Dear Senator,
I know you're in a tough spot. It would be bad enough if you only had to get Ben Nelson, Evan Bayh, Mary Landrieu and Blanche Lincoln on board, but anyone who has to kiss Joe Lieberman's derriere deserves a congressional medal of honor.
But Harry, you really need to take on future healthcare costs. The House bill fails to do this. The public option in the House bill is open only to people without employer-provided health insurance. That will be too small a number to have bargaining clout to get good deals from drug companies and medical providers. And it will mainly attract people who have more expensive medical needs, which is why the Congressional Budget Office decided it would cost more than it would save.
You also know a public insurance option that's open to everyone would cut future health costs dramatically by imposing real competition on private for-profit insurance plans. That's why the private insurers hate the idea. Even if states were allowed to opt out of this robust public option, the big states would almost certainly opt in, giving it the scale needed to negotiate great deals from drug companies and medical providers. This would put pressure on any state that opted out because its citizens would soon discover they're paying far more.
In addition to the House's weak public option, the deals the White House and Max Baucus made with the drug companies and the American Medical Association will force Americans to pay even more. If, on the other hand, Medicare were allowed to negotiate lower drug prices, biotech drugs weren't granted a 12-years monopoly, and doctors had to accept Medicare reimbursements in line with legislation enacted years ago, Americans would save billions.
You know all this but you're also trying to get 60 votes in order get any bill to the floor. You have my sympathies, but unless you get these reforms into the final Senate bill you're not really helping most Americans afford future healthcare.
So what do you do?
First, try for the "reconciliation" process, which requires only 51 votes. Every one of the reforms I mention above would fit under the Byrd rule.
If that doesn't work, wrap these reforms together -- a public option open to everyone (allow states to opt out of this if they dare), Medicare-negotiated drug benefits, no 12-year monopoly for new drugs, and a major squeeze on Medicare reimbursements for doctors -- and have CBO score the savings. I guarantee you, the number will be large. Then you should dare anyone, Democrat or Republican, to vote against saving Americans so much money in years ahead. How is Ben Nelson going to face voters in Nebraska who would have to pay, say, 20 percent more for healthcare in the future if Nelson refuses to go along?
If neither of these tactics work, then take whatever bill you must to the Senate floor. But then introduce this reform package as the very first amendment to the bill. Call it the "Ted Kennedy Amendment for Helping Middle Class Families Afford Healthcare," and whip the hell out of the Democrats. Get the president to help you. Surely Joe Biden will. If you can't get 51 votes out of Dems for this, publish the list of Dems who vote against it, strip them of their committee chairs or sub-chairs, and make sure the Democratic Senatorial Campaign Committee gives them zilch when they're up for reelection.
Nobody promised you this would be easy, Harry. But, hell, why are you there, anyway? Your responsibility isn't just to pass whatever will muster 60 votes and that the president and Dems can later call "healthcare reform." It's to do the right thing by the American people and bring down future healthcare costs. Don't cave in to Lieberman or Nelson or the drug companies or the private insurers or the AMA or anyone else. Lead the charge.
All best.
Some important liberals are already getting in line behind the Senate's healthcare reform deal, as Gabriel Winant noted in an earlier post. And the biggest of them all -- at least when it comes to talk of healthcare, and a certain swath of progressives -- is backing the agreement as well.
"This is what should have been done in the first place," former Vermont Gov. Howard Dean said on CBS News Wednesday morning. He also called the deal "real reform." (Video below, with a hat-tip to Political Wire.)
Not everyone's been swayed, though. Two of the liberal blogosphere's biggest names, Markos Moulitsas of Daily Kos fame and Firedoglake's Jane Hamsher, are both disappointed with the deal, and with Democrats trying to play it up for donations.
Now that Senate Majority Leader Harry Reid has managed to produce a renegotiated healthcare deal, everyone has to figure out what to think about it. While Sen. Joe Lieberman, I-Conn., is hedging, liberals across the country are probably e-mailing each other right now, asking, “Where should we be on this?”
It’s early yet, but it’s looking like major progressive figures are feeling cautiously optimistic about the compromise Reid has crafted. Sen. Jay Rockefeller, D-W.Va., has been a major public option advocate all along. Of the new proposal, he says, “I’ve got a smile on my face. I don't smile naturally.” However, Rockefeller’s Senate colleague Russ Feingold, D-Wis., isn’t quite as happy a camper. In a comment given to the New York Times, Feingold expressed some disapproval -- though he didn't actually promise to vote against a bill. “I do not support proposals that would replace the public option in the bill with a purely private approach,” Feingold said.
Meanwhile, among liberal political observers, it’s much the same story. The Washington Post’s Ezra Klein thinks that the deal is “better by far than what Democrats looked likely to get a week ago.” He also points out that, should political conditions favor it, the proposed policies are structured so that they can easily be scaled up in the future. Mother Jones blogger Kevin Drum writes, “For now, the prospects for healthcare reform are looking as good as they ever have.” Writing in the Nation, under the headline, “Senate Dems ditch the public option,” John Nichols offers a characterization of the reforms in the deal as “not inconsequential.” And the current most-recommended diary at liberal superblog Daily Kos is an endorsement of the deal that claims, “This will lower total medical costs for everyone folks. And it's bigger news that the small fragment public option ever was.”
It’s hard to imagine liberals killing this thing -- as they threatened to do some months ago with any bill that didn't contain a public option. That means that if Reid has indeed found a compromise that can get enough centrist and conservative votes he’s probably got something that can pass.
Senate Democrats say they have a deal on healthcare reform. They're not saying what that deal is, really, but still: They say they have a deal.
Problem is, with 60 votes needed to break a filibuster in the Senate, every single senator's vote counts. And some of them, like Sen. Joe Lieberman, I-Conn., have been very hesitant about supporting Democrats' proposals. So the question remains -- will Lieberman support this deal? Or will he vote with Republicans to filibuster it?
A statement Lieberman put out Wednesday morning seems to suggest he'll back this new deal, but it also leaves him plenty of wiggle room to go either way. The full statement:
I am encouraged by the progress toward a consensus on proposals to send to the Congressional Budget Office to review. I believe that it is important to pass legislation that expands access to the millions who do not have coverage, improves quality and lowers costs while not impeding our economic recovery or increasing the debt.
My opposition to a government-run insurance option, including any option with a trigger, has been clear for months and remains my position today.
Regarding the ‘Medicare buy-in’ proposal that is being discussed, we must remain vigilant about protecting and extending the solvency of the program, which is now in a perilous financial condition.
It is my understanding that at this point there is no legislative language so I look forward to analyzing the details of the plan and reviewing analysis from the Congressional Budget Office and the Office of the Actuary in the Centers for Medicare and Medicaid.
After agreeing tentatively to jettison a key liberal priority -- a full-blown government-run insurance option -- Democrats say they are getting close to pushing President Barack Obama's health care bill through the Senate.
"We've overcome a real problem that we had," Majority Leader Harry Reid, D-Nev., said in announcing what he called a "broad agreement" Tuesday night.
Officials said it included nonprofit national health plans administered by the Office of Personnel Management, which runs the popular federal employees' health plan, as well as opening Medicare to uninsured Americans beginning at age 55, effective in 2011.
Greater government involvement would potentially kick in if private insurance companies declined to participate in the nationwide plan, although details weren't available. One possibility was for the personnel office to set up a government-run plan, either national in scope or on a state-by-state basis.
"I think when people see this they'll really like what we've done," said Sen. Mark Pryor, D-Ark., who was among five moderate senators who spent several days negotiating with five liberals. Reid planned to describe the plan in greater detail after getting an analysis from the Congressional Budget Office.
The White House weighed in quickly with a statement from spokesman Reid Cherlin. "Senators are making great progress and we're pleased that they're working together to find common ground toward options that increase choice and competition," he said.
The Senate is in its second week of debate on the 10-year, nearly $1 trillion legislation that would dramatically remake the U.S. health care system and extend coverage to millions of the uninsured, with a new requirement for nearly everyone to purchase insurance. New purchasing marketplaces called exchanges would make it easier for small businesses and people without government or employer coverage to shop for health insurance, and onerous insurance company practices such as denying coverage to people with pre-existing medical conditions would be banned.
The deal reached Tuesday puts even more requirements on insurers by requiring that 90 percent of premium dollars be spent on medical benefits, as opposed to administrative costs, officials said. The officials who described the details of the closed-door negotiations did so on condition of anonymity, saying they were not authorized to discuss them publicly.
Reid wants action on the health bill done by Christmas but more challenges lie ahead. On Wednesday, senators expected to debate an amendment by Sen. Byron Dorgan, D-N.D., to legalize the importation of prescription drugs from Canada and several other countries as a way of holding down consumer costs. The idea enjoys widespread support but is opposed by the pharmaceutical industry, which has worked closely with the administration on health care and has spent millions of dollars on television advertisements in support of legislation.
The Food and Drug Administration issued a letter saying it would be "logistically challenging" to assure the safety of imported drugs, raising concerns without stating outright opposition.
Underscoring the heated emotions surrounding the government insurance plan, Reid refused to acknowledge its demise, contending that reports it was gone were "not true."
In a statement, Reid said the emerging compromise "includes a public option and will help ensure the American people win in two ways: one, insurance companies will face more competition, and two, the American people will have more choices."
It wasn't clear what he meant by a "public option" -- the Medicare expansion or another element.
Either way, it's a far cry from what liberals had in mind when they envisioned the government competing directly with private insurers to offer health coverage to uninsured or self-employed Americans.
Even though the government plan would have been available to relatively few people, it took on outsize importance in the health care debate. Liberal groups clamored for it as necessary to offer consumers choice and competition, while Republicans and business groups -- and critically, a bloc of moderate senators -- contended it could mushroom out of control and drive private companies out of business.
In the end, dropping it was the price Reid had to pay for potential support from senators like moderate Blanche Lincoln, D-Ark., and Joe Lieberman, a Connecticut independent. Reid must have the support of all 58 Senate Democrats and two independents to achieve the necessary 60 votes to overcome Republican stalling tactics and advance legislation, giving great influence to the handful of moderates opposed to the government insurance plan.
Reid already faced the prospect of losing moderate Democratic Sen. Ben Nelson, D-Neb., who said his support was in question after the failure of an amendment he offered Tuesday to insert tougher abortion restrictions into the legislation. The vote was 54-45.
The health legislation passed by the House last month includes the tougher abortion language as well as a government insurance plan; those differences would have to be resolved, assuming the Senate passes its bill.
------
AP Special Correspondent David Espo contributed to this report.
Thus far, the public option has had more lives than a cat -- every time it's been declared dead, it's been reborn not long after. But now, it may really be on the way out.
The Associated Press is reporting that Democratic senators have reached a deal on their version of healthcare reform legislation. Under the agreement, according to the AP, the plan to create a government-run insurer would be dropped from the bill.
Details are very sketchy at the moment, but a couple replacements for the public option have been under discussion recently. One would let some Americans buy new plans that would be supervised by the Office of Personnel Management, which is responsible for the health benefits given to federal government employees. The other is an expansion of Medicare, opening the program up so that people who are 55 and older could buy into the program, which is usually restricted to those age 65 and up.
Update: It does seem like Senate Majority Leader Harry Reid wants to hang on at least to the semantics of "public option." As before, the detaisl of the deal aren't very clear, but it does still appear that the public option as we've been discussing it for months now is out. Still, Reid says, in a statement just released, that it's in. He's also denied the AP report.
The full statement:
This has been a long journey. We have confronted many hurdles, and tonight I believe we have overcome yet another one.
I asked Senators Schumer and Pryor to work with some of the most moderate and most progressive members of our diverse caucus, and tonight they have come to a consensus.
It is a consensus that includes a public option and will help ensure the American people win in two ways: one, insurance companies will face more competition, and two, the American people will have more choices.
I know not all 10 Senators in the room agree on every single detail of this, nor will all 60 members of my caucus. But I know we all appreciate the hard work that these progressives and moderates have done to move this historic debate forward.
I want to thank Senators Schumer, Pryor, Brown, Carper, Feingold, Harkin, Landrieu, Lincoln, Nelson and Rockefeller for working together for the greater good and never losing sight of our shared goal: making it possible for every American to afford to live a healthy life.
As is long-standing practice, we do not disclose details of any proposal before the Congressional Budget Office has a chance to evaluate it. We will wait for that to happen, but in the meantime, tonight we are confident.
Update 2: Some aides to senior Senate Democrats are telling Salon that there's some confusion among staffers (and possibly lawmakers) over exactly what the deal that's been reached looks like. Apparently only the 10 Democratic senators involved in the talks know for sure, at least as of late Tuesday night. One senior Democratic aide says the deal will still preserve some form of public plan, though it's significantly weaker than what was in the bill before the negotiations started.
Check back Wednesday morning for more details.
The right is still pretty upset about a comparison that Senate Majority Leader Harry Reid drew between those now opposing healthcare reform and people who fought against abolition, womens' suffrage and the civil rights movement. But Reid isn't backing down.
"At pivotal points in American history, the tactics of distortion and delay have certainly been present," the majority leader said Tuesday. "They've certainly been used to stop progress. That's what we're talking about here. That's what's happening here. It's very clear. That's the point I made -- no more, no less. Anyone who willingly distorts my comments is only proving my point."
Separately, the Wall Street Journal's John Fund criticized Reid on historical grounds, writing:
Historians also faulted Mr. Reid's curious reference to the Senate civil rights debates of the 1960s. After all, it was Southern Democrats who mounted an 83-day filibuster of the 1964 Civil Rights Bill. The final vote to cut off debate saw 29 Senators in opposition, 80% of them Democrats. Among those voting to block the civil rights bill was West Virginia Senator Robert Byrd, who personally filibustered the bill for 14 hours. The next year he also opposed the Voting Rights Act of 1965. Mr. Byrd still sits in the Senate, and indeed preceded Mr. Reid as his party's majority leader until he stepped down from that role in 1989.
Fund's line of attack was odd, and for more than one reason. For one thing, Reid never said it was Republicans who'd opposed the Civil Rights Act of 1964. (Fund gave it the inaccurate title of the 1964 Civil Rights Bill.) For another, making this sort of argument in a column titled "Harry Reid's History Lesson" is just ironic, because it betrays a lack of knowledge of the actual history of the Civil Rights Act and the years that followed.
Democrats did lead the filibuster of the Civil Rights Act, there's no doubting that, and that's something the party -- and especially Byrd -- has to reckon with. But there's a reason why President Obama is a Democrat. There's a reason why the vast majority of African Americans have voted Democrat for decades now, and it's not because they support the pro-segregation party.
The Civil Rights Act was the beginning of the end for the Southern faction that was once key to the Democratic party. Some Southern Democrats, like South Carolina Sen. Strom Thurmond, simply became Republicans. Others, loyal to generations of Democrats that came before them, hung on to their affiliation, only to become the last of a dying breed as Republicans -- using the Southern Strategy -- picked up the mantle of the party opposed to civil rights and ran with it.
There was one other very important senator who supported the filibuster, one whose name Fund didn't mention. That would be Sen. Barry Goldwater, R-Ariz., who said the bill was "a threat to the very essence of our basic system." Later that year, Goldwater became the Republican Party's nominee for president. He was also the model for President Reagan, and for much of the modern conservative movement.
Rush Limbaugh Says Poor Don't Deserve Healthcare
Spine, Are Some Democrats Getting a Spine? 
Insured breasts matter more
The Penis Has Landed