
At sundown on Friday, Democrats didn't have a lock on health care reform. That changed late Friday night over a handshake between Sen. Ben Nelson (D-NE) and Senate Majority Leader Harry Reid. On Saturday, Reid signaled his confidence that his party was unified and ready to move forward by drawing the amendment process to a close and committing the Senate to voting on his bill. At 1 a.m. Monday morning, Reid proved he was right: All 60 Democrats voted to move ahead with reform, demonstrating with one procedural vote that they will pass major, historic, controversial legislation.
What stands between Senate Democrats and passing legislation now are a series of yet more procedural votes, which will likely take place over the next four days, culminating in a final up or down vote on reform, on Christmas eve at the latest.
That could come earlier, if Republicans accept what everybody knows: they're in checkmate. Barring a truly shocking development, health care reform will pass--can pass today, in theory--and at this point the delays have nothing to do with Democrats coming to agreement, and everything to do with Republicans maximizing the amount of time they can squeeze out of the legislative process under the rules of the Senate.
Already, even swing-vote Democrats are talking about the bill as if it's already passed. "The next step, of course, will be to see what happens with the conference," said Sen. Ben Nelson.
Once the bill has passed, a new tussle will begin. Democrats in the House and Senate will have to put their two bills together and come out with a single piece of legislation that can win a majority in the House, and a supermajority in the Senate. And it could get ugly: The conference negotiations--likely to take place informally in discussions between Democratic leaders and the White House--will touch off a major ideological fight among progressives and the Democratic party.
Rounding up a filibuster-proof majority for health care reform required Reid to make major concessions to conservative Democrats in the Senate, and they are now insisting that they will filibuster the final package if those concessions are undone. But liberal members of the House, and progressive pressure groups won't take that lying down. Because conservative Democrats have more leverage than do their progressive counterparts--because each one has the power to kill the legislation, and have been clear that they will if the bill moves significantly to the left--the smart money is on House liberals being asked to swallow a bill that doesn't contain many of the provisions they value the most. Particularly, the public option.
And that will widen an already yawning rift between the progressive base and the White House and Democratic leadership. How that all shakes out--what liberals get in return for accepting a less progressive bill, who decides to support the bill, what the outside groups do, and how the party responds--is where the action will be in the weeks ahead.
Maritza
December 21, 2009 9:09 AM
I think that Obama needs to put in the budget bill for 2011 money so that states can start their own public plans which in turn states can bundle up together to fight insurance companies.
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Cool Blue Reason
December 21, 2009 9:37 AM
Can someone explain to me why they can't simply do the following:
1. The White House and Democratic leadership in the House and Senate make an agreement.
2. The House "ping-pongs" the Senate bill, unaltered, to the President's desk.
3. The current, "big" reform bill passes into law.
4. The House and Senate pass a follow-on bill, using budget reconciliation rules, to add in a public option and whatever else they can get with only 50+Biden votes in the Senate.
Why the hell isn't anyone talking about this scenario? It would mean a solution that is pretty close to maximal from a public policy standpoint, but not one more damned cloture vote in the Senate after the one on December 24. No conference, sign the bill before the end of the year, and bust out reconciliation in January.
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Seafarer
December 21, 2009 9:44 AM in reply to Cool Blue Reason
They're afraid to piss off the Republican elite and the screaming lunatics of the Ultra Far Right, like the Tea Partiers, the Birthers, Rush Limbaugh and Free Republic/Red State goon squads.
The path you describe is best for America; but it would send the above into fits unseen since the day after Nixon.
Our leadership is too scared to stand up to bullies.
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Cool Blue Reason
December 21, 2009 10:08 AM in reply to Seafarer
I would tend to agree, but those screaming fits are already happening, and are going to continue regardless of what we do.
I think the administration and congressional leadership would be able to take at least some cover on the DC cocktail party circuit from the fact that there have been repeated attempts at "bipartisan" engagement. It would also help if the could get a good CBO score on a robust public option / Medicare expansion. If they pull it off with reconciliation, we get good public policy, the left comes down off of their collective temper tantrum, and we probably win the support of a lot of people in the middle who will benefit from the package.
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wyt
December 21, 2009 12:55 PM in reply to Cool Blue Reason
Exactly. The Republicans have blown it. They have no more leverage, because they've made it clear that they'll lie on their backs kicking and balling no matter what. So there's no incentive to elicit better behavior from them. Better behavior's simply not in their range. They're like an austistic infant who no matter what kind of love they're shown keeps screaming and running head first into walls, while biting the hands reaching out to help.
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Peter Principle
December 21, 2009 4:26 PM in reply to wyt
They're like an austistic infant who no matter what kind of love they're shown keeps screaming and running head first into walls, while biting the hands reaching out to help.
Except for the fact that many autistic children are actually extremely intelligent and capable of performing amazing mathematical calculations in their heads. And nobody has accused the GOP of being any of those things in a long, long time.
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pirate jenny
December 21, 2009 9:51 AM in reply to Cool Blue Reason
THAT's what i'd like to know...
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matt
December 21, 2009 10:53 AM in reply to Cool Blue Reason
Because the Senate bill is a worthless piece of trash, and the folks with balls in the House are not likely to "ping-pong" it. Instead, let's throw away the Senate bill and "ping-pong" the House bill back to the Senate.
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plynch22
December 21, 2009 11:07 AM in reply to matt
Could you then explain what the next step would be, Matt? OK, so the House sends back its more progressive bill to a Senate that could barely pass a watered-down bill...and then Lieberman, Nelson, Landrieu and Lincoln get knocked off their horses on the way to Damascus?
The kvetching here and elsewhere utterly and completely ignores reality in a way that I would only expect from teabaggers. Punish Lieberman! I agree. OK, and then what? Then he'll vote with us out of shame, and by the way become more progressive? Rant about Nelson! Yeah, he sucks! And then he'll vote with us?
The bill reflects the Senate as it exists. The problem is people got hyped up thinking that we had a "filibuster-proof" 60, but why anyone ever thought all those people were ironclad progressives is beyond me. And why anyone thinks that punishing them would have made them fall in line is more ridiculous.
We are about to pass a minor healthcare reform bill against a mainstream media, a well-funded lunatic right and nearly 50 years of history that all said doing so was impossible. It is a solid and hard-fought victory. And it will leave Obama and the Ds in a more solid position to focus on the economy and jobs in 2010, and prepare for what will be a bloody election season. I implore everyone to get back on board. The train is still moving and is on the right track.
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LBJs Brain
December 21, 2009 11:13 AM in reply to plynch22
Yes. Thank you. The Sentate we have and the *current* rules are what we are dealing with. Get pissed at the Senate rules and a couple of Blue Dog Senators before anyone starts thinking about leaving the Democratic Party and Obama.
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DA in LA
December 21, 2009 12:35 PM in reply to plynch22
Hey, do the separate bodies of government even talk to each other? Is the President allowed to call them on the phone, even?
Your picture of what happened is laughably flawed and lacks understanding of how politics in America work.
Take a look at how Bush got his legislation through and you might understand.
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henk
December 21, 2009 11:14 AM in reply to matt
I agree, why splatter shit all over the table. Send the House Bill right back to the Senate. Of course we all know how the usual cast of characters will react.
But to answer Cool Blue's question: "Why the hell isn't anyone talking about this scenario? "
There is a very good possibility that there are things in the House bill the mess up deals that the White House has made the PhRma and other entities so they don't WANT the House version to pass. Watching all this unfold has lead be to believe that the bill that has come out of the Senate is the Bill the White House wants. Period.
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dustbunny44
December 21, 2009 12:04 PM in reply to Cool Blue Reason
But if they did that, the insurance companies would suffer.
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chitowner
December 21, 2009 12:22 PM in reply to Cool Blue Reason
Nobody's talking about it because the backroom sweetheart deal Obama struck with the corporate health care biggies at the outset is done. Senate Dems will sign on to his deal this week and House Dems in early '10.
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Tulkinghorn
December 21, 2009 1:18 PM in reply to Cool Blue Reason
"Why the hell isn't anyone talking about this scenario?"
The first rule of Ping-Pong and then Screw the Blue Dogs with Reconciliation Club is DON'T TALK ABOUT PING-PONG AND THEN SCREW THE BLUE DOGS WITH RECONCILIATION CLUB!
The second rule of...
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hunter
December 21, 2009 1:28 PM in reply to Cool Blue Reason
4. The House and Senate pass a follow-on bill, using budget reconciliation rules, to add in a public option and whatever else they can get with only 50+Biden votes in the Senate.
Why the hell isn't anyone talking about this scenario?
Well, if you wanted to pursue this strategy, the first thing you'd do is not talk about it. Go off running your mouth about a future end-run around Nelson/Lieberman/Lincoln/Landrieu and they'll ditch you on the first bill. Then you only get the parts of the bill that are compatible with reconciliation. So you can have the public option, and probably the subsidies, but you lose the exchanges and pretty much all the regulations on the insurance companies. I don't think getting a public option but continuing to allow companies to refuse to insure the sick is a good trade.
So, I don't know if leadership considers a future reconciliation patch bill viable or not. My hunch is not. But if they are planning on something like that, I wouldn't expect to hear about it until the regular-order bill is on the President's desk.
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warbaby
December 21, 2009 10:06 AM
It's very odd to think back that the current polarization is a result of passing the Voting and Civil Rights Acts in the early 1960's.
With the newly-enfranchised southern black voters on the rolls and with them guaranteed to vote Democratic, the Southern political oligarchies were guaranteed to cross over to the Republican Party -- as they signaled they would in the 1964 Johnson-Goldwater election. This was institutionalized by the Nixon Southern Strategy in 1968.
This destroyed the Eastern Liberal wing of the Republican Party and removed the Southern Democrats from the ruling Democratic Congressional majority. According to Godfrey Hodgson, this would have happened as soon as the 1974 midterm elections if Watergate had not happened.
So ever since then, we've had to play out the drama of reactionary polarization and progressive frustration at a national level.
We've got to the current situation by a demographic shift. Younger voters supported Obama's presidency. Voters who grew up in a country without segregation and de jure electorally disenfranchised cultural classes.
The current polarization is potentially very destabilizing because the Republican Party is locked into what Chalmers Johnson called "elite intransigence" - a reactionary refusal to engage policies which would address the growing dysfunctional division of labor and status roles (which is essentially what the Tea Party is upset about but unable to comprehend.)
The exogenous shock of 9/11 and the resulting defensive war against Afghanistan followed by the aggressive war against Iraq pushed the country into reactionary nationalism. Now we are trying to rebound from that and restore harmony in social and economic roles.
The manifest insanity of some of the reactionary propaganda (birthers, death panels, concentration camps, gun confiscation, etc ad nauseum) will subside over time, provided there are not additional endogenous shocks (like the collapse of the finance capital system) or exogenous shocks like an attack from outside the country.
The overall situation will be dominated in the near term by the regional differences that dictate House and Senate races.
If you thought this health care ride was crazy, wait until we get around to immigration reform - which is unquestionably the greatest source of dysfunction in the division of labor and social status.
Given this analysis, what the optimal national and local courses for progressives to follow?
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Eric Jaffa
December 21, 2009 10:28 AM
In Conference, they should at least drop the tax on "Cadillac Plans" (which would make people with good insurance get bad insurance) and the "Free Rider" tax on businesses, which encourages part-time employment and low-wages (because employers wouldn't have to reimburse cost of Medicaid but would have to reimburse cost of subsidies for private insurance.)
http://www.commondreams.org/newswire/2009/12/17-4
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Cool Blue Reason
December 21, 2009 10:38 AM in reply to Eric Jaffa
Disagree. The excise tax on high-cost health plans is one of a handful of important measures that create negative cost pressure on health care expenditures (in addition to providing a revenue stream for the program). And I say this as someone with a plan that would likely meet the criteria.
Union opposition to this measure has been short-sighted, I think. We will all be better off if health care spending can be brought under control. And employees would quite often be better off if more of that money were directed to wages instead.
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Cindy Etal
December 21, 2009 10:37 AM
Senator Paul Kirk of MA, in a post on HuffPo on 12/19, reminds us of the incarnations of the Civil Rights Act: 1960, 1964, and 1968. He points out that each piece of legislation was incomplete, but each bill "was a landmark that began the march of progress toward equality under our laws. And each created an environment in which we could continue to move forward so that our country's laws better fit our national character and the principle of equal justice."
Because of the caustic divisiveness this legislation has engendered, owed in no small part to republicans' humiliation at the polls in 2006 and 2008 and their ensuing spite, health care reform will likely follow the same path as Civil Rights legislation -- if we're lucky.
The striking difference is there is no compelling national "movement" toward health care reform as was the case with civil rights legislation. What movement there has been on the ground has been fragmented at best. Without a strong, centralized movement, public opinion has been shaped by allegations, speculation, and hysteria fueled by self-interested pundits and dejected politicians. It's been an ugly, uphill battle. Nevertheless, the groundwork has been laid for future legislative incarnations. To that, I say, "Bravo!"
Kirk's post in its entirety is at: http://www.huffingtonpost.com/sen-paul-g-kirk-jr/a-rebuttal-to-howard-dean_b_398218.html
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LBJs Brain
December 21, 2009 11:22 AM in reply to Cindy Etal
Good post. I agree with the main analogy re: Civil Rights legislation and, you might be interested to read the article in the Dec. 14th New Yorker entitled "Testing, Testing". In it, the author makes a parallel with the creation of the USDA in the early 20th c. His point is that there cannot be a "master plan" for solving the Health Care issues just as couldn't have been for agriculture, but, that the creation of pilot programs and constantly tweaking (managing) the problen eventually solved it. Took time and constant care-just as this will.
Re: no national movement-I see yur point but HCR may not need it in the sense that Civil Rights did b/c everyone knows there is a problem...? Interested to read your response.
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LBJs Brain
December 21, 2009 11:27 AM in reply to LBJs Brain
Not that everyone didn't realize there was a civil rights problem either...
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Cindy Etal
December 21, 2009 11:59 AM in reply to LBJs Brain
I'm not sure if everyone accepts there is a problem -- so many opinions have been shaped by deliberately misleading information.
Thanks for the tip on "Testing, Testing." I'll look for it.
Kathleen Sibelius, in her webcast with BlogHer this morning, pointed out that in 2010 people will see positive changes in health care coverage, particularly movement from a focus on sickness to a focus on wellness. One example she gave had to do with Medicare.
Currently, Medicare covers the cost of amputating the foot of a diabetic. It doesn't cover the four or five less costly steps that would likely save the foot and the self-sufficiency and productivity of the patient. That would change under this legislation for all types of insurance. Care would be paid for to prevent major medical expenses.
Another interesting point she made is that insurance companies will have to make public how much they spend on claims in relation to premiums they collect. This is a movement in the right direction toward making them more transparent -- and making it more obvious that the oft-maligned public health programs are actually much more efficient.
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sabocat
December 21, 2009 12:10 PM in reply to Cindy Etal
Here is a response to the idea that the current process of health care "reform", and the civil rights movement, are in some way similar. From a noted Civil Rights veteran:
What appears to be emerging as health reform in this country is obviously a deplorable travesty and tragedy from many perspectives. Concurrently the caving by many ostensible Congressional liberals bodes ill for what remaining time exists for what seemed to be Democratic moxie and muscle in Congress. Whether this thoroughly mediocre -- indeed, badly flawed and even dangerous -- "health" concoction survives the joint Congressional conference process is speculative. What isn't speculative are this very day's soaring insurance stocks -- e.g., Humana.
One of the rationales from those in Obama's camp is that this sick creation is simply a "first step" and they often point to the progression of civil rights acts. That's quite off the mark. The 1957 Civil Rights Act was notably weak, almost meaningless. Had the Movement not been in its fast developmental stage, it's highly probable that it would have been many years indeed before another civil rights act was enacted. As it was, it took a massive Movement effort, replete with all sorts of sacrifice, to secure the essentially good [though not strong on voting issues] 1964 Civil Rights Act and then, via continuing momentum, the good '65 Voting Rights Act.
That momentum for a sound and much needed Health Act is obviously missing now in this confused, flawed situation -- and if there's any significant grassroots momentum, the reverse is now the case. In addition, it's becoming increasingly clear that the Democrats are going to lose substantially in 2010.
Give the current crippled Thing a merciful death -- and start over immediately.
Hunter Bear
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Cindy Etal
December 21, 2009 1:08 PM in reply to sabocat
Thank you for filling in the missing pieces with respect to civil rights.
I do not, however, buy your case for starting over on health care.
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bill
December 21, 2009 10:38 AM
Pre and Post 'Reform'
Currently, you pay your health insurance premium. The insurance company takes your premium and covers administration, markets & advertises, pays bonuses & lobbies against your interests, and uses a portion to provide you with health care should it be needed. What’s different in the Senate’s ‘reform’ package? Answer: You are mandated to pay health insurance premiums, your taxes will subsidize the health insurance industry by paying for those who cannot afford health insurance and health insurers can use 20% of your premium on non-health care (see administration, etc. above). Comment: As with the financial industry, the bill promises ‘heavy regulation’ of the insurance industry.
Democrats, you are going to be pilloried by the voters. You must not pass this.
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Azdak
December 21, 2009 10:40 AM
I'm not necessarily saying this is what progressives ought to do, but the fact is that the only way to have true leverage is to be willing to walk away from the table. If Rahmbama is not convinced that progressives will truly blow up the process, then progressives will get their shit sandwich and a bottle of ketchup.
At this point, I agree with the tone of some comments that the best action by progressives would be to trade support for the Senate bill for something more meaningful--whether it's health care or something else. But at some point, progressives are going to have to call Rahmbama's bluff and inflict some wounds if they ever want to be taken seriously.
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matt
December 21, 2009 10:57 AM in reply to Azdak
"If Rahmbama is not convinced that progressives will truly blow up the process, then progressives will get their shit sandwich and a bottle of ketchup."
Azdak, you have nailed the crux of the problem. The Republicans and the anti-reform Democrats ARE willing to truly blow up the process, so they've been calling the shots. And the "progressives" are so desperate to pass a bill, any bill, that they're eating that shit sandwich. As you say, they need to stand up and say that the bill has been watered down to a point that it's not worth passing, and demonstrate that they are equally willing to blow up the process if they don't get a good bill. So far, they're not showing that courage.
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warbaby
December 21, 2009 10:59 AM in reply to Azdak
I disagree. Sometimes the optimal strategy is to offer support and there by become a swing vote. This essentially lays the groundwork for raising the stakes for a future withdrawal of support or transfer of support to a rival.
It may require more discipline than progressives can muster.
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jward
December 21, 2009 11:07 AM
"Those who would vote no on this bill need to look into the eyes of Americans who don’t have health care now and tell them they’re going to be better off without this bill — better off continuing to live without health coverage. They should explain to all those Americans who are denied coverage because they have pre-existing conditions or whose insurance ran out because of lifetime caps that they don’t need this..." Joe Biden, NYT 12/20/09
As soon as this bill is passed, children can no longer be denied insurance because they are ill.
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NJBOOMER
December 21, 2009 11:14 AM
Question: If Ben Nelson. Mary Landrieu or Joe Lieberman do not vote for the final conference bill do they still get the juicy deals they extracted by bald faced blackmail - so much for principles. They are all for sale to the highest bidder! What has gone on in Congress this year is beyond disgusting. They should ALL be voted out of office. We are the United States of Nothing.
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ericf
December 21, 2009 11:14 AM
As frustrating as it is that conservadems get a veto on the health care bill, it comes from a simple dynamic: first, all 60 Democrats are needed since no Republican will vote for any major bill, health care or otherwise, giving each Democrat a veto; second, liberals badly want this, while conservadems can live without it. If the liberals were the ones who could live without it, they would have the vetoes, and it may work that way on another bill. This time however, Nelson and Lieberman get vetoes. Starting over on the bill won't change that dynamic. Threatening to oppose the bill without a public option doesn't mean there can be a public option, but does guarantee no bill at all.
And no bill at all would be electorally crushing, except maybe for the conservadems who'll be running on their defiance of liberals anyway.
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DA in LA
December 21, 2009 12:52 PM in reply to ericf
No bill at all would be electorally crushing and this bill will be electorally crushing.
There was one answer. They chose the path of stupidity.
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chimpale
December 21, 2009 11:50 AM
I'm surprised they got the 60 votes. I mean the Republicans prayed their asses off to stop them, even prayed for 'something' to happen to a Democratic senator to keep him or her from being there for the vote. Does that mean that the Republicans don't own God anymore? Now that should be front page news.
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ericf
December 21, 2009 12:12 PM in reply to chimpale
It was front page news in Heaven. No wonder no conservatives saw it.
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geofu54
December 21, 2009 2:21 PM in reply to ericf
That's a good one.
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wbgonne
December 21, 2009 12:35 PM
Amazing how utter capitulation can move things along.
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Dorn76
December 21, 2009 12:48 PM
There seems to be a logical disconnect here. It's "utter capitulation" that gets zero GOP votes. You're on the same soapbox with the Teabaggers, and Michelle Bachmann. It's just bizzare.
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DA in LA
December 21, 2009 12:54 PM in reply to Dorn76
Yeah, just for 100% completely different reasons. But other than that, a fine point. You guys should keep this up. It will only help to drive people away.
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wbgonne
December 21, 2009 1:02 PM in reply to Dorn76
Comparing progressives who want real health care reform to Sarah Palin and the Teabaggers is stupid on every level.
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Johnny2Bad
December 21, 2009 12:52 PM
"Reform"?...."REFORM"???
Not.
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rbeats
December 21, 2009 1:09 PM
I was just reading the Bloomberg article in which Karen Ignagni was able to get the tax increase on insurers moved back yet another year.
This bill is a piece of shit and if Karen Ignagni is in favor of it is garbage.
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baltimore
December 21, 2009 1:15 PM
why have senators at all? just let the lobbyists write the legislation! that would cost less, eliminating the middleman.
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sabocat
December 21, 2009 2:11 PM in reply to baltimore
They're already writing legislation.
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Cindy Etal
December 21, 2009 1:16 PM
The naysayers and doomsayers either want it all now or nothing at all.
I'm delighted with a start in the right direction.
So, I've just finished a fax to my senator urging him to make sure it crosses the finish line -- not to mention congratulating him for having the courage to stick his neck out with all the "sky is falling" speculation and bad information shaping people's opinions.
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Icon
December 21, 2009 1:20 PM
I wonder if Steele is regretting his "You have 60 votes, Mr. President, pass the bill" comment now.
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Peter Principle
December 21, 2009 4:27 PM
I guess my basic reaction to the Senate bill is like the old joke about what you call 100 lawyers chained together at the bottom of the sea: A good start.
Of course, if one of those lawyers was Joe Lieberman, I'd call it an excellent start.
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joseph.crystal66
December 22, 2009 11:40 AM
Hey Obama – check this out: http://tictacdo.com/ttd/Get-Mental-Health-Care-in-US - seems like you need to have your head examined!!! How much did it cost to buy all those votes? Michelle's getting a bit less bling for xmas this year?? It's easy to bribe crooks, isn't it...it's not surprising that this has passed. Marxism never worked – who is Obama to impose it on us now? This is the era of destruction! You get to decide who gets to live and who gets to die?
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joseph.crystal66
December 23, 2009 9:46 AM
Obama clearly hates American and loves his own career over anything else. PALIN 2012!!!!!!
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