much a choice as plastic surgery.

So, how can the "greatest country on earth" not manage what the Netherlands does...plus, sex change operations! For 13 year olds!

<h2>Somethin' don't cipher!</h2>