
Senate Majority Leader Harry Reid got his 60 on Saturday, and when the Senate returns from Thanksgiving recess next week, they'll be debating and amending a major piece of health care legislation. However, the vote, and its aftermath exposed or clarified the cleavages within the Democratic party that will have to be bridged if Reid hopes to keep his caucus in line on the next cloture motion--to end a Republican filibuster and hold a simple majority vote on reform.
If you thought the opt-out compromise was a silver bullet for the public option, you may have gotten a bit ahead of yourself. It held up for a while, and could still survive, but that's going to require some interesting gymnastics from Democratic leaders. Leading up to Saturday's vote, and in its immediate aftermath, conservative Democrats entrenched their opposition to the public option in the Senate bill. Sen. Joe Lieberman (I-CT) repeated his threat to support a health care filibuster if it includes a public option of any kind, and, despite her earlier support for the provision, Sen. Blanche Lincoln (D-AR) took to the Senate floor Saturday and announced, "I'm promising my colleagues that I'm prepared to vote against moving to the next stage of consideration as long as a government-run public option is included." That gives her a bit more wiggle room than Lieberman's left himself, and Sens. Mary Landrieu (D-LA) and Ben Nelson (D-NE) have a bit more still, but that makes 60 for the opt out a tough climb. On the other side of the caucus, though, Sens. Bernie Sanders (I-VT), Sherrod Brown (D-OH), and Roland Burris (D-IL) have inched closer to threatening to block a health care bill from the left if the public option is weakened further. If reform is to pass, one side of the caucus will have to hold its collective nose and vote for something they don't like.
Leading Democrats are working with some of the centrists to find a solution that works for everybody, but those negotiations are nascent and sensitive and swapping out the opt out plan in the bill for something new could require the assent of the entire caucus.
Progressive Democrats in the House, meanwhile, insist that none of these Senate compromises will fly in the lower chamber after conference committee.
And that's just the biggest flashpoint. The others--taxes, abortion, unauthorized immigrants, the start-date of the key reforms--inspire less public hand wringing, but, in a reactive environment, could become silent killers.
The countervailing dynamic is that, after months of wrangling, and with the final votes in site, Democrats have simply invested too much effort, and have put too much on the line, for the party to fail because of intra-party disagreements over narrow provisions. As Brown put it on CNN's State of the Union this Sunday, "[I]n the end, I think that all four of our colleagues surveyed this -- look at this bill in the end and say, I don't think they want to be on the wrong side of history. I don't think they want to go back and say, you know, on a procedural vote, I killed the most important bill in my political career. I don't think they want to be there on that. So I think in the end, we get them."
They certainly got them Saturday. For weeks, conservative Democrats held out on the motion to proceed. But in the days before the vote, the pressure not to let health care come to naught simply became too intense. It's easy to imagine things playing out similarly in the days ahead.
cmpnwtr
November 23, 2009 11:55 AM
Memo to Dem. Congress: No bill= handing Congress to GOP for another generation. 45 thousand dead each year. Grow up, people!
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Steaming Pile
November 23, 2009 1:38 PM in reply to cmpnwtr
And a more virulent version of Republicanism than last time - something akin to Fascism. You can bet on that.
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expat46
November 23, 2009 12:01 PM
Sorry for re-posting this question in multiple threads but could someone explain to me why the Dems can't simply pass HCR without the public option and then put the PO in a budget reconciliation bill later?
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cmpnwtr
November 23, 2009 12:12 PM in reply to expat46
Thanks, I was wondering about that myself?
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expat46
November 23, 2009 12:31 PM in reply to cmpnwtr
It seems like common sense to me that we could get 90% of what we want in the Senate bill and then put a robust public option in a reconciliation bill later.
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FreeRider
November 23, 2009 12:31 PM in reply to expat46
The conference version of the bill can NOT be amended but it CAN be filibustered.
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expat46
November 23, 2009 12:35 PM in reply to FreeRider
I'm sorry but I don't understand. Are you saying that it's not possible to put the PO in a reconciliation bill later?
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Indie Pro
November 23, 2009 12:39 PM in reply to expat46
yes it could, if the will is there
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Cool Blue Reason
November 23, 2009 1:22 PM in reply to Indie Pro
Indie Pro, I'm not sure the will is there to do reconciliation (whether separately or "after" as you suggest). Unfortunately, the only way to truly get Lieberman & company on board at this stage is to make it clear that the alternative -- a reconciliation bill structured for 50+Biden votes -- will hurt the insurance industry a lot more than what is currently on the table for 60.
To the extent that Reid is unable to make the reconciliation threat credibly, I'm starting to think that we should try for some kind of "grand compromise" that cuts out Lieberman and brings in the senators from Maine. Yes, I'm talking about a "trigger."
The key would be to make sure that as part of the grand compromise, the PO on the other end of the trigger is "robust" (i.e., available to all and tied to Medicare rates).
Then make the trigger mechanism as real as possible and as sensitive as possible. If that is the way it is structured, with a robust PO on the other end, it will be a Sword of Damocles hanging over the heads of the insurance companies in the coming years.
As much as we all instinctively want to try to go for a PO from "day one" (which in fact means 5 years from now), I think the non-triggered PO we are likely to get will be "a P.O.S. from day one." Not only that, but the insurance companies will no doubt take the next 5 years as an opportunity to gouge the public and blame it on the HCR law in an attempt to have Congress repeal it post- 2010, 2012, 2014, etc. -- or at least scale it back further.
A "hair trigger" with a robust PO on the other end of it would have a chance of avoiding that outcome, and could lead to substantively better outcomes overall -- whether or not it is triggered. If our objective is in fact to create a PO that would disrupt the market power of the insurance industry, a triggered PO could actually create leverage that is effective from the day HCR is signed, as opposed to years from now when a non-triggered PO actually goes into effect (and if the non-triggered PO is so watered down that it can't disrupt the insurance companies' market power anyway, the entire thing will be moot).
In sum, if we blow our wad now on a watered-down, non-triggered PO, our leverage will have peaked, and the usual suspects will spend the next 5 or so years chipping away at even the modest edifice we will have erected. On the other hand, a trigger mechanism, if structured properly, could over time actually preserve and even increase our leverage over the insurance industry. And if it takes the form of a "bi-partisan" Senate bill that cuts out Lieberman from negotiations, so much the better.
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Tanjaoui
November 23, 2009 2:45 PM in reply to Cool Blue Reason
How could you avoid it being triggered state by state, creating weak state-wide POs? Would high prices by one company be enough to trigger a robust PO for the whole country? How is it triggered?
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FreeRider
November 23, 2009 2:02 PM in reply to expat46
Yes, they can put the public option in the conference bill. But Lieberman, et al can still filibuster it which would kill it.
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Docb
November 23, 2009 1:30 PM in reply to expat46
The PO will be the only way to get competition into any reform!
70+% want a public option and congress can not get it right but there will a cleanup on both sides of the aisle if nothing passed at all...History has not borne out that they will go back and strengthen anything! They more on to re-election immediately... Chicken livers all...But repubs are the worst I have seen in 50 yrs in politics! REVOLTING
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Odel Roo
November 23, 2009 2:39 PM in reply to Docb
4 to 6 million by CBO estimates of either bill will not ever be competition. Both have scored as being more expensive and will as one congressman put it "Ghetto" coverage.
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Indie Pro
November 23, 2009 12:05 PM
the best things liberals and progressives could do now, if not work to kill this reform all together
is to allow the PO to die (it is in name only anyway, at this point),
but only after they are successful in trumpeting that it is CONSERVATIVE democrats and the CONSERVATIVE GOP who are killing the PO and all other cost controls, like bringing the industry under AntiTrust laws, etc.
Tie conservatives (centrists, corporatists) and Dem leadership to the same philosphy (their philosophy) that has brought the US the loss of jobs due to free trade and nafta, a declining middle class, stagnant wages for decades, and deregulation and more corporatism.
When premiums and healthcare costs skyrocket, the blame is on conservatives of the D and R variety, as well as the leadership sheperding this legislation.
Tie it all together: the lack of a PO and cost controls and little regulation in HCR to conservatives of both parties. Name them. Write editorials, and call out all these representatives of the status quo and corporate greed.
That is what liberals and progressives should be working on!!
Conservatives (D & R (or centrists)) have killed the public option, bringing the insurance industry under antitrust laws, and any meaningful cost controls, regulation or oversite in healthcare reform. Obama and the Dem Leadership haven't sufficiently promoted or fought for these needed components either.
When people are forced to pay skyrocketing premiums, and healthcare costs go up, let the balme fall where it should be.
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Indie Pro
November 23, 2009 12:06 PM in reply to Indie Pro
if this reform is what Obama and the Dem Leadership are gonna hitch their fortunes to, let 'em.
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Dorn76
November 23, 2009 12:17 PM in reply to Indie Pro
I understand this position, but how do you get to what you want from there?
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Indie Pro
November 23, 2009 12:19 PM in reply to Dorn76
What do you mean?
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Dorn76
November 23, 2009 1:06 PM in reply to Indie Pro
I mean, if HCR fails now, how do you get to another bill with "real" reform, robust public option, etc?
Or would you prefer to jettison the PO, and pass a bill, then reintroduce a real PO later on?
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Dorn76
November 23, 2009 1:08 PM in reply to Dorn76
Sorry, brain cramps today. Just trying to see what you think the best strategy for getting a genuinely good reform would be.
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Indie Pro
November 23, 2009 1:10 PM in reply to Dorn76
no worries.
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Indie Pro
November 23, 2009 1:09 PM in reply to Dorn76
Or would you prefer to jettison the PO
that is what my comment says
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Tanjaoui
November 23, 2009 2:54 PM in reply to Indie Pro
Do you think they could trade for it (get repeal McCarran-Ferguson antitrust exemption, pass ERISA exemption for states that pass single payer...or trade the weak PO for mandates), then try to pass a real PO later, using reconciliation? A PO that can't be refused by any provider that accept Medicare and Medicaid, that is allowed to bargain, together with Medicare and Medicaid with providers, including Big PhRMA, a PO available to any- and everyone.
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Indie Pro
November 23, 2009 3:00 PM in reply to Tanjaoui
If it wins better controls, they should try.
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Viva!America!
November 23, 2009 12:55 PM in reply to Indie Pro
The blame will fall on Democrats. As long as they have a (D) in front of their name, they will get blamed for it. Most Americans have no clue or very little information on the difference between a Liberal, a Progressive and a Conservative Democrat. You are all Democrats. I STILL don't know the difference between a Lib and a Progressive. And I don't know who is a Conservative Democrat until someone from the Left labels them as one.
There is no way that the Left, who is often ignored and stereotyped by the media, is going to convince the majority of Americans in a little over a month that the Conservatives of either party are bad for America. Who are you? What do you stand for? Why should I trust you? The Left cannot execute this plan effectively before the bill passes.
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Indie Pro
November 23, 2009 1:01 PM in reply to Viva!America!
Then they should oppose it.
But I don't agree with you, on a whole. Establishing the record is what is important.
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Viva!America!
November 23, 2009 1:12 PM in reply to Indie Pro
You really think that most Americans know all these subgroups of each party and what they stand for?
The MSM doesn't ignore the Left?
What's important is that people know who you are and what you stand for. And they have to trust you. That takes a lot of time.
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Indie Pro
November 23, 2009 1:15 PM in reply to Viva!America!
most Americans don't vote or care.
a journey starts with small steps. It is time for the left to begin differentiating themselves.
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Dorn76
November 23, 2009 1:34 PM in reply to Indie Pro
"A journey starts with small steps".
Why not take this position on HCR?
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Indie Pro
November 23, 2009 2:07 PM in reply to Dorn76
because you left out the reform.
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Dorn76
November 23, 2009 3:38 PM in reply to Indie Pro
But there are some real reforms in there, the State by State impact was just released today...
Of course it isn't a great bill, but you're being cute saying we left out "reform" altogether.
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Indie Pro
November 23, 2009 3:54 PM in reply to Dorn76
"A journey starts with small steps".
Why not take this position on HCR?
I think you're being cute saying you don't understand the difference between liberals differentiating themselves from the democratic leadership -small steps here doesn't throw the electorate to the industry wolves
and healthcare reform that mandates people buy a product, but leaving out any true oversight, regulations or competition. -small steps here does throw the electorate to the industry wolves
The senate bill doesn't even put the industry under antitrust laws for pete's sake. Come'on.
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Dorn76
November 23, 2009 1:29 PM in reply to Indie Pro
We are hopeless at branding, though.
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CT Voter
November 23, 2009 12:10 PM
If Joe Klein is right, this is genius:
Start asking those conservative Democrats (and the weasel from CT) why they're unwilling for hardworking Americans to have similar benefits to theirs?
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ru4862
November 23, 2009 12:25 PM
If there is no public option in the final senate bill them members of congress should give up their government sponsored health insurance.
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traitorjoe
November 23, 2009 12:34 PM
Without government sponsored insurance, Joe needs to beg his wife's employers to insure him because of pre-existing conditions including hypocrisy, shingles, narcissism, excessive patronizing, hemorrhoids and chicken hawkus.
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jimbomoron
November 23, 2009 1:10 PM
Hey Brian,
Here's my list of possible amendments to the bill. They mostly focus on affordability and risk selection:
1. Increase the minimum actuarial value of the Bronze Tier to 70 percent, the Silver Tier to 80 percent, and the Gold Tier to 93 percent (House has a minimum actuarial value of 70 percent)
2. Lower -- or better yet, eliminate -- the oldest age which someone can purchase a policy having 50 percent actuarial value to 26 (House doesn't have a young invincible policy)
3. Decrease the age rating from 3:1 to 2:1, scrap the smoker rating and the prevention and wellness rating for private companies (this is the same as the House's rating rules and that of Massachusetts)
4. Increase the income exemption for the individual mandate penalty from 8% to 15% of income
5. Begin the $750/person, half for a minor, individual mandate penalty when the community rating begins (House is 2.5 percent of income)
6. Get rid of the free-rider provision, have a real employer-mandate, and use the revenue from the pay-or-play requirement to increase the subsidies for the 100-300 percent FPL level
7. Increase the standards for plans to offer health insurance on the Exchange -- in other words, increase the Exchange's bargaining power
8. Require insurance companies who sell across state lines to abide by the regulations where the purchaser -- not the insurance company -- resides
9. Set the beginning date of the Exchange to 2013 by lowering the excise tax threshold to $8,000/$21,000 plans or $6,000/$17,000 adjusted for CPI-medical rather than CPI+1%
Please feel free to tell me what you think.
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Indie Pro
November 23, 2009 1:17 PM in reply to jimbomoron
your number 8 is an execellent
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Schmed
November 23, 2009 1:11 PM
If there's no PO, then the mandate should die as well. You can't put a gun to everyone's head to benefit only the insurers.
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Indie Pro
November 23, 2009 1:16 PM in reply to Schmed
or be further weakened, I agree.
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GTFOOH
November 23, 2009 2:20 PM
Those two look like they just joined the cub scouts!
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Progressive Party
November 23, 2009 2:30 PM
I don't believe the public will blame the demccrats if the HCR fails to get passed. The GOP and the conservadems who stand for nothing but the status quo and killing the bill will pay a huge price! The public knows the health insurance industry is about money and profits and are cruel and grossly inhumane. Those who stand and fight for reform and lose will be far better off than those who will kill it. Define the issues and let the GOP and others kill it. I. and many others, will fight the bastards in 2010 and 2012 with our money and our votes to run these fuckers out of office!
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PurpleAvenger
November 23, 2009 2:43 PM
What I don't get is: Why can't the progressive dems use the threat of reconciliation to back off the blue dogs? Something like, either shut up about this circumscribed public option, or we'll use reconciliation to push thru a mandatory and broader public option (which, frankly, I think they should do anyway)?
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Tanjaoui
November 23, 2009 2:59 PM
The trick is to keep it bumper-sticker simple and repeat it over and over.
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Moose49
November 23, 2009 3:04 PM
It is pathetic that things have gotten to the point that several members of the Democratic caucus have no compunction at all about equating their vote on a procedural matter -- cloture -- with their vote on the merits of an amendment or the legislation as a whole. This should have been off the table on day one with the widespread understand that joining any Republican filibuster on a top priority issue is grounds for dismissal from the caucus.
Why can't Blanche Dubois Lincoln, Mary Moron Landrieu, Joe Schmendrake Lieberman and Ben Mutual of Omaha Nelson live with an up or down vote? If they would rather see the status quo remain and 47 million Americans stay uninsured than have health care reform with a public option, put it a vote. If they win, they win. If they lose, they live with the consequences. They vote no on final passage -- and must be held accountable for that -- but they let the majority rule because this is a democracy.
Failing this realization, Reid should just say fuck it and go to reconciliation.
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onecrappyusername
November 23, 2009 4:19 PM in reply to Moose49
That is exactly what I've been wondering about. The whole idea that voting for cloture means supporting the bill ipso facto...where the hell did that come from?
I can see the progression from someone saying "the dems need 60 votes in order to break a fillibuster" to "they need 60 votes to get this done/pass the bill" and having that get stuck in the collective consciousness of the mildly informed. But I can't see how the situation has then come to allow a handful of opportunistic twits to take advantage of that confusion, to ignore any and all responsibility they have to their party, nay, to the whole god damned democratic process, and not even be called out on it. There should be counter-parties to that movement of thought in the democratic party and in the media. But there's not.
As you said, pathetic.
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Tanjaoui
November 23, 2009 3:21 PM
I don't think there are many Senators who care that much about the Public Option or HCR in general. Obama doesn't want to rock the boat. He's content to score a few minor victories - stuff everyone can agree with - and get reelected with a lot of corporate support.
Basically, I agree with what Indie-Pro's saying (if I've understood him correctly): short of stripping the PO from this bill and passing a much more potent version using reconciliation, I think a few progressives (Sanders, maybe Brown) should help to kill this bill. Sometimes things have to get a lot worse before they get better. It isn't how things should be, but it's how it is. Americans are pretty immature about government. They want the best health care in the world and they don't want to pay for it. So until they're backed up against a wall of personal financial disaster, they're not going to get behind real reform. As bad as things are, they aren't bad enough yet.
What would really make sense is single payer Medicare for All financed by a value added tax.
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Stephanie Hunter
November 24, 2009 1:03 PM
We learned that there's still a lot of work to do, but also that it is attainable! Knowing how much good the public option is already doing, I'm very excited by this possibility! http://cli.gs/z3AtaY/
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