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White House: Our Health Care Fixes Can Pass Without GOP Support

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The White House has outlined a package of fixes to the Senate health care bill, which they hope can bring reform over the finish line, and they're prepared to push the changes through the filibuster-proof reconciliation process if Republicans insist on filibustering.

"This package is designed to help us [use reconciliation] if the Republican party decides to filibuster health care reform," said White House Communications Director Dan Pfeiffer. "That was certainly a factor that went in to how we put this proposal together."

Pfeiffer said the White House views this as "the opening bid," for the bipartisan health care summit scheduled for this Thursday. The hope--a long shot--is that one or more Republicans can agree to support this proposal, allowing Dems to pass it via more standard legislative channels. But if that fails, reconciliation can be used as a backstop.

"The president expects, and thinks the American people deserve, an up or down vote on health care reform," Pfeiffer said.

Working within those guidelines, the White House has modified an agreement it reached with organized labor on a controversial tax on so-called Cadillac insurance plans. Instead of exempting union health care plans from the tax for the first few years of the reform, the White House wants to delay the excise tax altogether until 2018, at which point it will be implemented across the board, and at a higher threshold than the Senate bill mandates.

Union officials are still examining the proposal, but the 2018 implementation date and raised thresholds will be key to winning their support. To replace the lost revenue, the White House supports expanding the tax base on high-income Medicare taxes to include investment income.

Separately, the White House proposal strengthens the employer responsibility requirement in the Senate bill. Like the Senate bill, it does not specifically require employers to provide insurance to their workers, but would require them to pitch in more money for each employee who ends up on federal assistance to buy their own health insurance. That money will be used to help cover the cost of subsidies, which are slightly higher on average in the White House bill than in the Senate bill.

Using the Senate bill as a baseline, White House proposal preserves the Senate bill's abortion language, and state-based exchanges, while scrapping the Nebraska Medicaid deal. It does not include a public option.

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February 22, 2010 10:23 AM   

So in his opening bid Obama gives away the public option, while taking us one step further to criminalizing a woman's control over her own body.

Change you can believe in, kiddies.

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February 22, 2010 10:36 AM    in reply to EastWest

In his opening bid, Obama is saying to the other side of the table that they can not prevent HCR from passing. They can work with the Democrats and get something out of it, or they can obstruct and get nothing.

It makes sense for him to propose something fairly centrist. It adds legitimacy to to the claims of bipartisanship if (or when) the Republicans reject the entire thing out of hand. Then they say, see we tried. There's no working with these people, and then go on to pass whatever their hearts desire or whatever their 51 vote reconciliation can get though.

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February 22, 2010 10:52 AM    in reply to MASON

It would make sense to propose something centrist, if by "centrist" you meant anything near the actual center. You seem to be buying into the thinking that says anything left of center is "partisan" while anything right of center is "centrist".

First rule of negotiating: Don't start low. If your opening gambit is a position of weakness you can never get stronger - only weaker.

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February 22, 2010 11:11 AM    in reply to EastWest

You presume that actual negotiating will be occurring.

I think everyone, including the White House, knows that the Republicans have no intent of negotiating. So, essentially, what's more likely is that we're simply seeing the White House laying the groundwork to pass healthcare reform with just Democrats.

By the way, if enough Senators sign on to the PO via reconciliation, and the Dems can figure out how to get it passed what seems to be the 60-vote threshold to even bring it to the floor for consideration, then the PO will be in play. Right now, it seems that they don't know how to overcome the 60-vote threshold necessary to get the PO an "up or down" vote, but I think they're still actively trying to figure it out. [There's also the pesky problem that only about 20 Senators (so far) have publicly endorsed the PO via reconciliation. That's far from the 51 (or 50 & VP) needed.]

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February 22, 2010 11:50 AM    in reply to hewhohasnoname

Here's a relevant quote from Reid:

Senate Majority Leader Harry Reid says he will support allowing the government to sell insurance in competition with private industry if the White House and Democratic leaders push a health care bill with no Republican backing.

Since there will be no Republican backing, the PO is perfectly alive... assuming there are 50 supporters in the Senate and 218 in the House.

You'll notice there isn't any tort reform in this bill either.

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February 22, 2010 12:18 PM    in reply to philogratis

Since we're doing it alone, I hope the White House is supporting the Public Option being added to the reconciliation amendment in the Senate. All we need is 50 Senators.
The White House better be looking at this polling:


What would make you more likely to vote for Democrats in the 2010 elections: If they pass health care reform that includes a public health insurance option but gets zero Republicans votes OR if they pass health care reform without a public option but with some Republican votes?

Nevada: 53% public option, 40% bipartisanship
Illinois: 61% public option, 30% bipartisanship
Iowa: 58% public option, 29% bipartisanship
Washington: 61% public option, 25% bipartisanship
Missouri: 49% public option, 36% bipartisanship
Virginia: 55% public option, 33% bipartisanship
Minnesota: 62% public option, 39% bipartisanship
Colorado: 58% public option, 43% bipartisanship

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February 22, 2010 11:28 AM    in reply to EastWest

I agree with your first rule of negotiation. Secondly, I agree about proposing something that is "centrist." "Centrist" in real terms would be national health care, IMO. We have no organized "left" in this country. Most Progressives and/or liberals are centrist at best.

This country apparently is at least centrist or farther to the left than that when it comes to social policies for everyone. The leadership in the Democratic Party is center right, while the "leadership" in the Republican Party is extreme right.

According to them, anything left of "center-right" is "leftist". It's screwed up, for sure.

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February 22, 2010 11:38 AM    in reply to EastWest

The center of the House and Senate is what matters when you are tying to pass a bill. The actual center of the country won't matter until election time but right now it doesn't really matter at all.

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February 22, 2010 11:05 AM    in reply to MASON

In that case I'm pulling for Republicans to obstruct and get nothing. The President's plan sucks, and any "compromise" he works out with the GOP is going to suck even worse.

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February 22, 2010 4:09 PM    in reply to superking

Wow - here's a great example of why Democrats and progressives in particular can't seem to get anything done in government.

You would rather scrap the whole thing and let 30 million Americans who could get coverage under this bill go without, because it doesn't meet your exacting ideological standards?

I'm a liberal, but sometimes even I wonder if we're capable of exercising the levers of power in a responsible way. Frustrated as I am with them, I'm sure glad our political leaders in Congress aren't listening to superking!

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February 22, 2010 11:28 AM    in reply to MASON

what bull.

Obama only got involved to make sure the PO which was gaining a bit of steam was removed from any bill.

where was he all along??

amazing what passes for understanding with some people.

the FACT is Obama could pass a bill with a strong PO by reconsiliation but he wont allow that to happen ever.

why?

because he is out to END medicare , so why expand it??

geez

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February 22, 2010 11:30 AM    in reply to JadeZ

*
reconciliation

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February 22, 2010 11:38 AM    in reply to JadeZ

End Medicare?

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February 22, 2010 11:39 AM    in reply to JadeZ

End Medicare?

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February 22, 2010 12:15 PM    in reply to MASON

Why not include it now, then let THEM reject it come Thursday?

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February 22, 2010 1:01 PM    in reply to MASON

What is left to give away? This should be the compromise in exchange for repuke votes.

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February 22, 2010 11:48 AM    in reply to EastWest

"Change you can believe in, kiddies."

Rhetoric to shoot yourself in the foot by children.

"God what a worthless shill."

God what a worthless crank.

Here's a little reality for you folks; you take this on move on or you help elect the far right and destroy any chance at straightening out anything ever. Ripping down the only leader you got only helps the Glenn Becks of the world.

Don't like those choices? Tough shit, time to grow up. In case you haven't noticed sanity is at a massive communications disadvantage in this country right now. Once upon a time we had a news media that dedicated itself to accuracy and responsibility as well as making money. Now we have a news media that's half obsessed with selling dramatic "narratives" that are as inaccurate as your typical Hollywood movie "based on real events" while the other half is outright FOX like propaganda. The details of what will work right and what won't don't break through the noise generated by the right wing media complex. Blame who you want the reform you want will never happen until you figure out how to break that noise barrier. Until then all this nastiness is akin to voting Nader in Florida circa 2k. You can feel pure while accomplishing nothing but loss and they get to win and feel pure as they do things like institute torture.

Nice.

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February 22, 2010 12:38 PM    in reply to johnnyba

Well said.

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February 22, 2010 12:18 PM    in reply to EastWest

Well of course he concedes in advance to the Republicans! He does so because it is a strategy that has worked so well in advancing progressive causes in the past don't ya know?

We have the most naive and strategically tone deaf President: ever!

Here we have the most openly hostile and defiant opposition party in Congress in memory, that has set a record for voting no on everything Obama proposes even if they agree with it and the dumbass is still trying to find common ground with these sociopaths! He hasnt' to be the most naive and just plain stupid world leader since Neville Chambelain!

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February 22, 2010 4:20 PM    in reply to oleeb

That's about as naive and stupid a statement as I've seen on huffpo (and I've seen right wing trolls say some pretty stupid things here)!

Other people here have commented about the right wing noise machine and the pathetic job our media has been doing. There's no question that Obama has missed a few opportunities to communicate more forcefully, but given the mood of the country and the problems he has faced, if he can make the case for passing a reasonably "centrist" health bill through reconciliation, I would consider that a major political victory. I think the Repubs needed to be given enough time and rope to hang themselves, and I have no doubt they'll continue to do that in the health reform summit this week.

What's amazing to see though is that the level of immaturity and vitriol for Obama from the left here matches that from the right, and that's a serious cause for concern in the long term.

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February 22, 2010 5:53 PM    in reply to Sambam

What's amazing is the people like you who can't admit he's a weak, ineffective and naive leader who has played right into Republican hands over and over and over and who has not only not brought change, but been the number one protector of the status quo from healthcare to torture, to the imperialist wars, fake credit card "reform", and just about everything else. And now he proposes to double down on the disastersouly stupid policy of attempting to appease the Republicans who won't do anything at all to cooperate. Everyone in the country understands this except Obama and perhaps kool aid drinkers such as yourself. Incredible.

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February 22, 2010 1:47 PM    in reply to EastWest

It has nothing to do with taking away a womans right to abortion. You can have all the abortions you want, knock yourself out, but why should my tax dollars pay for it? Tax dollars cannot be spent on abortion. That's the law as it stands today. Really what you are asking for is an expansion of your civil rights via a health care bill. This bill is about health care, not about you being able to get governemnt funded abortions. That is the only thing that "abortion language" is referring to. Don't hold the health care of 30 million people because you think the government should pay for abortions....

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February 22, 2010 10:37 AM   

Keep on trollin'. The real danger to Roe vs. Wade is that Chief Justice Roberts and his four amigos will decide to overturn it.

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February 22, 2010 10:50 AM    in reply to philogratis

Typical. You disagree, so the person you disagree with is a troll. Since I disagree with you, your logic dictates that you're a troll. Since we're all trolls, does that mean none of us are trolls?

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February 22, 2010 11:30 AM    in reply to EastWest

This is not an abortion bill. It is a health care bill. If you will recall, the Senate Bill has the less restrictive abortion language. In the House, Stupak got his way.

So yes, I'm calling you a liberal concern troll. You want to kill HCR because the abortion language isn't pure enough, and because the president won't go charging into left field and propose entirely new abortion language which has a zero percent chance of passing.

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February 22, 2010 11:56 AM    in reply to EastWest

It does appear that you are tying to "fight the good fight" instead of "fighting the fights that you can win."

And yes, the current Roberts Supreme Court is by FAR the biggest threat to abortion rights.

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February 22, 2010 11:12 AM   

Like the Senate bill, it does not specifically require employers to provide insurance to their workers, but would require them to pitch in more money for each employee who ends up on federal assistance to buy their own health insurance.

This could be cause for concern, because it might create a disincentive against employers hiring lower-middle income employees. I'd much rather they used the House approach of requiring employers not covering their employees to pay a percentage of payroll to the government.

One question I have is whether or not this includes the "Walmart loophole" -- does it exempt from this tax employers who offer their employees piss-poor coverage (e.g., a high-deductible, low-benefits policy and/or an employee share of the premium so high it's unaffordable for many) -- and does it preclude those employees not choosing the lousy employer coverage offered from getting federal subsidies?

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February 22, 2010 11:13 AM   

Look at all these fucking firebaggers! A month ago when it looked like any/all HCR was dead, they were screaming "pass the bill!"

Now that it looks like we might actually get the bill we would have gotten before the MA election, they're back with their unrealistic fetishes.

After torpedoing HCR for six months, Schultz, Olbermann, Dean, Huffington were practically begging to "just pass the bill" when it look liked we'd get nothing.

I bet they'll start screaming "this doesn't go far enough. Public option or die."

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February 22, 2010 11:17 AM    in reply to FreeRider

and thus the 'acts as if he's paid by the whitehouse' spokesperson speaks.

God what a worthless shill.

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February 22, 2010 11:23 AM    in reply to T Groan

At least I know White House is two words.

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February 22, 2010 11:26 AM    in reply to FreeRider

big fucking deal. that smile on Obama's face, that due to you being on you knees?

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February 22, 2010 11:48 AM    in reply to T Groan

No. It's because I know that White House is two words.

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February 22, 2010 12:19 PM    in reply to FreeRider

LMAO

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February 22, 2010 11:36 AM    in reply to FreeRider

As much as I sympathize with the House Progressive Caucus, they leave me shaking my head. You would think they'd recognize that the Senate bill, as inadequate as it is, represents the foundation upon which they can eventually get everything they want. The most effective bargaining chip the Democrats have is the fact that they have a bill that has already passed the Senate, yet they undermine it by throwing tantrums like a bunch of three year olds. Rahm Emanuel is right about them, his questionable choice of words notwithstanding.

If the Republicans thought for a second that there was greater than a snowball's chance in Hell the House would pass the Senate bill, if for no better reason than to move the yard markers down the field, and send it to the President's desk for signature, they would be a lot more inclined to negotiate on the details. But thanks to the Progressives, who apparently think Bill Frist still runs the Senate, no such threat exists.

That's bus league stuff - hardly worthy of a political party caucus that holds a 60-40 (more or less) majority in both houses in Congress, a majority built on the possibly naive assumption that the Democrats might actually get something accomplished with all those extra seats.

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February 22, 2010 12:34 PM    in reply to Steaming Pile

You are right in that the most effective bargaining chip is that the House has a bill that has already passed the Senate.

All the leverage exists BEFORE the House actually passes the bill, and disappears immediately after it passes.

I think the House is keeping the debate open by refusing to pass the Senate bill until they get some further concession. They have to hold out now because the instant they pass the Senate bill all political will for health care reform will disappear for at least the next two President cycles, barring cataclysmic price increases.

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February 22, 2010 2:01 PM    in reply to Darrius

I respectfully disagree. Even before the ink was dry, it was made clear by too many of the usual nervous Nellies that this wasn't going to pass the House unless the Senate acts first, unless it was taken apart and components passed singly (as if that was going to work), or in the case when Scott Brown won in MA, that they're going to have to start over on a less ambitious bill, etc. There was far too much fear and sniveling in the air for the threat of drop-kicking the Senate bill through the uprights to be credible. In short, my suggestion that too many House Democrats believe Bill Frist is still the Majority Leader is well-documented by statements of fact on this and other media sources to the effect that they do not trust the U.S. Senate to help fix this, even with a caucus of their own party still numbering nearly twice what the Republicans have had since Eisenhower went to Korea. That's too bad.

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February 22, 2010 12:39 PM    in reply to FreeRider

Exactly. The usual suspects., Bitching and fucking complaining because he was supposedly absent and now he's standing up and it's no fucking good. I am so disgusted with the whiners.

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February 22, 2010 12:45 PM    in reply to FreeRider

No, this FreeRider is exactly right. The left has grabbed onto the PO as if it were a dealbreaker now, when after Brown was elected, they were all demanding to pass the bill as is through reconciliation. The left is no friend of this process, sad to say. Hamscher's holding hands with Norquist seems proof enough to me.

I have to say that as I understand the exchanges there is always going to be a non-profit insurance option. Why this is so different from a public option beats me.

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February 22, 2010 12:49 PM    in reply to MyMy

The nutters on the left aren't into solutions; They're into obstructing and complaining because they believe it shows how pure they are.

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February 22, 2010 2:41 PM    in reply to MyMy

A nonprofit still has a HUGE overhead like the other insurance corporate middlemen. The profit is only a couple of percent, it is the HUGE fucking overhead of 30% that makes American corporate insurance so god damned expensive. Medicare has a 3-4% overhead just like a public option would.

Freerider~ Without the left wing screaming about how obscene and immoral it is to "compromise" away the lives of so many Americans it would allow the right wing even more freedom to claim that corporate fascism is actually "centrism" and anyone who doesn't like paying twice as much for shitty insurance is a "socialist" or worse. The truth is that a majority of Americans say they do not want "Obama's healthcare plan" because they have been so completely lied to about what it actually is. It is a center-right compromise that is being painted as a left wing takeover. Why oh why would you deny the left at least the public debate of what a center-left compromise might look like? Poll after poll shows strong support for a public option yet our Democratic President can't seem to get the words out of his mealy mouth. You would think in a "Democracy" that just agreeing with a majority of voters wouldn't seem to scare the piss out of him the way it does.

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February 22, 2010 11:13 AM   

Didn't President Obama state in September 2009, while addressing the country on national television:

"One more misunderstanding I want to clear up -- under our plan, no federal dollars will be used to fund abortions."

http://www.lifenews.com/nat6028.html

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February 22, 2010 11:26 AM   

It's a start...

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February 22, 2010 11:28 AM   

Where is the GOP bill posted?

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February 22, 2010 11:35 AM    in reply to hey norm

Tort reform....the end!

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February 22, 2010 11:41 AM    in reply to Politor

And the "privilege" of being able to buy insurance from the least regulated state.

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February 22, 2010 11:32 AM   

Pass. The. Damn. Bill.

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February 22, 2010 11:39 AM   

This is a good start. Pass it. Fast.

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February 22, 2010 11:43 AM   

Presumably this means the WH has been assured by Reid and Pelosi that the votes are there to push this through without the GOP?

A reconciliation that fails because of inability to get 50 Democratic Senators will be the death knell for our Party.

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February 22, 2010 11:44 AM   

Being new to TPM I'll assume there are not many Republicans posting here so you guys probably just assume everyone wants this bill to pass. Not the case. I'd prefer the federal government not be charged with yet another entitlement program since it doesn't exactly run the ones it has going well enough.

Frankly I believe this should be done by the states. You want better healthcare then have 50 states competing with one another.

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February 22, 2010 12:16 PM    in reply to GOPinNYC

There was a story on NPR this weekend about the winter meeting of the National Governor's Association. They interviewed a few governors, and of course every one of them was asked about health care.

They seemed to think that HIR and HCR was the responsibility of the states - that they were 'concerned' about the 'overreach' of the federal government. At first I saw their point.

Then I realized they've had plenty of time to address the issue of the uninsured and spiraling health care costs, and the vast majority of states have done jack shit. Hell, right now they can't even afford to - they're cutting funding for what few state-level health care programs have been put in place.

The need for access to quality health care is a universal concern. I disagree that it's a 'local' phenomenon and that the 'needs of West Virginia are different from those of California' in this area. Sick people need to see a doctor. It doesn't (and shouldn't) matter where you live.

If nothing else it comes down to competition. If Arkansas offers better corporate and property tax rates than Missouri because they don't provide health care, businesses may choose Arkansas for new facilities. What happens in Missouri? Politicians get antsy and gut expensive programs (like health care) so they can be more attractive to businesses and compete.

We need a level playing field for something as important and expensive as health care. Otherwise the states will eventually land on the lowest common denominator, which is lax regulation and no provision of health care to those who need it most - kinda like what we have right now.

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February 22, 2010 12:35 PM    in reply to Forrest

"We need a level playing field for something as important and expensive as health care. Otherwise the states will eventually land on the lowest common denominator, which is lax regulation and no provision of health care to those who need it most - kinda like what we have right now."

There is a fundamental issue that isn't addressed in this debate. I personally don't believe that anyone is entitled to healthcare unless their life is in danger. In other words a car crash or some catastrophic event. Going to see Dr. No Name for your yearly checkup or because you got the sniffles isn't to me something I should be helping you with. Not as a taxpayer.

Where health care got expensive is when we started billing out health insurer for every little expense related to health care. Insurance should revert back to catastrophic insurance as it was meant to be. Then a lot more people could afford it. In fact I'd argue everyone could.

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February 22, 2010 1:02 PM    in reply to GOPinNYC

Typical - you got yours, to hell with everyone else.

The facts are that the majority of expenses in health care could have been preventive by regular routine checkups that you think people are not entitled to.

As for leaving it up to the states... we see how well that has worked in the credit card industry.

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February 22, 2010 1:06 PM    in reply to mophan

Don't mean to come off disrespectful. Please excuse the snark. I have a bad habit of that.

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February 22, 2010 5:21 PM    in reply to mophan

You don't know me so don't make any assumption about what I may or may not have.

Additionally better life choices and just about everyone can afford the preventative care you so desperately want them to have. And by choices I mean what they spend their money on. Cellphone, Cable, Broadband Access, Twelve pairs of Nikes, A dozen handbags.

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February 23, 2010 9:00 AM    in reply to GOPinNYC

You are right, I don't know you. Just like you don't know the circumstances of people who don't have health insurance but need it. You make the assumption they have 12 pairs of Nikes, cable, cellphones, and other such items.

Many have lost their homes, and have had to declare bankruptcy because of being denied affordable health insurance, but it must be their fault they have preexisting conditions. It's their fault their employer doesn't provide health insurance benefits. It's their fault health insurance companies look at the numbers and don't see peoples lives, but instead their bottom line, and stock options for their shareholders. It is certainly their fault health insurance costs more than the average sedan for a family of four.

I see your point completely.

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February 23, 2010 9:50 AM    in reply to mophan

First. Please define many. I mean if we are going to completely scrap a system lets get real about the numbers that are being thrown around to justify messing with a good thing. I've read reports by Pacific Research Institute that indicate as few as 3% of this country isn't insured. So if we are going to tinker with a system where 97% are covered I want explained to me why we need to add trillions in taxes to make it happen for a few million people.

Second. I always love when people put forth the pre-existing conditions point to defend the take over of healthcare. Should we now require the insurance industry to provide insurance for those people buy homes in areas with pre-existing flooding issues? Maybe we should require insurance companies to insure those who are predisposed to being alcoholics so they can drive drunk. You demand for insurance for people with pre-existing problems is just as absurd to me as those situations I just listed. However I would like to put forth this question. Who are you to fuck with mother nature? Maybe this is the planet's way of culling the herd. By definition aren't those with pre-existing conditions the weak? Don't you liberal love natural selection?

Third. A person as a right to life but you don't to not have the right to an extended life.

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February 23, 2010 10:12 AM    in reply to GOPinNYC

So, people are nothing more than animals to you? I really do hope you never find yourself in a situation where the only assistance you are able to get is from the federal government.

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February 22, 2010 1:06 PM    in reply to GOPinNYC

But a lot of catastrophic events occur because of lack of medical care: for example, diabetes related amputations. And basically, you are saying that hospitals should get stuck with the bill for people who have these catastrophic events. That's the status quo, but it's not so great.

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February 22, 2010 1:07 PM    in reply to GOPinNYC

I see your point, but we're not really talking just about the sniffles here, but cancer, immunizations, infections, communicable diseases, and disabilities. Economically, we lose as a society if we don't head these things off early, because the cure is always more expensive than prevention. Without a system that covers everyone, we end up paying more at the back end, with an extra helping of human suffering for dessert.

In any case, you most definitely do NOT have a universal right to health care in a life threatening emergency. You have the right only to be treated and then hounded into bankruptcy if you survive but weren't insured.

We already accept the idea of supporting our fellow citizens in return for being supported ourselves in most areas of our lives without question. You're subsidizing my use of the highway to go on my next ski trip, the security that prevents a terrorist from hijacking my next flight, and even the firemen that save my house after I foolishly smoke in bed. And you will do this regardless of whether you personally drive, ski, fly, or smoke. Do you argue that all examples of acting collectively for the common good of all are inherently bad? There is certainly an element of the right that does.

Again, this comes back to the central difference between us. I regard health care as a right as important as education, religious freedom, and non-discrimination. I would support universal care even if it were more expensive than an efficient, profitable, and sustainable existing system. Of course, the system ISN'T any of those things. So, even if you don't, as your post suggests, agree with me on the moral point, I think we CAN both agree that the financial costs of continuing our current system will ruin us if they aren't fixed.

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February 22, 2010 2:55 PM    in reply to GOPinNYC

You asshole! Try just once in your life to accept facts as they are and not paint a rosy picture with your right wing economic bullshit. The reason American healthcare is twice as expensive per capita is because we allow a fucking circus of middlemen to jack up the price of everything without adding any value whatsoever. An insurance corporation has a 30% overhead to cover a big beautiful skyscraper and tens of thousands of paper pushers to think up every possible reason to deny coverage and dump policyholders that actually get sick. Medicare has a 3% overhead and does a great job of keeping sick people thinking about getting better not going broke. The fact is there is no viable or moral model to make a fat profit from healthcare that does not have the toxic byproduct of desperate uninsured sick who will go bankrupt and die. The Harvard study that puts that DEAD WITHOUT INSURANCE number at about 45,000 per year. I have heard that more than half the personal bankruptcies in America are for medical expenses. Those are the toxic waste of your cherry picking profit system. Every other advanced democracy on Earth has learned to deal with this reality and long long ago. America is held hostage by you and your pretend "free market" for everything. How do you sleep at night?

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February 22, 2010 12:27 PM    in reply to GOPinNYC

Fair enough. I don't agree that the government can't run its own programs, but that's not the point. The central idea here isn't whether or not the federal government should run health care, but whether it is either fiscally or morally sound to have a profit driven system that encourages healthy people to avoid it and leaves 10's of millions with only the emergency room for care. The economics speak to the sustainability (or lack thereof) of the current system. The progressive position is that the moral case is no less compelling. In my opinion, it is impossible to enjoy 'life' and 'liberty' or to 'pursue happiness' if one lacks for health. Hence, health care is a civil right every bit as valid as the right of trial by jury and the right to non-discrimination on the basis of race or religion.

Within that context, I'm fine with what you propose. I would be just as happy to see a national laboratory of state plans with universal coverage that include public only, public-private, and private only systems. The only requirement would then be that the role of the federal government is to set the minimum standards for these plans and provide the subsidies necessary to make it possible for them to succeed.

If you and I can agree on that, then we have the seeds of bipartisanship. Sadly though, even if WE agreed, there's not any chance at all of the national GOP going along, because they are making too much political progress by preventing anything from happening.

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February 22, 2010 12:41 PM    in reply to Problematic

Problematic I really couldn't support your concept simply because it continues to create a bureaucracy in D.C. There is no logical reason to send money to D.C. so D.C. can send it back to the states. It is better if the federal government doesn't have it's little fingers involved in how things are run.

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February 22, 2010 12:50 PM    in reply to GOPinNYC

I'd agree with you except for the fact that there needs to be basic level of care provided by every plan in order for this to work, and not every state has the economic wherewithal to provide that. This is already reflected in the fact that some states receive more federal dollars than they kick in from taxes. No one argues about this when it has to do with the interstate highway system or law enforcement, do they?

I don't believe that a huge federal bureaucracy would be necessary for a plan like this to work. There are many cases where it already does. For example, government mandates on civil rights, education, workplace safety, and law enforcement exist without these. A simple clear regulatory framework that outlines exactly *what* standard a state must meet in its health care plan is all that's required.

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February 22, 2010 1:35 PM    in reply to GOPinNYC

"There is no logical reason to send money to D.C. so D.C. can send it back to the states. It is better if the federal government doesn't have it's little fingers involved in how things are run."

I don't like big government, but there are certain things that I think *must* be regulated and 'equalized' across the states. We enjoy an incredible amount of mobility in this country, and that mobility is paramount for not only our quality of life but the viability of our private sector.

Inter-state commerce must be regulated. The means by which that commerce is conducted must be regulated. Levels of compensation and worker safety must be regulated. We have enough trouble losing jobs to developing nations an ocean away - could you imagine the kind of disparity we'd have if individual states had complete control over their own environmental, compensation, and safety standards? Not to mention the terrible squabbles over pollution and resource usage. It's bad enough already.

I think most of us see government as at least a little (if not a lot )evil - but it's a necessary evil. My personal opinion is that some of the teats (the defense budget especially) have gotten FAR too large, and the methods for dividing up the milk have become terribly corrupted. That doesn't mean we need to cut the teats off entirely, though. We need to fix the distribution system.

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February 22, 2010 1:43 PM    in reply to GOPinNYC

One other thing - I think some parallels can be drawn between the small government goal of conservatives and the European Union. They're having a hell of a time right now with some very poorly run countries posing a real danger to the Euro - to the point where they may well have to be bailed out by the economically stable countries. Not because they want to, but because if the struggling countries collapse it could wreak havoc on their currency.

They also need to be concerned about civil unrest in these countries. If things get worse, we could see some governments in southern Europe collapse entirely. What kind of economic and national security threats will that pose to the other member nations?

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February 22, 2010 4:25 PM    in reply to Forrest

This whole big government v small government thing is a straw man. The issue is/should be what's effective and what is not.

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February 22, 2010 6:18 PM    in reply to expat46

I disagree. There are very real dangers in an overly large government. Defense appropriations, for example. The bigger the pie, the more extreme the actions taken to get a slice. The fact that it takes ridiculous amounts of money to get chosen as the pie cutter just makes it that much worse.

Government, be it Federal or local, has one purpose: To guarantee the health, safety, and opportunity of the individual. Unfettered capitalism offers zero guarantee for the individual, and the wild swings it is prone to can lead to civil unrest without such guarantees.

Sure, individuals can make stupid personal choices regarding their health and safety, and they can squander their opportunities. While the consequences of such self-destructive behavior can be argued, those guarantees still have to be made at some level.

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February 22, 2010 3:05 PM    in reply to GOPinNYC

You complete asshole! So we need to send our money to Blue Cross and Aetna so they can skim 30% off the top for big shiny office buildings and corporate jets?!? Medicare has a 4% overhead and millions of happy secure customers. The private market is just a bunch of middlemen skimming huge amounts of money from the pockets of desperate sick and dying "customers"

Fuck that! Why not private police in your little conservative town? Why not a private fire department? Woops! didn't pay your FIRE INSURANCE? We just had to let your house burn down so we could report a profitable quarter to our shareholders! American has the most expensive insurance in the world because we allow middlemen in to add to the cost at every step. Why not do it the simple practical way other advanced countries do and save ourselves Trillions of dollars and how much death and suffering ..... ???? .... because you think the government is always bad and the profiteers are always good. What a blind ass!

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February 22, 2010 4:43 PM    in reply to hollywood

Come on Hollywood! This was a nice civil exchange. No need for names. I'm with you, but we have to accept that the conservative viewpoint is that these things are up to the individual and not the state. That doesn't make them bad people just, IMHO, wrong.

The best way to win here is to be reasonable and argue along the point you're making, which is that the economics don't work unless we put everyone into the system and enforce some regulation like we do with power companies.

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February 22, 2010 12:32 PM    in reply to GOPinNYC

While I don't agree with your position, your language is a great deal better than what I hear from most of the party. Keep up the effort.

I think a national approach to health care reform is better than a state by state one because of the mobility of our population and the frequency and ease with which we move around the country. Having each state craft their own solution, while massaging those who fear any federal approach, creates too much of a patchwork of problems. That's not to say that having 50 states working to come up with solutions that might improve a national plan is not a good thing, just that the go it alone concept will create a balkanized health system with haves and have nots depending on the political slant of a state's government.

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February 22, 2010 12:49 PM    in reply to acf_ma

Refreshing exchange here. Nothing to add, but encouraging to see some thoughtful commentary sans name calling.

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February 22, 2010 1:01 PM    in reply to Brownbagger

Co-sign. Very refreshing to see.

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February 22, 2010 1:11 PM    in reply to worthy9

Absolutely! If only we had more of this....

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February 22, 2010 11:46 AM   

AFT (About Fu68ing Time).

The only ones who whine about bipartisanship are the losers. Maybe the D's recognize that if they don't at least try to take care of their base now, it's gridlock in '11.

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February 22, 2010 11:51 AM   

So many people have no understanding about how progress is made. We always make progress by strongly advocating the "perfect" plan that fills our every need, but when it comes time to actually vote, we accept what can be passed, complete with the compromises that make passing it possible. Then, we start working on the next step - the modifications that improve the plan that just passed. This can be a lifelong effort, and success will only come slowly, one step at a time. The Progressive caucus in the House is perhaps just too lazy to contemplate all of the work they will continue to need to do to achieve the ultimate success they seek.

If Obama's plan can get enough votes in the Senate I say pass the damn thing and ignore the pimples that seem to cover it.

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February 22, 2010 12:23 PM    in reply to hoppycalif2

"So many people have no understanding about how progress is made."

Yup, too add another element last year some people started damning Obamas name because he didn't immediately end don't ask don't tell I tried to reasonably explain what he seemed to be doing and got the usual hysterical attacks. To me this seemed obvious, if he came out swinging with an executive order or some similar immediate action they would respond by making it all about Obama and the process. Nobody ,least of all the fourth estate, would give a flying fuck about whether the policy worked and was even necessary anymore. The whole discussion would be about Obama forcing his radical agenda on the military and so on. You've heard it all before. Hang tight I said, its going away you just need to let him make it appear that they are doing this all of their own accord.

Well that wasn't good enough so we have full on hysteria.

Then Admiral Mullen destroyed the worst the wacko right could throw at him and the military rank and file suddenly was free to discuss the whole thing as they saw it without all that political pressure from the right forcing them into a box. Now its likely to end without even achieving whimper status let alone a bang.

The point of this is that when it comes to making noisy propaganda to get your way the GOP has a solid lock. Wrong or right the progressives cannot compete that way right now. The alternative is patient movement taking each step in the right direction as a victory. Sure, call your congressman and press him for what you want, write impassioned internet posts explaining why your ideas work best, but can the invective and accept compromise when it comes. Progress means one foot in front of the other one day at a time not standing still and doing nothing on principal when you can't run as fast as you want.

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February 22, 2010 1:10 PM    in reply to johnnyba

Can I get an amen? Great post.

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February 22, 2010 2:47 PM    in reply to johnnyba

Bravo! Ben detto.

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February 22, 2010 12:00 PM   

"Republican ideas"

In one word 'NO'

Worthless

And the curent proposal without a public option.

In one word 'NO'

HOPE indeed

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February 22, 2010 12:03 PM   

You wont get better health care that way. You will get Health Corp all moving to the state with the least amount of regulation. Don't think there can be any argument as to who will benefit from that...deregulation of corporations whose sole motivation is profits and only profits will never give us better health care.

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February 22, 2010 12:07 PM   

Pass the damn bill.

I hope this isn't any kind of "starting point" in negotiations. Because if it is, you don't pre-compromise away your key items.

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February 22, 2010 1:05 PM    in reply to AnswerFrog

ditto

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February 22, 2010 12:13 PM   

I live in California. Blue Cross Anthem just raised premiums 39%. This is obscene. PASS THE BILL.

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February 22, 2010 12:14 PM   

Key items? I guess you mean PO, and a national exchange vs. state exchanges.

The PO caucus needs to show their strength first. 20 Senators signing a letter is nice, but 40 Senators would show some momentum.

Not sure what the deal on the exchanges is, but is it possible that it couldn't be changed with reconciliation? It's not clear to me that national exchange vs. state exchanges applies as a budgetary rules.

Key items to me are guaranteed issue, no discrimination based on pre-existing conditions, a Medicaid expansion, and generous subsidies for working class people. Oh, and an individual mandate, just because I'm a wonk. That's all in there.

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February 22, 2010 12:23 PM   

So how come it took this long for the White House to realize this? Getting health care done last year would have meant far less political damage and would have allowed 2010 to be focused exclusively on the economy and bolstering support for Dems and the president's agenda before the fall.

http://www.political-buzz.com/

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February 22, 2010 12:30 PM   

Hoppycali - don't mean to be rude but you don't have a effing clue. I can't believe how naive the "half a loaf is better than no loaf" crowd really is. My God are you that dense! Your half a loaf is a week old with mold all over it. You would eat it only if you were STARVING! It offers NOTHING! Mandated insurance (with no cost controls)and no more pre-existing conditions - but it will cost you up to 3X as much - is this the starting point where you expect to begin? "But yes of course it will all be regulated" you say. Like Wall Street? This is a once-in-a-lifetime opportunity folks. You CANNOT piecemeal this legislation. What don't you get? And when there's a Pub in the WH or Pubs controlling the Congress how much progress do you think you'll make on HCR. And what makes you think it won't be pushed back, stripped down and dissolved into nothing if the Pubs are ever in control again. Take a fucking stand! If you have any self respect you know we all deserve better. Don't accept the fucking crumbs! Our children deserve better!

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February 22, 2010 1:13 PM    in reply to Cornelius

Read the article.

Mandated insurance (with no cost controls)

Just today, Obama proposed a new binding regulatory body that could stop rate increases. That's a cost control, and potentially a rather draconian one.

The mandate has been further watered down. It's so low that it's probably smarter for a lot of healthy people to pay the fine and wait til they are sick to sign up.

"pre-existing conditions (but it will cost you 3X as much)"

Insurers will not be allowed to charge even one penny extra for pre-existing conditions. They can charge 3X as much for people who are 55 or older, as opposed to the status quo where they charge 10-15X as mcuh.

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February 22, 2010 1:14 PM    in reply to Cornelius

"Hoppycali - don't mean to be rude but you don't have a effing clue....Take a fucking stand! If you have any self respect you know we all deserve better. Don't accept the fucking crumbs!"

So, why were you rude if you didn't mean to be? The "public option" is nothing more than the red cape a bull fighter uses. A government run health insurance program, that covers a very small percentage of the population, will do nothing to reduce health care costs. Those costs themselves need to be reduced, and that is the real goal to help our children. It is also the goal that directly attacks the income source of many thousands of people who work in that industry, so it will be a long hard slog to reach. Right now we are distracted by the red cape.

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February 22, 2010 2:28 PM    in reply to Cornelius

Sister~ WE ARE STARVING! I live in California and my insurance is with Blue Shield. They raised my rates through the rood two years ago so I switched to a high deductible plan. Then last year they raised those rates through the roof again so now I cannot even go see my doctor without it costing a fortune. Now I understand I will get the 39% raise this year and I am just going to have to drop my insurance and hope I survive until ... until I die anyway! ANY move toward slowing down this nightmare is better than NOTHING! I am hoping we can elect a liberal Democrat as governor this November and pass some statewide reforms that keep people like me covered. If that doesn't happen I will be moving to a more civilized country where the government does not allow the corporations to kill people for profit.

If the Senate cannot pass a Public Option ....... THIS IS NOT A DEMOCRACY!

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February 22, 2010 12:32 PM   

Think how much mess we could have avoided if he'd started this whole thing out by saying exactly this.

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February 22, 2010 1:00 PM   

Pass. The. Damn. Bill.
+1

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February 22, 2010 2:14 PM   

Take your time. It's not like the opposition or media will get organized and oppose this.

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February 22, 2010 4:51 PM   

This is the bill he should have unveiled after his joint message to Congress back in September since by that point only the Senate Finance committee had yet to approve their plan. On the bill itself, as much as I would like to see a robust public option available to everyone (Medicare for All if you will), I understand that sweeping changes are not made overnight. Even with issues like Social Security and civil rights, the initial act which implemented these reforms were incomplete.

Social security, when passed in 1935, did not include domestic or agricultural workers (largely in an effort to placate conservative Southern congressmen and Senators) but over time it has evolved into the program we have now. Even the landmark civil rights legislation of the 1960s was an incremental upgrade to protections written into law in the 1940s and 1950 as well as some key SCOTUS decisions.

That much said, while I have many reservations about this bill, chief among them is that there is very little help on prescription drug coverage but it is better than the Senate bill. In a perfect world, we would be implementing a single-payer system akin to the one in Canada and parts of Europe. But I accept the reality that we must strive for the bill we can GET not necessarily the one we WANT. Let us not make the perfect the enemy of the good here.

The lengthy implementation periods in this proposal might actually be okay. Let some of the insurance regulations kick in as quickly as possible. I actually believe we could get some kind of public option passed in time for the exchanges in 2014, using reconciliation if the filibuster has not been reformed/exterminated before then, especially if there is public outcry for such a program.

The most important thing to take away from this post is that if we don't get SOMETHING right now, it will be another two decades before Congress will have the stomach to take on this issue again and then we will be fighting for an even smaller plan (look at the 1994 plan compared to the 2010 plan) under an even worse healthcare system if the last 16 years are any indicator. Not passing health care reform at this stage will virtually guarantee the 112th Congress will be a Republican Congress, meaning we can say goodbye to other key reforms such as financial industry regulation, climate change and immigration. Even a less than stellar bill will allow for future amendments and extensions and show the people that steps are being taken to fix this broken excuse of a healthcare system and just might reverse the doom-and-gloom predictions about the Democrats' chances in November.

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