1) Individual mandates

The problem: Without a public option, the Senate bill would force Americans to buy healthcare from private insurance companies, who could act as a monopoly. So according to this line of reasoning, the real winners would just be the private insurers who got us into this mess in the first place. MSNBC's Keith Olbermann is one proponent of this point of view, arguing on "Countdown" Wednesday night that he will go to jail rather than purchase private insurance under this mandate, and urging his progressive audience to do the same.

The diagnosis: There is no way to expand the current insurance system to cover everyone without an individual mandate. At the moment, insurance companies discriminate against people who would be most likely to use insurance by making it unavailable to those with preexisting conditions. Healthcare reform would make this illegal and force insurers to make coverage available to everyone. But without an individual mandate, young, healthy people might not buy healthcare at all, causing premiums for older, sicker people to skyrocket. That's why every healthcare system (British, Swedish, French, Canadian, you name it) with anything approximating universal coverage has some version of individual mandates. Otherwise, universal coverage just doesn't work.

Salon's prescription: Keep individual mandates -- and work on introducing higher subsidies and better regulations to help make insurance affordable for the millions of people who will suddenly have access to it.

2) Who's covered, and how?

The problem: While proponents say the bill will extend coverage to another 31 million Americans, that's a shell game; they're doing it by mandating Americans to purchase insurance.

The diagnosis: The bill would do more than just make people purchase private healthcare: 14 million of these people would gain coverage through the expansion of Medicaid. The other 17 million, who would effectively be "forced" to buy into some private plan, are mostly people who can't currently afford to buy healthcare. Under the Senate bill, people making up to 400 percent of the poverty line ($88,200 for a family of four) would be given subsidies to purchase this insurance.

Salon's prescription: Again, push for higher subsidies extended to more Americans, so the new insurance isn't as unaffordable as the status quo is.

3) Preexisting conditions

The problem: Allegedly, the ban prohibiting insurers from denying coverage to people with preexisting conditions is meaningless. Sure, insurance companies would have to sell these people a plan -- but they could still charge exorbitant premiums and effectively price them out of the market.

The diagnosis: Under the most recent draft of the Senate bill, insurance companies can still charge more for insurance under certain circumstances. However, the bill dictates that premium rates can only vary based on age (older people can be charged up to three times as much for insurance as other planholders) or tobacco use (smokers or other users can be charged up to 1.5 times as much for insurance). Of course, in an ideal world, these factors wouldn't affect premium costs either, but the Senate bill would still make it significantly easier for people with preexisting health conditions to buy insurance.

Salon's prescription: Other than ensuring that there aren't any hidden loopholes, leave it be. The Senate's regulations regarding preexisting conditions would actually accomplish quite a bit.

4) Annual care caps

The problem: The Senate healthcare bill would allow insurance companies to implement annual dollar limits on medical care for people with a costly illness like cancer. This would defeat the purpose of health insurance, since it would no longer protect people from the worst-case scenario (you know, the one where you contract an incredibly costly illness whose treatment you can't possibly afford).

The diagnosis: Although the Senate Finance Committee prohibited annual caps altogether, the Senate bill would only bar "unreasonable" annual caps on medical costs. A Reid spokesperson justified the decision by citing concerns that banning all annual limits could lead to higher premiums. Getting rid of these caps might lead to higher premiums, but permitting them would definitively defang health insurance: It would provide coverage for everyone except people who need it most.

Salon's prescription: Remove this provision from the bill, or define "unreasonable" caps at a level that actually makes sense for the average family's budget. This shouldn't be too difficult: The White House has already indicated that it wants to strike the provision, and even Lieberman hasn't threatened to filibuster a bill that doesn't permit annual caps.

5) Insurers operating across state lines

The problem: The Senate bill would permit insurance companies to sell policies across state lines -- and let the companies choose which states' laws and regulations they would have to follow. This would allow insurers to avoid the strongest consumer protections and benefits required by state governments. A group of House Democrats from Maine and California argue that the arrangement "will lead to a race to the bottom in insurance regulation and severely threaten the important and often lifesaving protections the residents of our states enjoy."

The diagnosis: The bill does already contain several provisions to help avert this scenario. First, states would only be able to join interstate compacts by enacting a state law. So, any state that ended up undermining its own insurance regulations by joining an exchange would have done so through its own legislation -- which is unlikely. Also, insurance companies -- regardless of where they were based -- would still have to comply with some of the regulations of the state where the insurance purchaser lives. Finally, insurers would also need to obey the federal requirements stipulated by the bill in order to participate in the insurance exchanges it would set up. (But these regulations have yet to be spelled out.)

Salon's prescription: Push for stricter federal requirements as part of the insurance exchange system the bill would set up. Doing so would force insurance companies to provide better coverage across the nation, regardless of what state they were based in.

Yglesias' words are best left unaltered:

Providing prenatal services to pregnant women is a pro-life gesture by any stretch of the imagination. As is providing health insurance to young children. As we saw the other day, uninsured children are over three times more likely to die from their trauma-related injuries than are commercially insured children, even after adjustment for other factors such as age, gender, race, injury severity and injury type.

But Nelson won’t let those lives be saved unless the bill is modified in an insulting and discriminatory way. And part of the insanity of it is that the actual impact on the number of abortions in America is going to be tiny. Middle-class women will be able to pay for abortions out of pocket, and the “Hyde Amendment” status quo already screws poor women. But it’s a nice symbolic dig at pro-choice America, and a further means of stigmatizing reproductive health services as somehow not real health care. And Nelson, Bart Stupack, and various bishops love the idea of holding the whole package hostage to this point, since I guess the dead kids with trauma injuries will go to heaven anyway or something.

Nice.

In an interview with Salon late Thursday, however, Dean insisted that he would support a version of the current legislation, with certain changes, and that he had "never said" he would only back a bill that included a public option. "We're not going to get reform," he said, meaning what he regards as true reform, which would have to include a public option or an expansion of Medicare. "The question is, can we get a bill that does some good instead of more harm than good. And in order to do that, the protectionist legislation for the insurance companies that is in there now needs to be stripped out entirely."

What irks him the most in the current bill, he said, is that it permits insurance companies to charge as much as 300 percent more to some customers than others. So even though they must provide coverage to anyone who applies -- known as "guaranteed issue" -- the price differential that can be charged to older or sicker customers virtually erases that promise. "If you have to pay $20,000 a year for insurance, what good does it do if you have guaranteed issue?" he asked rhetorically. "Which is in fact what you'd have to pay if they can charge you three times as much as they do ordinary people. They have 300 percent rate differences in that bill. In Vermont, we have 20 percent rate differences, and that works."

The bill lacks sufficiently stringent controls on insurance company pay for executives and other wasteful expenditures as well, Dean argues, which is why he also opposes its mandate requiring all Americans (with few exceptions) to buy health insurance. "Why should you force Americans into a system that takes between 20 and 30 percent off the top for CEO salaries and return on equity?" he asked. "You're forcing them into that system and it's unfair." There should be no mandate without a public option, he said.

The best way to remedy this fundamental flaw, according to Dean, is to expand Medicare, because that avoids all of the political and market problems of a system based on private insurance. In the current legislation, he supports the insurance "exchange mechanism, because I assume we would need that no matter what else we do in the bill -- it is the most sensible way to buy insurance, and it was pioneered in Massachusetts," where insurance costs have declined. "I would certainly leave in the expansion of Medicaid," he added, "and make it bigger and have the feds put more money in it so the states don't get left on the hook. That's how we did universal insurance for kids [in Vermont] and I'm a huge fan of that." He also supports the expansion of community health centers and for wellness and preventive care in poor communities.

At the center of his argument with the Senate leadership and the White House is his insistence that their bill is a hodgepodge of "hocus pocus" and not "real insurance reform." He still believes that Congress could pass a Medicare expansion next year using the reconciliation process, needing only 51 votes rather than 60 -- and including $500 billion in cuts applied to Medicare Advantage subsidies to private insurers to pay the cost.

So does he really want to kill this bill? "Oh, I think they should vote no on it. I would like to see it redone," he said. "You can't vote for a bill like this ... You can't say, oh, we'll all vote for this piece of junk now, just to get it to the conference committee [with the House], because it's not going to get any better when it comes out of the conference committee if four Senators from the insurance industry can veto the result." He declined to name those four Senators, because "I'm trying not to get too much into ad hominem attacks."

Regardless of the nasty personal remarks about him that have been emanating from the White House, Dean wanted to emphasize that he still supports the president. He dismissed any talk of another run for president. "I plan to support President Obama vigorously in 2012. I think he's done a terrific job on things like the environment and restoring America's name in the rest of the world," he said. "I remember what it was like to have George Bush as president and I'm not on a mission to destroy the Democratic Party, having rebuilt it. But we didn't elect Democrats to pass crap. We elected Democrats to make a difference"

Will this bill make a difference despite its flaws? He doesn't think so. Although much of Dean's critique makes sense -- and he is hardly alone in his disappointment -- some of his arguments have been disputed by other progressive experts, notably Ezra Klein and Paul Starr.

But the real crux of the argument between Dean and the bill's supporters is less about the details than over what this act means for the future of healthcare in America. For those who want the bill to pass despite its defects -- a position that I have come to share -- this is the moment when the nation decides that health insurance must be provided to every citizen, period. That tidal shift is why right-wing politicians and pundits are so ferociously opposed to this bill -- and why its passage would represent an important victory on the way to restoration of the American social contract.

Short summary: Wood and the Crystal Ball rate 21, or fewer than half the 52, as safe incumbents running for re-election. In the other 31 cases there is a mix of members retiring (3), running for other office (1), plus 27 who are running for re-election in districts where the underlying demographics have Republicans licking their chops. "In fact, over a third of Blue Dogs hail from districts Obama won last November," writes Wood. 'While the coalition is often portrayed as a group of Southern congressmen who must vote conservatively or risk losing reelection, nineteen members represent districts Obama carried, with seven representing districts in which Obama won over 60 percent of the vote."

OK, so what can we expect come November for this group, which includes a lot of southerners, yes, but many outside the region? Well, if we presume the historical, 16-seat average loss for a president's party in the House during that president's first mid-term, and given that the 52 Blue Dogs are almost exactly one-fifth of the caucus' 258 total members, that would mean a loss of 3 Blue Dogs--if their vulnerability were no greater or less than Democrats generally.

But, of course, they are more vulnerable. Partly this may be a result of their voting records. Woods looks at their roll call on the House healthcare reform bill. Twenty-four voted against, providing 24 of the 39 nay Democratic votes, or 62 percent of nay votes; whereas they provided just 28 of the Democrats' 219 aye votes, or just 12 percent of ayes. But voting against healthcare is going to be the safe electoral move for some of them.

Part of it is that a disproportionate share of them are so-called "McCain-Democrats," those who won in districts that President Obama lost in 2008, as Woods points out. And therein lies a strange political calculus for the president--having to fight harder to save the seats who backed him and his legislative agenda at far lower rates.

Not only are Republican senators threatening to block funding for the troops. Not only are they doing so under cover of night. (The move happened around 1 a.m. early this, Friday morning.) Not only does this go against all of the soft-on-defense attacks the GOP has launched against Democrats since, oh, 1968. 

But some Republicans openly admit they are doing it.

If President Obama and Senate Democrats cannot turn this into a holy shit storm of criticism, there's something wrong with them. This is a breakaway dunk for Lebron James. This is a tipped pass headed straight into the cornerback Darrell Green's hands, with nothing but an open sideline between him and the end zone. This is a fat pitch down the middle to Albert Pujols on a full count with the bases loaded. This is my beloved Alex Ovechkin with the puck on his stick and an open net in front of him.

This is, in short, an opportunity for Obama--not Reid, Obama--to throw up his hands and finally say what he should have said long ago, something like: "You know what, for a year now I've tried to negotiate in good faith with my Republican counterparts, but too many of them have ceased to be people of good faith. Their threats to shut down military funding are like the government shutdown of 1995--actually worse, because these are troops fighting two wars abroad right now. Apparently, the Republicans were for the troops before they were against them. This proves they are the party that stands for nothing--absolutely nothing--other than the excercise of power for power's sake. And they should be ashamed."

Then let Fox News have to run that clip all day.