Beth's Health Care Reform Blog

A humorously serious look at life’s trials & tribulations,
American politics, religion, and other social madnesses by Beth Isbell.

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Post by roxybeast » November 17th, 2009, 11:54 pm

Analyst Doubts Health Overhaul Can Pass
By REED ABELSON

New York Times, November 17, 2009

Arguing that the political winds are shifting away from the support necessary for an overhaul, one Wall Street analyst is now predicting Congress will not pass any significant health care legislation anytime soon.

In a report to investors on Tuesday, Richard Evans, an analyst with Sector & Sovereign in New York, writes, “We no longer expect Congress to pass impactful health reform legislation this year, or even in this political cycle.”

Mr. Evans cites several factors that he believes makes passage less and less likely, including the increasing public opposition to the overhaul, as well as the emergence of politically divisive issues like abortion and immigration in the debate over the legislation’s specifics.

He also notes that the House and the Senate take very different views on how the overhaul should be paid for, with the House favoring a tax on the wealthy, and the Senate preferring a tax on the most generous insurance policies, the so-called Cadillac plans.

The result is what Mr. Evans sees as irreconcilable differences in opinion about where to get the money for reform, with the House and Senate “settled on a plan that the other cannot pass.”

“In short, we don’t think health reform is failing because someone hasn’t written the right bill; health care reform is failing because no one created a durable coalition in the first place, and potential members of such a coalition have been drawn into other (abortion, immigration, class) battles,” Mr. Evans writes. “For the time being, it‘s simply over.”

You can read the full Evans report here: http://graphics8.nytimes.com/packages/f ... argins.pdf

Source: http://prescriptions.blogs.nytimes.com/ ... -can-pass/

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Post by roxybeast » November 17th, 2009, 11:55 pm

Reid Says He’s Close to Unveiling Health Bill
By DAVID M. HERSZENHORN

New York Times, November 17, 2009

The Senate majority leader, Harry Reid of Nevada, said Tuesday that he was close to unveiling his health care bill and that Democrats remained committed to passing it. But asked if he had the 60 votes needed to bring up the bill for debate on the Senate floor, Mr. Reid was not entirely certain.

“I feel cautiously optimistic that we can do that,” Mr. Reid said at a news conference.

Aides said that Mr. Reid was awaiting one more cost analysis by the Congressional Budget Office. Mr. Reid then plans to present the bill and the cost study to the Democratic caucus before holding a news conference to make the legislation public.

A first procedural vote could be held on Friday or Saturday.

“We’re all eager to hear the final word from C.B.O., but I’m confident we’ll be introducing in the next little while a bill that cuts costs, stops insurance company abuses and provides affordable choices for all Americans,” Mr. Reid said Tuesday.

Even as Democrats remain divided on some crucial issues, such as the proposal to create a government-run insurance plan, Mr. Reid insisted that his caucus was intent on passing landmark legislation.

“Based on the talk in the caucus today, our purpose and resolve remain strong,” he said. “We’re energized. We stand on the doorstep of delivering historic reform to the American people.”

But the Senate Republican leader, Mitch McConnell of Kentucky, said Democrats faced mounting public opposition.

“I think the public is saying to all of us, quit passing thousand-page bills, concentrate on improving the economy,” Mr. McConnell said. “Every poll I’ve seen, the American people are saying, ‘Don’t pass this health-care bill.’ And I’m perplexed at the Democrats’ intent to ignore public opinion and go forward with this.”


Source: http://prescriptions.blogs.nytimes.com/ ... alth-bill/

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Post by roxybeast » November 18th, 2009, 12:14 am

<center>Summary of the House Health Care Reform Bill
Provided by the House Committee on Education & Labor
</center>

<center>SUMMARY</center>

America’s Affordable Health Choices Act provides quality affordable health care for all Americans and controls health care cost growth. Key provisions of the bill released today include:

• COVERAGE AND CHOICE
• AFFORDABILITY
• SHARED RESPONSIBILITY
• CONTROLLING COSTS
• PREVENTION AND WELLNESS
• WORKFORCE INVESTMENTS


I. COVERAGE AND CHOICE

The bill builds on what works in today’s health care system and fixes the parts that are broken. It protects current coverage – allowing individuals to keep the insurance they have if they like it – and preserves choice of doctors, hospitals, and health plans. It achieves these reforms through:

• A Health Insurance Exchange. The new Health Insurance Exchange creates a transparent and functional marketplace for individuals and small employers to comparison shop among private and public insurers. It works with state insurance departments to set and enforce insurance reforms and consumer protections, facilitates enrollment, and administers affordability credits to help low- and middle-income individuals and families purchase insurance. Over time, the Exchange will be opened to additional employers as another choice for covering their employees. States may opt to operate the Exchange in lieu of the national Exchange provided they follow the federal rules.

• A public health insurance option. One of the many choices of health insurance within the health insurance Exchange is a public health insurance option. It will be a new choice in many areas of our country dominated by just one or two private insurers today. The public option will operate on a level playing field. It will be subject to the same market reforms and consumer protections as other private plans in the Exchange and it will be self-sustaining – financed only by its premiums.

• Guaranteed coverage and insurance market reforms. Insurance companies will no longer be able to engage in discriminatory practices that enable them to refuse to sell or renew policies today due to an individual’s health status. In addition, they can no longer exclude coverage of treatments for pre-existing health conditions. The bill also protects consumers by prohibiting lifetime and annual limits on benefits. It also limits the ability of insurance companies to charge higher rates due to health status, gender, or other factors. Under the proposal, premiums can vary based only on age (no more than 2:1), geography and family size.

• Essential benefits. A new independent Advisory Committee with practicing providers and other health care experts, chaired by the Surgeon General, will recommend a benefit package based on standards set in the law. This new essential benefit package will serve as the basic benefit package for coverage in the Exchange and over time will become the minimum quality standard for employer plans. The basic package will include preventive services with no cost-sharing, mental health services, oral health and vision for children, and caps the amount of money a person or family spends on covered services in a year.


II. AFFORDABILITY

To ensure that all Americans have affordable health coverage the bill:

• Provides sliding scale affordability credits. The affordability credits will be available to low- and moderate- income individuals and families. The credits are most generous for those who are just above the proposed new Medicaid eligibility levels; the credits decline with income (and so premium and cost-sharing support is more limited as your income increases) and are completely phased out when income reaches 400 percent of the federal poverty level ($43,000 for an individual or $88,000 for a family of four). The affordability credits will not only make insurance premiums affordable, they will also reduce cost-sharing to levels that ensure access to care. The Exchange administers the affordability credits with other federal and state entities, such as local Social Security offices and state Medicaid agencies.

• Caps annual out-of-pocket spending. All new policies will cap annual out-of-pocket spending to prevent bankruptcies from medical expenses.

• Increased competition: The creation of the Health Insurance Exchange and the inclusion of a public health insurance option will make health insurance more affordable by opening many market areas in our country to new competition, spurring efficiency and transparency.

• Expands Medicaid. Individuals and families with incomes at or below 133 percent of the federal poverty level will be eligible for an expanded and improved Medicaid program. Recognizing the budget challenges in many states, this expansion will be fully federally financed. To improve provider participation in this vital safety net – particularly for low-income children, individuals with disabilities and people with mental illnesses – reimbursement rates for primary care services will be increased with new federal funding.

• Improves Medicare. Senior citizens and people with disabilities will benefit from provisions that fill the donut hole over time in the Part D drug program, eliminate cost-sharing for preventive services, improve the low-income subsidy programs in Medicare, fix physician payments, and make other program improvements. The bill will also address future fiscal challenges by improving payment accuracy, encouraging delivery system reforms and extending solvency of the Medicare Trust Fund.


III. SHARED RESPONSIBILITY

The bill creates shared responsibility among individuals, employers and government to ensure that all Americans have affordable coverage of essential health benefits.

• Individual responsibility. Except in cases of hardship, once market reforms and affordability credits are in effect, individuals will be responsible for obtaining and maintaining health insurance coverage. Those who choose to not obtain coverage will pay a penalty of 2.5 percent of modified adjusted gross income above a specified level.

• Employer responsibility. The proposal builds on the employer-sponsored coverage that exists today. Employers will have the option of providing health insurance coverage for their workers or contributing funds on their behalf. Employers that choose to contribute will pay an amount based on eight percent of their payroll. Employers that choose to offer coverage must meet minimum benefit and contribution requirements specified in the proposal.

• Assistance for small employers. Recognizing the special needs of small businesses, the smallest businesses (payroll that does not exceed $250,000) are exempt from the employer responsibility requirement. The payroll penalty would then phase in starting at 2% for firms with annual payrolls over $250,000 rising to the full 8 percent penalty for firms with annual payrolls above $400,000. In addition, a new small business tax credit will be available for those firms who want to provide health coverage to their workers. In addition to the targeted assistance, the Exchange and market reforms provide a long-sought opportunity for small businesses to benefit from a more organized, efficient marketplace in which to purchase coverage.

• Government responsibility. The government is responsible for ensuring that every American can afford quality health insurance, through the new affordability credits, insurance reforms, consumer protections, and improvements to Medicare and Medicaid.


IV. PREVENTION AND WELLNESS

Prevention and wellness measures of the bill include:

• Expansion of Community Health Centers;

• Prohibition of cost-sharing for preventive services;

• Creation of community-based programs to deliver prevention and wellness services;

• A focus on community-based programs and new data collection efforts to better identify and address racial, ethnic, regional and other health disparities;

• Funds to strengthen state, local, tribal and territorial public health departments and programs.



V. WORKFORCE INVESTMENTS

The bill expands the health care workforce through:

• Increased funding for the National Health Service Corp;

• More training of primary care doctors and an expansion of the pipeline of individuals going into health professions, including primary care, nursing and public health;

• Greater support for workforce diversity;

• Expansion of scholarships and loans for individuals in needed professions and shortage areas;

• Encouragement of training of primary care physicians by taking steps to increase physician training outside the hospital, where most primary care is delivered, and redistributes unfilled graduate medical education residency slots for purposes of training more primary care physicians. The proposal also improves accountability for graduate medical education funding to ensure that physicians are trained with the skills needed to practice health care in the 21st century.



VI. CONTROLLING COSTS

The bill will reduce the growth in health care spending in a numerous ways. Investing in health care through stronger prevention and wellness measures, increasing access to primary care, health care delivery system reform, the Health Insurance Exchange and the public health insurance option, improvements in payment accuracy and reforms to Medicare and Medicaid will all help slow the growth of health care costs over time. These savings will accrue to families, employers, and taxpayers.

• Modernization and improvement of Medicare. The bill implements major delivery system reform in Medicare to reward efficient provision of health care, rolling out innovative concepts such as accountable care organizations, medical homes, and bundling of acute and post-acute provider payments. New payment incentives aim to decrease preventable hospital readmissions, expanding this policy over time to recognize that physicians and post-acute providers also play an important role in avoiding readmissions. The bill improves the Medicare Part D program by creating new consumer protections for Medicare Advantage Plans, eliminating the “donut hole” and improving low-income subsidy programs, so that Medicare is affordable for all seniors and other eligible individuals. A centerpiece of the proposal is a complete reform of the flawed physician payment mechanism in Medicare (the so-called sustainable growth rate or “SGR” formula), with an update that wipes away accumulated deficits, provides for a fresh start, and rewards primary care services, care coordination and efficiency.

• Innovation and delivery reform through the public health insurance option. The public health insurance option will be empowered to implement innovative delivery reform initiatives so that it is a nimble purchaser of health care and gets more value for each health care dollar. It will expand upon the experiments put forth in Medicare and be provided the flexibility to implement value-based purchasing, accountable care organizations, medical homes, and bundled payments. These features will ensure the public option is a leader in efficient delivery of quality care, spurring competition with private plans.

• Improving payment accuracy and eliminating overpayments. The bill eliminates overpayments to Medicare Advantage plans and improves payment accuracy for numerous other providers, following recommendations by the Medicare Payment Advisory Commission and the President. These steps will extend Medicare Trust Fund solvency, and put Medicare on stronger financial footing for the future.

• Preventing waste, fraud and abuse. New tools will be provided to combat waste, fraud and abuse within the entire health care system. Within Medicare, new authorities allow for pre-enrollment screening of providers and suppliers, permit designation of certain areas as being at elevated risk of fraud to implement enhanced oversight, and require compliance programs of providers and suppliers. The new public health insurance option and Health Insurance Exchange will build upon the safeguards and best practices gleaned from experience in other areas.

• Administrative simplification. The bill will simplify the paperwork burden that adds tremendous costs and hassles for patients, providers, and businesses today.

Source: http://edlabor.house.gov/documents/111/ ... 071409.pdf

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Post by roxybeast » November 18th, 2009, 9:39 pm

Read The Abortion Compromise In Harry Reid's Senate Health Care Bill
by Ryan Grim

Huffington Post, November 18, 2009

The health care reform package unveiled by Senate Majority Leader Harry Reid (D-Nev.) Wednesday night bars the use of federal funds for abortion services, but does not go as far as the House bill -- which prevents women in many cases from buying insurance with their own money that covers abortion.

The Senate version would require at least one plan within the health insurance exchange that the bill sets up to offer a plan that covers abortion and one that doesn't. It would also authorize the Health and Human Services Secretary to audit plans to make certain that abortion isn't being paid for with federal dollars.

Rep. Lois Capps (D-Calif.), who authored compromise abortion language in the House that both sides had agreed to before the more restrictive measure won out, is pleased with the Senate version.

"I am pleased that the Senate has adopted a reasonable, common ground approach on this difficult question," she said in a statement. "It appears that their approach closely mirrors my language which was originally included in the House bill. It ensures that federal funds do not pay for abortions but allows continued access to this legal medical procedure. This is a bill about health insurance reform not about expanding or contracting access to abortion services. I am glad that the Senate has rejected the more extreme Stupak language and look forward to continuing to work with my pro-life and pro-choice colleagues on a reasonable compromise on this issue."

HuffPost scored a copy of Reid's bill, which you can read here. The abortion compromise begins on page 116 with section 1303.

Write ryan@huffingtonpost.com if you notice any unexpected restrictions that could result from this language. Please refer to the page numbers and the line numbers to the left.

14 SEC. 1303. SPECIAL RULES.
(a) SPECIAL RULES RELATING TO COVERAGE OF ABORTION SERVICES.--
VOLUNTARY CHOICE OF COVERAGE OF ABORTION SERVICES.--

19 (A) IN GENERAL.--Notwithstanding any
20 other provision of this title (or any amendment
21 made by this title), and subject to subpara22
graphs (C) and (D)--
23 (i) nothing in this title (or any
24 amendment made by this title), shall be
25 construed to require a qualified health plan

Story continues below

Page 117

1 to provide coverage of services described in
2 subparagraph (B)(i) or (B)(ii) as part of
3 its essential health benefits for any plan
4 year; and
5 (ii) the issuer of a qualified health
6 plan shall determine whether or not the
7 plan provides coverage of services described
8 in subparagraph (B)(i) or (B)(ii) as part
9 of such benefits for the plan year.
10 (B) ABORTION SERVICES.--
11 (i) ABORTIONS FOR WHICH PUBLIC
12 FUNDING IS PROHIBITED.--The services
13 described in this clause are abortions for
14 which the expenditure of Federal funds ap15
propriated for the Department of Health
16 and Human Services is not permitted,
17 based on the law as in effect as of the date
18 that is 6 months before the beginning of
19 the plan year involved.
20 (ii) ABORTIONS FOR WHICH PUBLIC
21 FUNDING IS ALLOWED.--The services de22
scribed in this clause are abortions for
23 which the expenditure of Federal funds ap24
propriated for the Department of Health
25 and Human Services is permitted, based

Page 118

1 on the law as in effect as of the date that
2 is 6 months before the beginning of the
3 plan year involved.
4 (C) PROHIBITION ON FEDERAL FUNDS
5 FOR ABORTION SERVICES IN COMMUNITY
6 HEALTH INSURANCE OPTION.--
7 (i) DETERMINATION BY SEC8
RETARY.--The Secretary may not deter9
mine, in accordance with subparagraph
10 (A)(ii), that the community health insur11
ance option established under section 1323
12 shall provide coverage of services described
13 in subparagraph (B)(i) as part of benefits
14 for the plan year unless the Secretary--
15 (I) assures compliance with the
16 requirements of paragraph (2);
17 (II) assures, in accordance with
18 applicable provisions of generally ac19
cepted accounting requirements, circu20
lars on funds management of the Of21
fice of Management and Budget, and
22 guidance on accounting of the Govern23
ment Accountability Office, that no
24 Federal funds are used for such cov25
erage; and

Page 119

1 (III) notwithstanding section
2 1323(e)(1)(C) or any other provision
3 of this title, takes all necessary steps
4 to assure that the United States does
5 not bear the insurance risk for a com6
munity health insurance option's cov7
erage of services described in subpara8
graph (B)(i).
9 (ii) STATE REQUIREMENT.--If a State
10 requires, in addition to the essential health
11 benefits required under section 1323(b)(3)
12 (A), coverage of services described in sub13
paragraph (B)(i) for enrollees of a commu14
nity health insurance option offered in
15 such State, the State shall assure that no
16 funds flowing through or from the commu17
nity health insurance option, and no other
18 Federal funds, pay or defray the cost of
19 providing coverage of services described in
20 subparagraph (B)(i). The United States
21 shall not bear the insurance risk for a
22 State's required coverage of services de23
scribed in subparagraph (B)(i).
24 (iii) EXCEPTIONS.--Nothing in this
25 subparagraph shall apply to coverage of

Page 120

1 services described in subparagraph (B)(ii)
2 by the community health insurance option.
3 Services described in subparagraph (B)(ii)
4 shall be covered to the same extent as such
5 services are covered under title XIX of the
6 Social Security Act.
7 (D) ASSURED AVAILABILITY OF VARIED
8 COVERAGE THROUGH EXCHANGES.--
9 (i) IN GENERAL.--The Secretary shall
10 assure that with respect to qualified health
11 plans offered in any Exchange established
12 pursuant to this title--
13 (I) there is at least one such plan
14 that provides coverage of services de15
scribed in clauses (i) and (ii) of sub16
paragraph (B); and
17 (II) there is at least one such
18 plan that does not provide coverage of
19 services described in subparagraph
20 (B)(i).
21 (ii) SPECIAL RULES.--For purposes of
22 clause (i)--
23 (I) a plan shall be treated as de24
scribed in clause (i)(II) if the plan
25 does not provide coverage of services

Page 121

1 described in either subparagraph
2 (B)(i) or (B)(ii); and
3 (II) if a State has one Exchange
4 covering more than 1 insurance mar5
ket, the Secretary shall meet the re6
quirements of clause (i) separately
7 with respect to each such market.
8 (2) PROHIBITION ON THE USE OF FEDERAL
9 FUNDS.--
10 (A) IN GENERAL.--If a qualified health
11 plan provides coverage of services described in
12 paragraph (1)(B)(i), the issuer of the plan shall
13 not use any amount attributable to any of the
14 following for purposes of paying for such serv15
ices:
16 (i) The credit under section 36B of
17 the Internal Revenue Code of 1986 (and
18 the amount (if any) of the advance pay19
ment of the credit under section 1412 of
20 the Patient Protection and Affordable Care
21 Act).
22 (ii) Any cost-sharing reduction under
23 section 1402 of thePatient Protection and
24 Affordable Care Act (and the amount (if
25 any) of the advance payment of the reduc122
O:\BAI\BAI09M01.xml [file 1 of 9] S.L.C.
1 tion under section 1412 of the Patient
2 Protection and Affordable Care Act).
3 (B) SEGREGATION OF FUNDS.--In the case
4 of a plan to which subparagraph (A) applies,
5 the issuer of the plan shall, out of amounts not
6 described in subparagraph (A), segregate an
7 amount equal to the actuarial amounts deter8
mined under subparagraph (C) for all enrollees
9 from the amounts described in subparagraph
10 (A).
11 (C) ACTUARIAL VALUE OF OPTIONAL
12 SERVICE COVERAGE.--
13 (i) IN GENERAL.--The Secretary shall
14 estimate the basic per enrollee, per month
15 cost, determined on an average actuarial
16 basis, for including coverage under a quali17
fied health plan of the services described in
18 paragraph (1)(B)(i).
19 (ii) CONSIDERATIONS.--In making
20 such estimate, the Secretary--
21 (I) may take into account the im22
pact on overall costs of the inclusion
23 of such coverage, but may not take
24 into account any cost reduction esti25
mated to result from such services, in123
O:\BAI\BAI09M01.xml [file 1 of 9] S.L.C.
1 cluding prenatal care, delivery, or
2 postnatal care;
3 (II) shall estimate such costs as
4 if such coverage were included for the
5 entire population covered; and
6 (III) may not estimate such a
7 cost at less than $1 per enrollee, per
8 month.
9 (3) PROVIDER CONSCIENCE PROTECTIONS.--No
10 individual health care provider or health care facility
11 may be discriminated against because of a willing12
ness or an unwillingness, if doing so is contrary to
13 the religious or moral beliefs of the provider or facil14
ity, to provide, pay for, provide coverage of, or refer
15 for abortions.
16 (b) APPLICATION OF STATE AND FEDERAL LAWS
17 REGARDING ABORTION.--
18 (1) NO PREEMPTION OF STATE LAWS REGARD19
ING ABORTION.--Nothing in this Act shall be con20
strued to preempt or otherwise have any effect on
21 State laws regarding the prohibition of (or require22
ment of) coverage, funding, or procedural require23
ments on abortions, including parental notification
24 or consent for the performance of an abortion on a
25 minor.

Page 124

1 (2) NO EFFECT ON FEDERAL LAWS REGARDING
2 ABORTION.--
3 (A) IN GENERAL.--Nothing in this Act
4 shall be construed to have any effect on Federal
5 laws regarding--
6 (i) conscience protection;
7 (ii) willingness or refusal to provide
8 abortion; and
9 (iii) discrimination on the basis of the
10 willingness or refusal to provide, pay for,
11 cover, or refer for abortion or to provide or
12 participate in training to provide abortion.
13 (3) NO EFFECT ON FEDERAL CIVIL RIGHTS
14 LAW.--Nothing in this subsection shall alter the
15 rights and obligations of employees and employers
16 under title VII of the Civil Rights Act of 1964.
17 (c) APPLICATION OF EMERGENCY SERVICES
18 LAWS.--Nothing in this Act shall be construed to relieve
19 any health care provider from providing emergency serv20
ices as required by State or Federal law, including section
21 1867 of the Social Security Act (popularly known as
22 ''EMTALA'').

Source: http://www.huffingtonpost.com/2009/11/1 ... 63117.html

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Post by roxybeast » November 18th, 2009, 9:42 pm

Senate Dems Close In On Reform: Details Of Health Care Bill Revealed
by Ryan Grim

Huffington Post, November 18, 2009

Senate Democrats moved one step closer Wednesday night to comprehensive health care reform as Sen. Majority Leader Harry Reid (D-Nev.) unveiled a health care reform package that is a product of a merger of twin plans that passed the health and finance committees.

With the House having already passed its own package, Congress has never been so close to completion of reform in the six decades that Democrats have pursued it.

"We're now down to the week we've been waiting for for a long time," said Sen. John Kerry (D-Mass.) after emerging from the meeting.

Democratic leadership expressed confidence that the votes would be there by Saturday for a motion to proceed to a floor debate on the bill. Three senators - Ben Nelson (D-Neb), Mary Landrieu (D-La.) and Blanche Lincoln (D-Ark.) - have yet to commit to vote for the motion to proceed and Reid deferred questions about their position to them.

During the meeting, the fence-sitting members spoke to the caucus, but didn't commit one way or another on the motion to proceed, said one Democratic senator who spoke not for attribution.

The bill presented by Reid is stronger than pundits ever thought possible in the summer months, when centrist and conservative Democrats worked to kill the public health insurance option. A loud round of applause could be heard toward the end of the meeting - unusual for Senate gatherings.

Reid's bill includes a national public plan that would be available to consumers within health insurance exchanges that the reform effort establishes. Skeptical states would be allowed to opt out of the plan.

The bill will be posted online Wednesday night, Senate Majority Whip Dick Durbin (D-Ill.) said. "I would hope [Republicans] would take this opportunity to post their health care bill online," Durbin teased. The GOP has no health care bill.

Story continues below

The bill does not go as far as the House did in restricting access to abortion. The House bill blocked a woman's ability to purchase health insurance that covers abortion even with her own many in many instances. The Senate package, several senators said, makes crystal clear that no federal funds could be used to pay for abortion. But at least one plan within the exchange must offer abortion coverage and one plan must not.

An aide who saw the specific language said the bill authorizes the secretary of Health and Human Services to audit plans to make certain no federal funds are being used to pay for abortion services.

House conservatives have threatened to block the reform bill if their more restrictive provision isn't included. Kerry acknowledged that there could still be negotiations, "but that's where the Senate is starting.

Instead of taxing the rich to pay for a significant piece of the bill, as the House does, the Senate plan taxes "Cadillac" health plans. But the value of plans that would be taxed is increased from previous versions to $8,500 for an individual and $23,000 for a family of four. Higher values are allowed in high-cost states and workers in high-risk jobs - such as coal miners - are given an exemption.

Reid's bill also altered the formula by which businesses would be assessed a fee for not insuring their workers. But the new formula was unclear. Kerry called it "convoluted" and Durbin dubbed it "complex."

Reid presented to his colleagues a preliminary Congressional Budget Office analysis of the Senate health care legislation. It finds that the bill will cost $849 billion over the next decade while covering 94 percent of eligible Americans; 31 million currently uninsured Americans would be covered under the legislation. The bill would also lower the deficit by $127 billion over the next decade and by $650 billion during the decade after that. Kerry cautioned that the numbers were still being finalized and could change slightly.

By keeping the total cost of the bill under $900 billion, Reid met one of the conditions set by the Obama White House. The bill is also expected to drastically bend the cost curve in the health care system -- another major Obama objective -- by achieving "almost a trillion dollars in cost savings" within the health care system.

Reid will file a cloture motion Thursday, which will be followed by an intervening day, by Senate rules, leaving Saturday for the vote.

Source: http://www.huffingtonpost.com/2009/11/1 ... 63094.html
And see ...
Senate leader unveils $849 billion health care bill
CNN, November 18, 2009

Washington (CNN) -- Senate Majority Leader Harry Reid unveiled a sweeping health care bill Wednesday that would expand health insurance coverage to 30 million more Americans at an estimated cost of $849 billion over 10 years.

Reid and other Senate Democrats cited an analysis by the nonpartisan Congressional Budget Office for the coverage and cost figures.

In addition, they said at a news conference, the budget office estimated that the proposal would reduce the federal deficit by $127 billion over the next 10 years and by more than $600 billion in the following decade.

The proposal drafted from two separate bills approved by Senate committees now goes to the full Senate, where Republicans have vowed to try to block it.

Reid, D-Nevada, met behind closed doors with Senate Democrats to brief them on details of the bill before the news conference.

Now Reid needs to round up 60 votes in the 100-member Senate to overcome a certain GOP filibuster attempt and open the chamber's debate on the bill.

Democratic leadership sources have said a Saturday vote to start debate is likely. It remains unclear, however, whether Democrats will have enough votes to fend off a filibuster.

Earlier Wednesday, Reid met with Sens. Mary Landrieu of Louisiana, Blanche Lincoln of Arkansas and Ben Nelson of Nebraska, moderate Democrats who have expressed concerns about the cost and scope of health care reform proposals.

The trio will play a pivotal role in the success or failure of health care reform in the Senate. If Republicans stay unified in opposition to the health care bill, Reid would need the support of all 58 Senate Democrats as well as independent Sens. Bernie Sanders of Vermont and Joe Lieberman of Connecticut to overcome a filibuster.

Landrieu said she has concerns relating to the bill's costs to small businesses and individuals. She also expressed opposition to a public health insurance option "that will undermine the private insurance market." If that's included in the measure, she said, "it needs to come out at some point."

She stated, however, that Reid gave her multiple "assurances ... that he's working hard toward those goals."

Nelson released a statement Wednesday noting that the likely weekend vote represents an opportunity "to commence debate and an opportunity to make changes" to improve the bill.

A source close to Nelson indicated that the Nebraska senator may be willing to vote to start debate even if he doesn't support everything that's in the bill.

Landrieu, Lincoln and Nelson have all indicated that they want a chance to read the budget office-scored bill before deciding whether to back a vote starting debate.

Reid has spent the past several weeks melding bills passed by two Senate committees. A version passed by the House -- by a 220-215 vote -- was crafted by Democratic leaders who merged legislation from three House committees.

The House measure is projected to cost more than $1 trillion over the next 10 years.

If the Senate manages to pass a bill, a congressional conference committee would need to merge the House and Senate proposals into a consensus version requiring final approval from each chamber before moving to President Obama's desk to be signed into law.

Democratic leaders in both chambers have been wrestling with a series of controversial issues tied to health care reform, including abortion and immigration. They're also at odds over how to pay for reform.

They have, however, reached agreement on a broad range of changes that could impact every American's coverage.

Among other things, they've agreed to subsidize insurance for a family of four making up to roughly $88,000 annually, or 400 percent of the federal poverty level.

They've also agreed to expand Medicaid and create health insurance exchanges to make it easier for small businesses, the self-employed and the unemployed to pool resources and purchase less expensive coverage.

They also would limit total out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.
Insurers under the Democratic plans would be barred from charging higher premiums based on a person's gender or medical history.

Source: http://www.cnn.com/2009/POLITICS/11/18/health.care/

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Post by roxybeast » November 18th, 2009, 10:06 pm

To read other columns, articles, poetry, song lyrics & other writings by Beth Isbell ... http://www.studioeight.tv/phpbb/viewforum.php?f=59

To check out Beth's original music, including rock, blues, folk, country, reggae, gospel, and other original and cover songs, and youtube videos, and her official CDs ... http://www.studioeight.tv/phpbb/viewtopic.php?t=16212

To follow Beth on Twitter: http://twitter.com/bethisbell

To connect with Beth on FaceBook: http://www.facebook.com/bethisbell

And thanks for reading my health care blog - updated frequently with the best articles about health care reform and the status of the legislation! :)

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Post by roxybeast » November 18th, 2009, 10:26 pm

<center>Will the Moderate Dems in Senate Vote For Cloture to Get Bill to Floor?</center>
Will the moderate Democrats who have been holding out on whether they will support a motion for cloture to get the bill to debate and vote on the Senate floor come around and oppose a Republican filibuster?
Nelson: I'm Comfortable Being Lone Democrat To Derail Reform
by Sam Stein

Huffington Post, November 18, 2009

One of the key moderate Senate Democrats, Ben Nelson (D-Neb.) said on Wednesday that he was pleased with the changes party leadership had made to its version of health care legislation, specifically on matters of deficit reduction. But the Nebraska Democrat, whose vote has been elusive to pin down so far, said he would be comfortable being the lone Democrat to prevent the bill from passing a Republican filibuster.

"I'm very comfortable having my vote, whatever it is, whichever way it goes," Nelson said, in response to a question from the Huffington Post. "I've said that from the beginning. There are other ways. I just have to make a decision based on what I think is best for the people of Nebraska and the people of our country. And then we will let the chips fall wherever they fall."

Speaking to reporters following a Democratic caucus meeting, Nelson said he was pleased with the direction that the bill was moving, though he wanted to see specific language, and he remained concerned about the structure of the government-run insurance option.

"I've said, for me, all along, that [a public plan with an opt-out provision for states] is not the way in which I would proceed. And that has problems as far as I'm concerned," he said. As for an alternative proposal that would allow states to opt-in to a national government-run plan, Nelson added; "I certainly would look at that more positively than an opt-out."

On Wednesday night, Senate Majority Leader Harry Reid unveiled the preliminary outlines of his health care reform legislation. The bill includes the opt-out public option, a tax on expensive insurance plans, and language on abortion that does not go as far as the House's largely restrictive provision. Estimates of the proposal have it costing $847 billion over the next decade, covering 31 million uninsured, and reducing the deficit by $127 billion during the next ten years.

"Any time you add more to deficit reduction you have to say that it is a move in the right direction," Nelson said. "So, there is no doubt that there has been some areas of improvement. That clearly would be one. But again, you have to have a lot of faith and trust in the scoring system."

The Nebraska Democrat did essentially proclaim that he would vote with his party on the first parliamentary hurdle - a procedural vote that would allow the bill to be brought to the floor for amending and debate. He would not commit to voting on the second parliamentary hurdle - another cloture vote to end that debate.

"I said I won't make a decision until I've seen and reviewed the language of the legislation," he said. "That's fairly clear. And it has been that from the very beginning. As to the question about sometimes wavering -- I've never wavered on this. I've been clear from the beginning that you have to see the actual language before you can make a decision on whether you are going to vote for cloture on the motion to proceed... I'm still undecided. That's different than being on the fence."

Source: http://www.huffingtonpost.com/2009/11/1 ... 63046.html
And ...
Landrieu Slightly Tones Down Her Rhetoric On A Public Option
by Jon Walker

FireDogLake Blog, November 18, 2009

Mary Landrieu (D-LA), along with Ben Nelson, Blanche Lincoln, and Joe Lieberman is seen as one of the biggest obstacles in the way of getting a health care bill with a public option through the Senate. Her previous statements about the public option have been very negative. After coming out of a Wednesday meeting with Harry Reid, though, she seems to have warmed slightly to the idea:
“I’ve been very clear. There are two or three issues,” [Mary Landrieu] told CNN. “One, does this bill actually drive down costs to individuals, to businesses and to the government. Number two, is there a quote, public option that will undermine the private insurance market – and if there is, it needs to come out at some point. It needs to come out at some point.”
The fear that the public option will undermine the private insurance market seems unfounded. The public option will only be available on the new exchange. Even if it were the much stronger public option based on Medicare rates, which it is not, the CMS projected that it would only get 40% of the customers on the exchange. The CMS predicts the negotiated rates public option in the House bill would only sign up roughly 25% of the people on the exchange.

The irony is that even if an incredibly progressive “Medicare for all” health care system was adopted, that reform would still probably not undermine the private market for health insurance. Medicare Advantage, Medigap supplemental coverage, and Medicare Part D are all part of a thriving private health insurance market within and around the Medicare program. Even the French health care system, which is seen a bastion of liberalism, has robust private health insurance for supplemental coverage.

If Mary Landrieu only needs a guarantee that the public option won’t undermine the private insurance market in order to gain her support, then that is a new and more achievable goal. Of course, Landrieu’s statements on the public option have been all over the map.

Source: http://fdlaction.firedoglake.com/2009/1 ... ic-option/

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Post by roxybeast » November 18th, 2009, 11:55 pm

Bring Back the Cots! The Filibuster and Health Care Reform
by Jerome Karabel

Huffington Post, November 18, 2009

In a recent interview on Fox News, Senator Joseph Lieberman threatened to derail health care legislation, asserting that "as a matter of conscience, if proposed Senate legislation includes a public option, I will not allow the bill to come to a final vote." Note that Senator Lieberman is not simply saying that he will vote no on any such bill, but that he will prevent the majority of his Senate colleagues from even having the opportunity to vote on the issue. That he is able to do so is testimony to the power of the filibuster -- an increasingly common, if poorly understood, Senate procedure that stands in direct contradiction to the principle of majority rule. Yet paradoxically, the filibuster -- a classic device of obstruction -- may turn out to be the unexpected pathway to health care reform.

The term filibuster traces back to the Spanish word filibustero or pirate (itself derived from the Dutch vrijbuiter or freebooter) and refers to the capacity of obstructionist legislators to hijack or "pirate" legislative debate. In today's Senate, the filibuster refers to the ability of a minority of Senators (41 out of 100) to block legislation by threatening endless speechifying. It is not enshrined in the Constitution and could in principle be eliminated at any time by a change in Senate rules. But it is a long-standing tradition with roots dating back to the early nineteenth century, and it has frequently been used to great effect by political minorities committed to frustrating the will of the majority.

Though the filibuster first gained wide public attention in James Stewart's unforgettable portrayal of an idealistic Senator who launches a filibuster against powerful and corrupt interests in Mr. Smith Goes to Washington, the actual history of the filibuster is decidedly less noble. In the twentieth century, the filibuster was repeatedly used by Southern Senators trying to block civil rights legislation; to this day, the record is held by Senator Strom Thurmond, who filibustered against the Civil Rights Act of 1957 for 24 hours and 18 minutes. Seven years later, Southern Senators filibustered for 75 consecutive hours in an unsuccessful attempt to block the Civil Rights Act of 1964.

The filibuster is now such a familiar part of the Senate landscape that its profoundly undemocratic character has escaped public scrutiny. But the filibuster is incompatible with the core principle that in a democracy the will of the majority should prevail. The filibuster falls short of the democratic ideal in at least three ways: (1) It gives a minority of Senators the effective right to block legislation favored by the majority. (2) In practice it gives disproportionate power to Senators from less populous states; in the current Senate, the 40 Republican Senators (all of whom now seem likely to vote in favor of a filibuster) represent just 35 percent of the American population. (3) It allocates power to a minority within a Senate that is itself inherently undemocratic.

By constitutional design, every state has two Senators, regardless of population. What this means in practice, of course, is that California, which has a population of over 36 million, has no more representation in the Senate than Wyoming, with a population of 532,000 -- an absurdity in a democratic society. Not coincidentally, both of California's Senators favor health care reform including the public option, while both of their Wyoming Senate colleagues stand in opposition. And this is part of a larger pattern; of the ten largest states, whose inhabitants together comprise over 54 percent of the nation's population; only 5 of the 20 Senators are Republican and likely to support a filibuster.

Despite its profoundly undemocratic character, the filibuster has become more, not less, common in recent years because of a little-noticed change in Senate practice. Whereas the traditional filibuster required the continuous physical presence of the Senator delivering the marathon speech and a quorum of Senators on the floor (hence the presence of cots for fatigued Senators and the famous story of an aide to Senator Thurmond standing by in the Senate cloakroom with a pail in case the Senator needed to relieve himself), today's Senate requires nothing more than the mere threat of gathering the necessary 41 votes to derail legislation (60 votes are necessary for "cloture" or the closing of debate).

Not surprisingly, filibusters have become more common than ever before in American history (from 6 votes on cloture in 1967-1968, 13 in 1977-1978, 43 in 1987-1988, 53 in 1997-1998, and 112 in 2007-2008), with the consequence of growing legislative paralysis. The filibuster has become routine, with devastating effects on the Senate's ability to legislate.

With health care now consuming more than one-sixth of America's GDP and a recent Harvard study estimating that 45,000 Americans die each year from lack of health insurance, the nation can no longer afford this pattern of legislative deadlock. The solution is for Senate Majority Leader Harry Reid to exercise his right to restore the traditional filibuster. Were Senator Reid to do this, the opponents of health care reform would have to make their arguments against permitting the majority to vote in full public view.

The outcome of such a public debate is by no means preordained. But it would take a matter of urgent public policy import out of the backrooms of the Senate and into the public arena. Democrats who favor health care reform should not shrink from an old-fashioned filibuster, but welcome it. And if Senator Lieberman and his colleagues wish to argue their case in the court of public opinion, then by all means let them do so. For the result may be not only the end of an untenable status quo in health care, but also the weakening of an archaic Senate tradition that has debilitated the legislative process. Bring back the cots!

Source: http://www.huffingtonpost.com/jerome-ka ... 62628.html

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Post by roxybeast » November 21st, 2009, 2:42 pm

<center>2 Down & 1 To Go; Only 1 Dem Holdout Remains on Cloture/Filibuster</center>
Earlier today, the Senate Democratic leaders got Sen. Mary Landrieu (D-La) to agree that she would vote in favor of cloture & against any GOP filibuster to send the Health Reform bill to the floor & open it up for debate, amendment and final vote. Yesterday, they convinced Sen. Ben Nelson (D-Ne) to do the same thing. That leaves only one lone Democratic Senator holding out, Sen. Blanche Lincoln (D-Ar).

And the message to Sen. Lincoln should be this: If you do not agree, the DNC will cut 100% of your political campaign funding and all support, and will run a strong Democratic candidate against you in the primary, and every major Democratic interest group that has supported the bill and the DNC will run ads & pour mega-millions into an all out effort to make sure that you will not win the primary and will not be re-elected. The GOP can threaten to target her in the general election for her seat, but the DNC can guarantee that her political career will end.

Time is of the essence as the vote for cloture of preliminary proceedings and against filibuster, which would allow the bill to move forward for floor debate, amendment and final vote is scheduled for later tonight. If the cloture motion passes and the threat of filibuster is defeated, it is very likely that the Democrats will be able to garner a coalition of 51 votes to pass the Senate version of a health reform bill and send the matter to conference to resolve differences between the House and Senate versions of the bill and setting up a final vote for passage later this year. Tonight's vote may be the most critical in providing victory to President Obama in time for his State of the Union speech in January.

This article is about Sen. Mary Landrieu's announcement earlier today:
A Holdout Will Support Democrats’ Health Bill
By DAVID M. HERSZENHORN and ROBERT PEAR

New York Times, November 21, 2009

WASHINGTON — Senate Democrats moved to the brink of a crucial preliminary victory on major health care legislation as Senator Mary L. Landrieu of Louisiana, one of two last hold-outs, announced on Saturday afternoon that she would vote in favor of bringing the bill to the floor for weeks of full debate.

Ms. Landrieu’s remarks, shortly before 1 p.m., came as Democrats made a forceful case for legislation to revamp the nation’s health care system, condemning the practices of insurers and decrying the plight of the uninsured in a parade of floor speeches aimed at cementing party unity ahead of a first crucial vote.

“I have decided there are enough significant reforms and safeguards in this bill to move forward, but much more work needs to be done.” said Ms. Landrieu, whose decision left Senator Blanche Lincoln, Democrat of Arkansas, as the only member of the Democratic caucus yet to commit to support opening formal debate.

She said that her vote on Saturday should not be construed as an indication of how she might ultimately vote on the bill. “It is a vote to move forward to continue the good, and essential, and important and imperative work that is underway,” Ms. Landrieu said.

She also praised Ms. Lincoln for pushing the Senate to post the bill 72 hours before the preliminary vote in an effort to make the process more transparent. “I have used that time I think very well these last two and a half days,” Ms. Landrieu said.

Senate Republicans, powerless to stop the bill from coming to the floor for weeks of debate unless they could break the ranks of the Democrat majority, countered with an equally impassioned denunciation of the measure. They derided it as an ill-conceived, budget-busting expansion of government and a threat to the health and economic security of all Americans, especially the elderly.

With the Democrats nominally controlling 60 votes — the precise number needed to overcome the Republican attempt to stop the bill in its tracks — the procedural vote on Saturday evening loomed as the biggest test yet of the Democrat’s resolve and of the ability of the majority leader, Harry Reid of Nevada, to unite his fragile caucus around President Obama’s signature domestic initiative.

“Last year 750,000 Americans filed bankruptcy,” Mr. Reid said in a speech opening the debate. “Over half of those bankruptcies were because of medical expenses. Over half of the people who filed bankruptcy because of medical expenses had health insurance. Don’t we need to do something on health insurance reform? Of course we do.”

Mr. Reid derisively accused Republicans who oppose the legislation of “living in a different world,” and said, “The health insurance industry has an insatiable appetite for more profit.”

He also accused the Republicans of cowering from the debate and the difficult votes that would still lie ahead, in which he may have to sway one or more Republicans to his side to offset any defections.

In closing, Mr. Reid said: “This legislation that we are going to vote on a motion to proceed to saves lives, it saves money and it saves Medicare. Pretty good deal, I would think.”

The Republicans, in turn, sought to turn the test vote, technically a vote to end the preliminary debate on a motion to bring the health bill up for full debate and amendments, into a proxy for the bill itself and to shake the confidence of Democrats who have wavered in recent days, particularly Ms. Lincoln, who faces a tough re-election campaign in Arkansas next year.

“We know that Americans oppose this bill,” said the Republican leader, Mitch McConnell of Kentucky, citing poll results. “They are not buying the claim that this legislation would do anything whatsoever to lower our nation’s staggering costs.”

Calling the bill a “monstrosity,” he added: “The experts agree with the public opinion polls that this 2,074-page bill is a budget buster.”

Mr. McConnell warned of the political consequences for senators who voted to move ahead.

“Senators who support this bill have a lot of explaining to do,” Mr. McConnell said. “Americans know that a vote to proceed on this bill, to get on this bill, is a vote for higher premiums, higher taxes and massive cuts to Medicare.”

Saturday night’s procedural vote was required because Senate rules and precedent have long granted a right of virtually unlimited debate, or filibuster, to the minority. It which can be curtailed only by a super-majority vote of 60 senators to move ahead.

Senator Patrick J. Leahy, Democrat of Vermont, on Saturday morning assailed the Republicans as obstructionists.

“I will vote today to end the filibuster so the Senate can begin the historic debate to improve and reform our nation’s health insurance system,” he said. “Let’s not duck the debate, let the debate begin. Let’s not hide from the votes, let’s have the courage to stand up and vote.”

The health care bill, unveiled by Mr. Reid on Wednesday evening, seeks to extend health benefits to roughly 31 million Americans who are now uninsured, at a cost of $848 billion over 10 years.

It would do so by broadly expanding Medicaid, the state-federal insurance program for the poor, and by providing subsidies to help moderate-income people buy either private insurance or coverage under a new government-run plan, known as the public option.

According to the Congressional Budget Office, the cost of the legislation would be more than offset by new taxes and fees and reductions in government spending, so that the bill would reduce future federal budget deficits by $130 billion through 2019.

The bill, which would affect virtually every American, would reshape the health care industry, which accounts for nearly one-sixth of the nation’s economy. It also seeks to slow substantially the growth in government spending on Medicare, which covers Americans 65 and older.

Republicans have accused the Democrats of using an array of financing gimmicks to create the appearance that the bill would reduce federal deficits, including a delay in the implementation of most of the legislation’s major provisions until Jan. 1, 2014.

Mr. McConnell, in his opening speech, asserted that the bill would actually cost the nation $2.5 trillion — a claim that Democrats dismiss as wildly overstated and a political attack intended to distort the debate.

In making their calculation, the Republicans note that major provisions of the bill, like the expansion of Medicaid and subsidies to help people buy insurance, do not take effect until 2014.

Senator John Thune, Republican of South Dakota, said: “Many revenue components in the bill begin to kick in next year, on Jan. 1, 2010. But much of the spending in the bill would be deferred until much later, not taking effect until Jan. 1, 2014. That distorts the true picture of what this legislation would cost.”

The $2.5 trillion figure reflects the cost from 2014 to 2023, Republicans said, while the $848 billion figure is for 2010 to 2019

Mr. Reid and other Democrats counter that the bill will actually save much more money than the Congressional Budget Office has predicted, because the office does not calculate the potential savings from prevention and wellness programs that cannot be directly attributed to the legislation and to federal spending.

“We get no credit for all the wellness things we do in this bill,” Mr. Reid said. “In spite of that, everything in this bill is fully paid for, it reduces short- and long-term debt, it expands coverage.”

Because all 40 Republicans are expected to oppose the procedural motion to begin debate, Mr. Reid needs the unanimous support of all 60 members of his caucus — 58 Democrats and 2 independents who align with them.

Carl Hulse contributed reporting.

Source: http://www.nytimes.com/2009/11/22/healt ... ealth.html
This article is about Sen. Ben Nelson's decision yesterday:
Nebraska Senator Will Vote to Start Health Debate
By ROBERT PEAR and DAVID M. HERSZENHORN

New York Times, November 21, 2009

WASHINGTON — Senator Ben Nelson of Nebraska, one of three wavering Democrats, said Friday that he would vote to start debate on a giant health care bill as Democrats and Republicans squared off over the legislation in advance of its first big test in the Senate.

Mr. Nelson’s announcement had the effect of increasing pressure on the two other uncommitted Democrats, Senators Mary L. Landrieu of Louisiana and Blanche Lincoln of Arkansas, who faces a difficult race for re-election next year.

In agreeing to proceed to the bill, Mr. Nelson emphasized that his vote should not be construed as support for the legislation in its current form.

“Throughout my Senate career,” Mr. Nelson said, “I have consistently rejected efforts to obstruct. That’s what the vote on the motion to proceed is all about. It is not for or against the Senate health care bill released Wednesday. It is only to begin debate and an opportunity to make improvements.”

“If you don’t like a bill,” Mr. Nelson asked, “why block your own opportunity to amend it?”

The Senate plans to vote Saturday on whether to take up the legislation, which would remake the nation’s health care system and provide insurance to more than 30 million people, at a cost of $848 billion over 10 years. The House passed a different version of the legislation two weeks ago.

With no immediate prospect of support from Republicans, the Senate Democratic leader, Harry Reid of Nevada, needs backing from all 60 members of his caucus to clear the first hurdle to action on the bill, which embodies President Obama’s top domestic priority.

Democratic leaders expressed confidence they could muster the 60 votes, even as Republicans stepped up the pressure on centrist Democrats.

Senator John McCain, Republican of Arizona, sent an e-mail message on Friday, urging his supporters to call Mr. Nelson and “ask him to vote ‘no’ on government-run health care.”

In the e-mail, Mr. McCain provided telephone numbers for Mr. Nelson’s offices in Washington and Nebraska. Mr. McCain wrote in his role as chairman of a new political action committee, the Country First PAC.

Technically, the vote Saturday will be on whether to limit debate on Mr. Reid’s motion to take up a bill being used as a vehicle for the Senate Democrats’ health care proposals. But both parties see the vote as a crucial test of strength on the legislation itself.

In debate Friday, senators previewed the arguments they will use. Democrats said their bill would guarantee affordable health care for all Americans, slow the growth of insurance premiums, reduce the federal budget deficit and strengthen Medicare.

“It will save lives and it will save money,” said Senator Richard J. Durbin of Illinois, the No. 2 Democrat in the Senate.

Republicans said the bill would increase taxes, cut Medicare and lead to higher premiums for tens of millions of people who already have insurance.

“Why are we trying to do this — pass this 2,000-page bill that the American people oppose — when we ought to be addressing matters that are clearly needed and urgent?” said the Senate Republican leader, Mitch McConnell of Kentucky.

If Democrats prevail on Saturday, the debate on health care could run for several weeks. Senator Charles E. Grassley of Iowa, the senior Republican on the Finance Committee, predicted that the debate would continue into January.

But Senator Tom Harkin, Democrat of Iowa and chairman of the Senate health committee, said he felt sure the effort would overcome the obstacles that have blocked similar legislation for decades.

“This time it’s unstoppable,” Mr. Harkin said. “We’ve come this far, and we are not going to turn back. We are fulfilling a mandate the American people gave to President Obama and the Democratic Party last November.”

As part of his effort to solidify support for the bill, Mr. Reid disclosed Friday that he had accepted a potentially significant change, which would provide additional insurance options to at least a million people who cannot easily afford insurance offered by their employers.

Under the proposal, by Senator Ron Wyden, Democrat of Oregon, the employer’s contribution to health coverage would be converted into a voucher. Workers could use the voucher to shop for coverage on their own, in new government-regulated markets known as insurance exchanges.

“This would empower individuals, expand consumer choice and create a real health care marketplace where there has been none,” Mr. Wyden said.

Mr. Wyden said he would propose amendments to provide similar choices to millions of additional workers who now have a very narrow range of options — just one or two health plans selected by their employers.

Many companies are apprehensive about such changes, saying they would undermine the employer-based system of health insurance, which provides coverage to more than 150 million people.

R. Bruce Josten, executive vice president of the United States Chamber of Commerce, said Mr. Wyden’s proposal could “encourage employees to abandon their employer’s plan.”

Republicans repeatedly asserted that the Democrats’ bill would expand the federal role in health care and lead to a rationing of care.

“As costs escalate, and the amount of money available is insufficient to pay for everything, inevitably, as in other systems like Great Britain, rationing will result,” said Senator Jon Kyl of Arizona, the No. 2 Republican in the Senate. “Delay of care, that’s how it begins. Then denial of care.”

But Senator Debbie Stabenow, Democrat of Michigan, said, “The ultimate in rationing occurs right now when people lose their lives because they cannot find affordable coverage or are arbitrarily dropped by their insurance companies and cannot see a doctor or get the care they need.”

In scheduling the vote on Saturday, Mr. Reid made sure to keep a commitment to Mrs. Lincoln that all senators would have at least 72 hours to study the bill after it was released.

Mr. Reid posted the text of his bill on the Internet on Wednesday night, after a meeting of the Democratic caucus. Aides to Mrs. Lincoln said Friday that she was still studying it.

Source: http://www.nytimes.com/2009/11/21/healt ... ealth.html
This article explains about the critical pending pro-cloture/anti-filibuster vote scheduled for later tonight (Saturday, Nov. 21) ...
Senate Health Care Bill Faces Crucial First Vote
By ROBERT PEAR

New York Times, November 19, 2009

WASHINGTON — The Senate version of sweeping health legislation would cover five million fewer people than a companion bill passed by the House, but it would cost less, in part because Senate Democratic leaders felt they had to win support from fiscally conservative members of their party.

The Senate is expected to vote Saturday on whether to take up the legislation. The majority leader, Harry Reid, Democrat of Nevada, refused to say Thursday whether he had the 60 votes needed to clear that procedural hurdle.

While the guts of the Senate and House bills are similar, Mr. Reid came up with a new method of financing coverage, not found in any other major health bill. His proposal would significantly increase the Medicare payroll tax for high-income people.

The Senate and House bills would provide coverage to millions of the uninsured by expanding Medicaid and subsidizing private insurance for people with moderate incomes.

The Senate bill would spend $821 billion over 10 years on Medicaid and subsidies. The House bill would spend 25 percent more: $1.03 trillion over 10 years.

A big gulf separates the House and the Senate on the emotional issue of abortion.

Over the objection of Speaker Nancy Pelosi, the House adopted much stricter limits. Under the House bill, federal money could not be used “to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion,” except in case of rape or incest or if the life of a pregnant woman was in danger. Thus, a plan that received federal subsidies for low- and moderate-income people could not offer abortion coverage.

Under the Senate bill, insurers would not be required or forbidden to cover abortion. But, the measure says, in every part of the country, the government would have to ensure that there is at least one plan that covers abortion and at least one that does not.

The secretary of health and human services would decide whether a proposed new government insurance plan would cover abortion. In general, if insurers cover abortion, they could not use federal money to pay for the procedure. They could use only subscriber premiums and would have to keep the money separate from subsidies received from the federal government.

Opponents of abortion describe this bookkeeping arrangement as a sham. “It’s a shell game,” said Senator Mike Johanns, Republican of Nebraska.

But Mr. Johanns said he doubted that the Senate would accept the stringent restriction adopted by the House.

“I don’t see it in the final bill,” Mr. Johanns said. “I don’t believe there are enough pro-life senators to break a filibuster to make this a part of the final bill.”

Supporters of abortion rights were pleased with the treatment of abortion in Mr. Reid’s bill. “It maintains the decades-long compromise of no federal funds for abortion, while allowing a woman to use her own private funds for her reproductive health care,” said Senator Barbara Boxer, Democrat of California.

Mr. Reid and other Democratic leaders said that the unveiling of the bill, hatched in his office, had given them political momentum going into the first test vote. Despite solid Republican opposition, the Democrats said they were confident they could enact some kind of national health insurance program, a goal that has eluded politicians for more than 75 years. But Congress appears highly unlikely to meet President Obama’s goal of finishing work on the bill this year.

The Congressional Budget Office estimates that Mr. Reid’s bill would provide coverage to 31 million people who are uninsured, while the House bill would cover 36 million people.

A major difference between the bills is the effective date for important provisions, like the requirement for people to obtain insurance and the obligation of employers to help pay for it.

Many provisions of the House bill would take effect in 2013. But to help hold down the cost of the bill, Mr. Reid decided to delay the effective date for many provisions by one year, to 2014.

How to pay for the legislation is another major point of disagreement. The Senate and the House would both raise money from the health care and insurance industries and from high-income people, but they take different approaches.

Mr. Reid’s bill would impose a tax on “Cadillac health plans” — employer-sponsored group health plans with premiums over $8,500 for individual and $23,000 for family coverage. He would impose a new 5 percent tax on “elective cosmetic medical procedures.” And he would impose annual fees on insurance companies and makers of medical devices and brand-name drugs. By contrast, the House relies on an income surtax to raise $460 billion from 2011 to 2019. The tax would be 5.4 percent of adjusted gross income exceeding $1 million for couples and $500,000 for individuals.

Senators of both parties said the government should finance any expansion of coverage with savings and revenues related to health care. House Democrats felt no such obligation. In a report on their bill, they said a surtax on the highest-income people would increase “fairness and progressivity in the tax code.”

The two chambers also disagree on whether to create an independent commission to help cut the growth of Medicare. Senate Democrats say such a commission could make politically unpopular decisions needed to put Medicare on a sound financial footing. But House leaders say it is the duty of Congress to make such tough decisions.

The Congressional Budget Office estimated that the proposed Medicare commission would save $23 billion from 2015 to 2019. Both bills would both create a public insurance plan. However, all Republican senators oppose the idea, and some moderate Democrats are skeptical, so the public plan could be significantly reconfigured or cut back in debate on the Senate floor.

Carl Hulse contributed reporting.

Source: http://www.nytimes.com/2009/11/20/healt ... ealth.html

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Post by roxybeast » November 21st, 2009, 3:30 pm

Senate Health Care Vote Saturday
Erica Werner, AP

Huffington Post, November 21, 2009

WASHINGTON — And then there was one.

Historic health care legislation advanced to a Saturday night Senate showdown as centrist Sen. Mary Landrieu, D-La., fell in line as the 59th vote in an early test of party unity on President Barack Obama's top domestic initiative.

"I've decided that there are enough significant reforms and safeguards in this bill to move forward, but much more work needs to be done," Landrieu said on the Senate floor as she delivered her long-awaited announcement just hours before the 8 p.m. EST vote.

Senate Majority Leader Harry Reid, D-Nev., needs 60 votes in the 100-member Senate to go forward on his 2,074-page bill to overhaul the nation's health care system. The lone holdout is another moderate Democrat, Sen. Blanche Lincoln of Arkansas, who faces a tough re-election next year.

The Senate's 40 Republicans are unanimously opposed.

A largely overlooked provision in the Senate bill would send $100 million to Louisiana to help it cover costs for Medicaid, the federal-state health care program for the poor. In her speech, Landrieu rejected the notion that she was voting to advance the bill simply because of the money.

"I am not going to be defensive about asking for help in this situation," she said, recalling the devastation inflicted on her state by Hurricane Katrina in 2005 and her Republican governor's support for the provision. "I'm proud to have asked for it. I'm proud to have fought for it. And I will continue to."

During earlier debate on the bill, Democrats called a revamp of the nation's health care system long overdue.

Story continues below

"The country suffers when there is a failure to act on serious challenges that millions of ordinary Americans face in their daily lives," Sen. Patrick Leahy, D-Vt., said during the rare weekend session.

United in opposition, Republicans cast the bill as a costly government takeover, built on budget gimmicks.

"Move over, Bernie Madoff. Tip your hat to a trillion-dollar scam," said Sen. Kit Bond, R-Mo., referring to the mastermind of a multibillion-dollar Ponzi scheme.

Most everyone would be required to purchase insurance under Reid's legislation, and billions in new taxes would be levied on insurers and high-income Americans to help extend coverage to 30 million uninsured. Insurance companies would no longer be allowed to deny coverage to people with medical conditions or drop coverage when someone gets sick.

The action in the Senate comes two weeks after the House approved a health overhaul bill of its own on a 220-215 vote. After the vote Saturday night, senators will leave for a Thanksgiving recess. Upon their return, assuming Democrats prevail on the vote, they will launch into weeks or more of unpredictable debate on the health care bill, with numerous amendments expected from both sides of the aisle and more 60-vote hurdles along the way.

Senate leaders hope to pass their bill by the end of the year. If that happens, January would bring work to reconcile the House and Senate versions before a final package could land on Obama's desk.

The bills have many similarities, including the new requirements on insurers and the creation of new purchasing marketplaces called exchanges where self-employed individuals and small businesses could go to shop for and compare coverage plans. One option in the exchanges would be a new government-offered plan, something that's opposed by private insurers and business groups.

Differences include requirements for employers. The House bill would require medium and large businesses to cover their employees, while the Senate bill would not require them to offer coverage but would make them pay a fee if the government ends up subsidizing employees' coverage.

Another difference is in how they're paid for. The Senate bill includes a tax on high-value insurance policies that's not part of the House bill, while the House would levy a new income tax on upper-income Americans that's not in the Senate measure. The Senate measure also raises the Medicare payroll tax on income above $200,000 annually for individuals and $250,000 for couples. Both bills rely on more than $400 billion in cuts to Medicare.

Source: http://www.huffingtonpost.com/2009/11/2 ... 66316.html
And AARP comes out in favor of voting for cloture on Reids' bill ...
Old Folks To Senate: Vote For Cloture Already
by Ryan Grim

Huffington Post, November 21, 2009

In a letter to Senate Majority Leader Harry Reid (D-Nev.), AARP CEO Addison Barry Rand backed the leader's health care bill and urged the chamber to vote yes to end a filibuster and move to a floor debate on Saturday.

"We strongly urge the Senate to vote for cloture this Saturday to begin debate on the Patient Protection and Affordable Care Act," wrote Rand.

The letter, sent Friday, is AARP's first endorsement of Reid's bill, which is a merged product of measures passed be the finance and health committees.

All 40 Republicans are expected to vote against the motion to proceed to a debate. Fifty-nine members of the Democratic caucus have committed to vote yes. One remains undeclared: Blanche Lincoln of Arkansas.

The cloture vote, which would allow debate on the actual bill to proceed, is scheduled for 8:00 p.m. ET Saturday.

Source: http://www.huffingtonpost.com/2009/11/2 ... 66447.html

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Post by roxybeast » November 21st, 2009, 3:54 pm

<center>Lincoln Folds! Dems Have Votes to Defeat Filibuster Tonight!</center>
Awesome news America ... the GOP will not be able to hold health reform hostage. The bill will move forward for final debate & vote!
Senate Health Care Vote Saturday
Erica Werner, AP

Huffington Post, November 21, 2009

WASHINGTON — Democrats have hit the magic number of 60 to move ahead on historic health care legislation.

Arkansas Sen. Blanche Lincoln said on the Senate floor that she will vote with her party, hours before the 8 p.m. EST roll call.

She said it was important that the Senate begin debate on a critical issue.

The centrist Democrat was the lone holdout. Facing unanimous Republican opposition, Senate Majority Leader Harry Reid needed the 58 Democrats and two independents to vote to move forward on the sweeping bill to remake the nation's health care system.

Source: http://www.huffingtonpost.com/2009/11/2 ... 66316.html
And ...
Democrats Clinch Vote for Health Debate
By DAVID M. HERSZENHORN and ROBERT PEAR

New York Times, November 21, 2009

WASHINGTON — Senate Democrats said they had clinched the votes needed on Saturday to propel major health care legislation to the floor for weeks of full debate, as the majority party’s two last hold-outs said that they would not block consideration of President Obama’s top domestic initiative.

Both senators, Mary L. Landrieu of Louisiana and Blanche Lincoln of Arkansas, cautioned that their support on what was expected to be a party-line vote on Saturday evening did not guarantee that they would ultimately vote for the bill itself. And their comments signaled that more horse-trading lies ahead when the vigorous debate and amendment attempts begin after Thanksgiving. Big changes might be required if the bill is to be approved.

Still, the decision by the two senators set the stage for a crucial, preliminary victory and an important psychological boost for the Democrats, who spent the day on Saturday laying out their arguments for the bill, condemning the practices of insurers and decrying the plight of the uninsured in a parade of floor speeches aimed at cementing party unity.

“I have decided there are enough significant reforms and safeguards in this bill to move forward, but much more work needs to be done,” Ms. Landrieu said.

Mrs. Lincoln, who faces a tough re-election campaign next year, said that her decision was not driven by political considerations.

“Although I don’t agree with everything in this bill, I believe it is more important that we begin debate on how to improve the health care system for all Americans,” she said, adding: “The vote tonight will mark the beginning of consideration of this bill by the full U.S. Senate not the end.”

Mrs. Lincoln said flatly that she would continue to oppose a government-run program like the public option that is now part of the legislation — clearly signalling that more parliamentary maneuvering like Saturday’s lies ahead.

Senate Republicans, powerless to keep the bill from reaching the floor unless they could break the ranks of the Democrat majority, countered with an impassioned denunciation of the measure as an ill-conceived, budget-busting expansion of government and a threat to the health and economic security of all Americans, especially the elderly.

With the Democrats nominally controlling 60 votes — the precise number needed to overcome the Republican attempt to stop the bill in its tracks — the procedural vote on Saturday evening loomed as the biggest test yet of the Democrat’s resolve and of the ability of the majority leader, Harry Reid of Nevada, to unite his fragile caucus.

“Last year 750,000 Americans filed bankruptcy,” Mr. Reid said in a speech opening the debate. “Over half of those bankruptcies were because of medical expenses.

Over half of the people who filed bankruptcy because of medical expenses had health insurance. Don’t we need to do something on health insurance reform? Of course we do.”

Mr. Reid accused Republicans who oppose the legislation of “living in a different world,” and said, “The health insurance industry has an insatiable appetite for more profit.”

He also accused the Republicans of cowering from the debate. But with tough votes still ahead, Mr. Reid may yet have to sway one or more Republicans to his side.

Mr. Reid said: “This legislation that we are going to vote on a motion to proceed to saves lives, it saves money and it saves Medicare. Pretty good deal, I would think.”

The Republicans sought to turn the test vote, technically a vote to end the preliminary debate on a motion to bring up the health bill for full debate, into a proxy for the bill itself and to shake the confidence of Democrats who have wavered in recent days.

“We know that Americans oppose this bill,” said the Republican leader, Mitch McConnell of Kentucky, citing poll results. “They are not buying the claim that this legislation would do anything whatsoever to lower our nation’s staggering costs.”

Calling the bill a “monstrosity,” he added, “The experts agree with the public opinion polls that this 2,074-page bill is a budget buster.”

Mr. McConnell warned of the political consequences for senators who vote to move ahead.

“Senators who support this bill have a lot of explaining to do,” he said. “Americans know that a vote to proceed on this bill, to get on this bill, is a vote for higher premiums, higher taxes and massive cuts to Medicare.”

Republicans also said the test vote was a proxy for a larger dispute over abortion, because they said the bill did not sufficiently restrict the use of federal funds for insurance covering abortions.

Senator Mike Johanns, Republican of Nebraska, said, “The motion to proceed is the key vote on abortion in the health care debate — the most important vote a pro-life senator will cast.”

Saturday night’s procedural vote was required because Senate rules and precedent have long granted a right of virtually unlimited debate, or filibuster, to the minority. It which can be curtailed only by a super-majority vote of 60 senators to move ahead.

Senator Patrick J. Leahy, Democrat of Vermont, on Saturday morning assailed the Republicans as obstructionists.

“I will vote today to end the filibuster so the Senate can begin the historic debate to improve and reform our nation’s health insurance system,” he said. “Let’s not duck the debate, let the debate begin. Let’s not hide from the votes, let’s have the courage to stand up and vote.”

The health care bill, unveiled by Mr. Reid on Wednesday evening, seeks to extend health benefits to roughly 31 million Americans who are now uninsured, at a cost of $848 billion over 10 years.

It would do so by broadly expanding Medicaid, the state-federal insurance program for the poor, and by providing subsidies to help moderate-income people buy either private insurance or coverage under a new government-run plan, known as the public option.

According to the Congressional Budget Office, the cost of the legislation would be more than offset by new taxes and fees and reductions in government spending, so that the bill would reduce future federal budget deficits by $130 billion through 2019.

Ms. Landrieu, however, highlighted a number of issues she wanted addressed in the weeks ahead. In her floor speech, she methodically catalogued provisions of the bill that she liked and those that she said needed improvement.

Under the bill, she said, owners of small businesses would no longer face "volatile costs" for health insurance. In addition, she said, the bill would "encourage employers to move away from high-cost benefit plans” and shift some compensation to wages, so workers might get more take-home pay.

Because of federal subsidies that would be provided for the purchase of insurance, Ms. Landrieu said, most families in Louisiana "would pay no more than 10 percent of their income on health care.”

But she said, "A great deal more work needs to be done.”

The bill, which would affect virtually every American, would reshape the health care industry, which accounts for nearly one-sixth of the nation’s economy. It also seeks to slow substantially the growth in government spending on Medicare, which covers Americans 65 and older.

Republicans have accused the Democrats of using an array of financing gimmicks to create the appearance that the bill would reduce federal deficits, including a delay in the implementation of most of the legislation’s major provisions until Jan. 1, 2014.

Mr. McConnell, in his opening speech, asserted that the bill would actually cost the nation $2.5 trillion — a claim that Democrats dismiss as wildly overstated and a political attack intended to distort the debate.

In making their calculation, the Republicans note that major provisions of the bill, like the expansion of Medicaid and subsidies to help people buy insurance, do not take effect until 2014.

Senator John Thune, Republican of South Dakota, said: “Many revenue components in the bill begin to kick in next year, on Jan. 1, 2010. But much of the spending in the bill would be deferred until much later, not taking effect until Jan. 1, 2014. That distorts the true picture of what this legislation would cost.”

The $2.5 trillion figure reflects the cost from 2014 to 2023, Republicans said, while the $848 billion figure is for 2010 to 2019

Democrats said that the bill would actually save more money than the Congressional Budget Office has predicted, because the office does not calculate the potential savings from prevention and wellness programs that cannot be directly attributed to the legislation and to federal spending.

“We get no credit for all the wellness things we do in this bill,” Mr. Reid said. “In spite of that, everything in this bill is fully paid for, it reduces short- and long-term debt, it expands coverage.”

Because all 40 Republicans are expected to oppose the procedural motion to begin debate, Mr. Reid needs the unanimous support of all 60 members of his caucus — 58 Democrats and two independents who align with them.

Source: http://www.nytimes.com/2009/11/22/healt ... ealth.html
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Post by roxybeast » November 21st, 2009, 3:59 pm

What the Passage of Health Care Legislation Means for the Future
by Mike Lux

Huffington Post, November 20, 2009

Being into the whole history thing enough to have written a book on it, I tend to take a long view on the big policy battles we fight today. As I wrote the other day, no piece of legislation ever gets to perfection, and on plenty of them you can have a perfectly legitimate debate even over the most well-intentioned bill over whether it does more harm than good. In addition to the actual policy particulars, lawmakers have to weigh (if they care about political survival) a wide range of other factors, including the political implications both nationally and in their home districts, the symbolism of what they are doing, how the interest groups and donors that matter the most to them are impacted, and how the media nationally and back home are treating the issue. Trying to factor in all these things is intense, and it is understandable that politicians sometimes have trouble making up their minds.

For reasonably progressive-minded advocates and lawmakers on a huge issue like health care, after you factor in all of the above, at the end of the day you also have to ask yourself two very big questions. The first is whether the passage of this legislation sets the stage on other issues for better or worse things to come. The second is whether the legislation, even with all of its flaws and compromises, creates a platform to build on in the future.

I know that all of you think I'm writing about health care, and I am. But I think these two questions are equally applicable to the other big fights looming immediately in front of us- climate change, financial reform, immigration, maybe (hopefully) a jobs bill, Employee Free Choice Act. In every single case, progressives are going to have to make difficult decisions re the compromises they will be forced to make. On none of these issues will we be able to get what we want, and some of the tradeoffs will really suck. But as we are debating the policy pros and cons, we also need to keep those two big questions in mind.

Bob Creamer's post yesterday eloquently makes the argument for health care based on the first question, and my own experience in the Clinton White House, and in researching and writing my book, makes me think Bob nails it dead on. When we lost on health care in 1994, and then lost Congress in the elections because our base was so discouraged that they didn't turn out, it made Clinton and Democrats in general hyper-cautious about trying to do anything big or bold the rest of his Presidency. If we had won on health care, we would have kept Congress, and we would have emboldened Democrats to try other big things. It is one of the most basic laws in politics: victory makes you stronger, and defeat makes you weaker. You can fault Obama for some of his specific policy proposals, and for being too ready to compromise on some things, but one thing he has been willing to do is try to do big things, and if health care goes down, the attempt to do big things will probably will stop- climate change probably is given up on as too hard, financial reform gets weaker, efforts to create more jobs probably is given up on, immigration reform very likely gets shelved. If a health care bill is passed, as Bob argues, it will create the possibility of doing other big things.

The second question is more complicated, and depends on how you read the policy being developed. Paul Begala and I got into a debate this summer, because he was suggesting that progressives were being too stubborn on the public option, that we were "making the perfect the enemy of the good." I strongly disagreed with that argument, saying that I believed some reasonably strong form of a public option was an absolutely essential component of health care reform, because without it there would no check at all on the power of the private insurance industry. I still think I'm right, that the public option is part of the thing that gives us a platform we can build on for the future, but Paul's strongest argument was about Social Security: that when it was first passed, it was far weaker than today, and had many flaws progressives of today would have been rightfully upset about, but that it was a platform future progressives could build on. I think that's how we have to view this health care bill, the climate change bill, and at least some other legislation coming down the pike.

Making big changes is incredibly hard in this country. As I write about in The Progressive Revolution, chances to make truly big changes only tend to come along every 30-40 years, and those chances can be snuffed out very quickly, like they were with Clinton on health care. Where there is some early success, momentum can build into something bigger and more progressive over time: Lincoln, Teddy Roosevelt, FDR, and LBJ all achieved most of their big historic changes after more than a year in office. We need to create that platform so we can build big change one step at a time. Every one of those steps will be slow and painful and infuriating. I still have hope, though, if we can get the first step of health care done, we can take another step, and then another one, and that we will be able to look back many years from now with pride because we made big change history when our opportunity for it came.

Source: http://www.huffingtonpost.com/mike-lux/ ... 65261.html

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Post by roxybeast » November 21st, 2009, 4:15 pm

Crashing the Gates of the Status Quo
by Robert Creamer

Huffington Post, November 21, 2009

Senate Majority Leader Harry Reid's announcement that he will send health insurance reform to the floor of the Senate this week signals that the long march to change America, that began with Barack Obama's announcement for president three years ago, has arrived at the gates of what is most certainly the "castle of the status quo."

The next two months will -- without question -- be a decisive period in American history. The Obama victory opened up a great historic opportunity to make fundamental change in America. But the ability of the progressive forces to take advantage of that opportunity now hinges on our success at laying siege to that "castle" and crashing through its gates by passing significant health care reform.

Everyone realizes that health insurance reform is not just another piece of legislation. But its significance goes well beyond the fact that it affects one-sixth of the economy; or that it will massively impact our country's ability to create jobs in the future; or even that it will determine whether or not health care finally becomes a right in America.

If we succeed in winning health insurance reform we will have breached the gates of the status quo. We will demonstrate that fundamental change is possible. Into that breach will flow a wave of progressive change. That victory will also make it possible for us to pass legislation to restructure the energy economy -- to put the brakes on climate change and free us from the tyranny of foreign oil. It will make it possible for us to rein in the power of Wall Street and pass long-overdue comprehensive immigration reform. It will make it possible to structure a bottom-up economy that can produce the jobs of the future.

Of course none of these changes will happen automatically. The massive forces whose economic interests lie in maintaining the status quo will not just roll over and concede defeat. But if they are capable of preventing our victory on health care reform, they will make it ever so much more difficult for us to succeed on other critical fronts.

So an enormous amount is at stake -- both for the progressive agenda and for the forces that oppose us.

All depends on our ability to vanquish the forces that -- over the next two months -- will use every weapon at their disposal to prevent our success. It won't matter whether the special interests in question have a fundamental interest in health care. The Chamber of Commerce, the insurance industry, the Republican Party, and right wing talk show hosts will all rally to defend the status quo. They understand beyond the shadow of a doubt the significance of this engagement. They will lie, they will threaten, they will sew fear, they will batter our supporters with negative advertisements, they will pay for busloads of right wing zealots, they will offer jobs, they will do favors, they will bite, scratch and poke out eyes -- they will do whatever is necessary to prevent us from breaching those gates.

It is up to us to have the resolve, the resourcefulness and endurance to defeat them.

This particular battle is so decisive for three reasons:

1). Change is about momentum. Just as in physics, it takes a great deal more energy to accelerate an object at rest than it does to continue its motion. Those who fear change have always used delay and obstruction to slow momentum to a standstill.

In the Senate, the other side will do everything it can to delay action. Their first trick will be to demand that the entire 1,900 page bill be read aloud. America has debated health insurance reform for over 60 years. We have seriously debated the current round of proposals for nine months. Now is the time for action. Americans deserve and up or down vote on health care.

As we confront the obstructionists in the Senate, we must maintain our momentum for change and make our movement a battering ram that is un-slowable and therefore unstoppable. Progressives in the Senate cannot accept infinite delay. They must be -- and I believe they are -- prepared to use every parliamentary technique available to make certain there is an up or down vote. If the other side insists on a filibuster, we need to make them filibuster -- 24 hours a day, 7 days a week. We need to force them to stay on the Senate floor and show themselves to be the obstructionists they are, for as long as it takes.

2). To maintain an unjust status quo, those with power must always prevent the majority from believing that change is possible. They must extinguish hope. They must convince us that the status quo is immutable -- the natural order -- that we must accommodate ourselves to things as they are, and satisfy ourselves with our lot in life.

Once people see that change is possible, the flood gates open, so the defenders of the status quo must prevent us from even imagining a different world.

Once the sons and daughters of African American families left their lives as sharecroppers in the South -- took jobs in Chicago and New York -- saw Europe during World War II -- there was no longer any stopping the surging demand for change that ultimately became the civil rights movement. Suddenly, they could imagine the possibility of a different world.

The other side understands this completely. If they block health care reform, they know that it will convince millions of Americans that change -- not just health care reform -- is not possible -- that they have to live with things as they are. They know it will snuff out the light of hope that was ignited by the Obama victory. And just as important, it will drain the reservoir of confidence that President Obama can make change. They know it will cause America to lose faith in possibility - and that is exactly what they desperately want to do, because they know that the reverse is also true. They know that if we win, faith in the possibility of change -- and in President Obama's ability to deliver change -- will explode.

3). The outcome of this battle will send a signal to economic and social forces throughout American society, telling them whether they should get onboard the bandwagon of change, or settle in and accommodate themselves to the status quo.

That is true of politicians who know that failure will make change appear to be "bad politics." It is true of business people who will either make investment decisions that seek opportunities in a new economy, or do their best to exploit the inequities of the present order. It is true of everyday voters who want to be with a winner.

The results of this battle will define a narrative about the likelihood of change that will shape millions of individual decisions about career and educational choices, investment opportunities, and votes.

The battle that will happen over the next two months will test the mettle of progressive leaders -- in and out of political office. More than anything else it will be a test of wills.

It is not appropriate to pull out the big guns for every engagement. You can't go-for-broke on every issue, every day. But this is the time.

* We must demand that Congress pass a health insurance reform bill that restructures the relations of power in the health care industry by creating a strong, viable public option that will free us all from the stranglehold of the private insurance industry.

* We must demand that health care decisions are ripped from the control of Wall Street investment bankers and insurance company bureaucrats, and returned to doctors and their patients.

* We must do whatever is necessary to assure that we do not miss this historic opportunity to finally make health care a right for all Americans.

This is an historic opportunity. Of course nothing in history is preordained. It is up to us to make that history by winning this decisive battle and turning this opportunity into a new era of progressive change in America.

Source: http://www.huffingtonpost.com/robert-cr ... 63622.html

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Post by roxybeast » November 21st, 2009, 6:13 pm

Democrats Are United -- For Now
Ryan Grim

Huffington Post, November 21, 2009

At least for the moment, Democrats are united behind Senate Majority Leader Harry Reid (D-Nev.).

All 60 members of the party's caucus have publicly pledged to back him in key vote on the Senate floor Saturday night -- this one to allow debate to proceed on Reid's health care reform bill.

But that unity may not last.

"That was the easy part. Now it's only going to get tougher from here on out," Reid spokesman Jim Manley told HuffPost.

Back-to-back announcements on the Senate floor on Saturday from the two remaining holdouts -- Louisiana's Mary Landrieu, followed by Arkansas' Blanche Lincoln -- put Reid over the top, giving him the 60 votes he needs to overcome the expected Republican filibuster.

The official vote will be called at 8:00 Saturday evening. The Senate will then move to several weeks of floor debate and amendments, followed by another crucial vote to end a second expected filibuster and move to a final tally.

A handful of Democrats are still threatening to filibuster the final bill if certain changes aren't made. Sen. Joe Lieberman, an independent who caucuses with Democrats, is insisting on the removal of a public health insurance option that would compete with private insurers, many of which are based in his home state of Connecticut.

Sens. Ben Nelson (D-Neb.), Landrieu and Lincoln are also withholding their final support, and trying to extract concessions.

"My vote today to move forward," Landrieu said on the floor, "should in no way be construed" as an indication that she'll back the final bill. "Much work needs to be done," she said.

Lincoln, who could face a primary challenge over her health care stand, similarly said she'd work to amend the bill and expressed her concerns with protecting private insurers from being required to compete with a public plan.

"Rather than create an entirely new government-run health care plan to compete with private insurers. I support health insurance reform that focuses on changing the rules of our existing employer-based private health insurance system," Lincoln said. "I believe we should change the current rules that permit insurance companies to bully their customers and cherry pick healthy patients, so we can force them to compete with each other. This initial procedural vote simply allows us to open debate on health care reform, nothing more or less. My decision to support this vote is not my last nor is it my only chance to shape health insurance reform."

If the Senate does pass a bill, House and Senate conferees will then meet to hash out the considerable differences between their packages. Each chamber must then approve the compromise before it heads to the president's desk for his signature.

Source: http://www.huffingtonpost.com/2009/11/2 ... 66494.html

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Post by roxybeast » November 22nd, 2009, 1:38 am

<center>Victory Is Within Reach!</center>
Tonight, the Senate by a vote of 60-39 passed the motion for cloture to end preliminary proceedings on the health reform legislation and clear the way for the bill to proceed to floor debate, amendments & final vote. Historic night. From here on out, the Democrats only need 51 votes.

Update/Correction - I've been informed that the Dems may also still need 60 votes on a procedural motion to close debate and force a final vote. But perhaps tonight's vote signals that the Dems can and will remain united on these kinds of procedural matters.
Sealed With A Kiss: Dems Unite To Beat GOP Filibuster
by Ryan Grim

Huffington Post, November 21, 2009

Harry Reid sealed the biggest legislative victory of his career Saturday night with a kiss. And then a hug.

Emotionally reserved doesn't begin to describe the Senate majority leader, a Democrat facing reelection in Nevada. Yet the man was beaming as the members of his caucus left the Senate floor, each one of them having given him their support, leaving him with exactly the 60 VOTES he needed to overcome a filibuster and move to an official floor debate on landmark health care reform legislation.

Three of those votes had been uncertain up until the last two days, until Sens. Mary Landrieu (D-La.) and Blanche Lincoln (D-Ark.) said in floor speeches Saturday that they'd back the motion to proceed, which allows the bill to move a major step forward. Sen. Ben Nelson (D-Neb.) broke what little suspense there was about his vote on Friday.

Reid approached Landrieu after the vote, smiling ear to ear and locked arms with her, gripping her right elbow as she locked his right arm in return. After the two spoke, he grasped her hand with both of his, leaned over and laid a kiss on it.

From there, he trod up the floor's risers to find Lincoln in the back row where she'd been sitting with Sen. Evan Bayh (D-Ind.). Reid smiled broadly and put his two hands on her shoulders, which is typically what counts as a hug from Harry Reid. Then he went all in, wrapping her in a full embrace.

Sen. Chuck Schumer (D-N.Y.) followed Reid's lead, smothering Lincoln with both arms. Lincoln blushed as she emerged from his embrace.

Reid left the floor to speak on the phone to Ted Kennedy's widow Vickie in the Democratic cloak room; she was crying and deeply moved, he later said. As Reid returned to the floor and headed for the exit, where he'd speak to reporters, he spied Sen. Chris Dodd (D-Conn.), who had shepherded the reform bill through the health committee in Kennedy's absence. Reid laid a hug on him.

Nelson was not gifted with such affection, though he had only himself to blame: as soon as the vote ended, he headed for the GOP side to chat up arch-conservative Sen. Jim DeMint (R-S.C.).

The effusive display of gratitude followed a unusually somber, silent vote. Normally, senators approach the front desk to cast their vote and chat amongst themselves. This night, each voted from his or her seat as the chamber sat in dead, eerie silence.

"I mean, it was sort of like a European parliamentary summit or something, but it was worth it," remarked Sen. Jay Rockefeller (D-W.Va.), who alternately suggested it felt like "somebody was getting impeached."

As the roll was called, senators stood and announced either "aye" or "nay." It was too much for John McCain.

"Ooooh, this is soooo tense," the Arizona Republican could be heard stage-whispering.

Nelson was seated as the roll was called and unceremoniously declared his yes vote. Landrieu and Lincoln, however, were absent at the start, as was Sen. Bob Byrd (D-W.Va.), the 92-year-old who this week became the longest-serving senator in the history of the upper chamber.

His presence is never assured at votes and his absence added an element of real suspense, McCain's mocking notwithstanding. A few minutes into the vote, Byrd was wheeled in and pointed to the sky, signaling an "aye." He pulled in next to Reid, who grasped his hand with both of his.

Sen. Arlen Specter (D-Pa.), whose vote would have made the bill bipartisan just a few months ago, rose to his feet and strode over to Byrd to shake the former majority leader's hand.

Sen. Roland Burris (D-Ill.), whose route to the Senate took him through an Illinois impeachment hearing and a Senate ethics panel, stood to vote aye and, after retaking his seat, backhand slapped Joe Lieberman on his arm and flashed a wide grin. Lieberman, the independent from Connecticut, had voted yes as well, but continues to hold his vote for the final bill at bay, hoping to remove the public health insurance option.

Lieberman smiled and the two shook hands heartily. Just moments later, however, he rose from his chair and fled Burris, finding more comfortable ground next to Lincoln. The two hold-outs batted each others arms and exchanged chuckles.

As the vote tally was called in the House exactly two weeks ago, the Democratic caucus erupted in celebration. The Senate is not that sort of place. Sen. Chris Dodd (D-Conn.), as presiding officer, announced the final 60-39 vote and scattered, muted "yay"s rose from the Democratic side, as the victors seemed unsure what to do. Only Sen. Sherrod Brown (D-Ohio) could be seen clapping; a few tourists in the gallery booed at the chamber. (The absentee senator was Republican George Voinovich of Ohio. Brown told reporters that his fellow state lawmaker had decided to attend a celebration of the thirtieth anniversary of his Cleveland mayoral election instead.)

Outside the chamber, the volume was turned up.

"It's an historic vote, a terrific vote, and one of the better moments since I've been in the Senate," Sen. John Kerry (D-Mass.) told HuffPost.

McCain seconded the historic sentiment. "It was the most dramatic moment in the history of the Senate," he told Huff Post. (He might have been sarcastic, or he may have been saying "traumatic"; earlier, during a floor speech, he had judged the bill "hernia-inducing.")

"We're rounding third and we're heading home," said Sen. Tom Harkin (D-Iowa), who now chairs the health committee.

"We can see the finish line now, but we're not there," Reid told reporters after the vote.

A lone Democrat can yet derail the effort.

Before the vote, Mitch McConnell begged for such a Democratic defection.

"All it takes is one vote. Just one," said the Kentucky Republican, turning to the left side of the chamber with an outstretched palm. "The simple math is this: If there were one democrat, just one of our friends on the other side of the aisle, just one, who would say no tonight, the voices of the American people would be heard... And then we could start over with a common-sense, step by step approach."

Mike Enzi (R-Wyo.) also begged for a do-over: "I still hope we can start over and get to work on a bipartisan bill."

Lieberman is among several in the caucus who have threatened to spoil the effort over the public option, and he played Eeyor again Saturday night, calling the public option "an eleventh-hour addition to a debate that's gone on for decades. Nobody's ever talked about a public option before, not even in the presidential campaign last year."

From the liberal end, Burris repeated a threat made earlier that if the public option was taken out, he's gone. "I won't vote for it," he said.

"You'll lose people on the left," confirmed Brown.

Reid, aware of the fine line he's walking, told reporters that Landrieu, Schumer and Sen. Tom Carper (D-Del.) are working on a compromise public option, perhaps something that 60 folks could support and save face.

"Now," said Kerry, "we just have to go forward and really legislate."

Arthur Delaney contributed to this report.

Source: http://www.huffingtonpost.com/2009/11/2 ... 66626.html
And ...
Senate Votes to Open Health Care Debate
By DAVID M. HERSZENHORN and ROBERT PEAR

New York Times, November 21, 2009

WASHINGTON — The Senate voted on Saturday to begin full debate on major health care legislation, propelling President Obama’s top domestic initiative over a crucial, preliminary hurdle in a formidable display of muscle-flexing by the Democratic majority.

“Tonight we have the opportunity, the historic opportunity to reform health care once and for all,” said Senator Max Baucus, Democrat of Montana, and a chief architect of the legislation. “History is knocking on the door. Let’s open it. Let’s begin the debate.”

The 60-to-39 vote, along party lines, clears the way for weeks of rowdy floor proceedings that will begin after Thanksgiving and last through much of December.

The Senate bill seeks to extend health benefits to roughly 31 million Americans who are now uninsured, at a cost of $848 billion over 10 years.

The House earlier this month approved its health care bill by 220 to 215, with just one Republican voting in favor. That measure is broadly similar to the Senate legislation, but there are some major differences that would have to be resolved before a bill could reach Mr. Obama, and that would almost surely push the process into next year.

As the Democrats succeeded Saturday in uniting their caucus by winning over the last two holdouts, big disagreements remained, making final approval of the bill far from certain.

Two reluctant Democratic senators, Mary L. Landrieu of Louisiana and Blanche Lincoln of Arkansas, warned that their support for a motion to open debate did not guarantee that they would ultimately vote for the bill. Their remarks echoed previous comments by several other senators, including Ben Nelson, Democrat of Nebraska, and Joseph I. Lieberman, independent of Connecticut.

Those comments made clear that more horse-trading lies ahead and that major changes might be required if the bill is to be approved. And it suggested that the Senate majority leader, Harry Reid of Nevada, who relied only on members aligned with his party to bring the bill to the floor, may yet have to sway one or more Republicans to his side to get the bill adopted.

The Senate Republican leader, Mitch McConnell of Kentucky, said his party’s opposition would persist. “The battle has just begun,” he said.

In a rare ceremonial gesture reserved for major votes, senators cast their yeas and nays from their desks in the chamber, each one rising to voice his or her position. Senator George V. Voinovich, Republican of Ohio, was not present and did not vote.

After the vote, Mr. Reid said he understood that Ms. Landrieu was already working with two other Democratic senators, Thomas R. Carper of Delaware and Charles E. Schumer of New York, to see if they could devise a public insurance plan with broad appeal.

The White House issued a statement praising the vote. “The President is gratified that the Senate has acted to begin consideration of health insurance reform legislation,” his press secretary, Robert Gibbs, said, adding that President Obama “looks forward to a thorough and productive debate.”

Mrs. Lincoln, who faces a tough re-election campaign next year and has in recent weeks been the target of millions of dollars in television advertising by both sides in the health care fight, said pointedly that she would not vote for the measure if it retained a government-run health insurance plan, known as the public option, to compete with private insurers. “Although I don’t agree with everything in this bill, I believe it is more important that we begin debate on how to improve the health care system for all Americans,” said Mrs. Lincoln, who was the last uncommitted Democrat, and whose speech, at about 2:30 p.m. Saturday, lifted a cloud of suspense that had hovered around the Capitol.

She added: “But let me be perfectly clear. I am opposed to a new government-administered health care plan as a part of comprehensive health insurance reform, and I will not vote in favor of the proposal that has been introduced by leader Reid as it is written.” But Senator Lieberman, who voted to take up the health care bill, said he was still staunchly opposed to a government-run plan. It is “a terrible idea,” he said.

Ms. Landrieu, whose support came after she won a provision that could be worth more than $100 million in additional federal aid for her financially troubled state, said, “I have decided there are enough significant reforms and safeguards in this bill to move forward, but much more work needs to be done.”

A parade of Democrats and Republicans spent Saturday laying out their arguments for and against the bill in floor speeches.

Mr. Reid, in a rousing closing speech given at his customary volume, which is barely audible, likened the health care bill to some of the most profound issues confronted by the Senate across history.

“Imagine if instead of debating either of the historic G.I. Bills — legislation that has given so many brave Americans the chance to brave college — if this body had stood silent,” Mr. Reid said. “Imagine if instead of debating the bills that created Social Security or Medicare, the Senate’s voices had been stilled. Imagine if instead of debating whether to abolish slavery, instead of debating whether giving women and minorities a right to vote, those who disagreed were muted, discussion was killed.”

With the Democrats nominally controlling 60 votes — the precise number needed to overcome the Republican attempt to stop the bill — the vote on Saturday evening was the biggest test yet of the Democrats’ resolve and of Mr. Reid’s ability to unite his fragile caucus. Mr. Reid faces a tough re-election fight next year.

The bill would expand health benefits by broadly expanding Medicaid, the federal-state insurance program for low-income people, and by providing subsidies to help moderate-income people buy either private insurance or coverage under a new government-run plan, the public option. And it would impose a requirement that nearly all Americans obtain insurance or pay monetary penalties for failing to do so.

According to the Congressional Budget Office, the cost of the legislation would be more than offset by new taxes and fees and reductions in government spending, so that the bill would reduce future federal budget deficits by $130 billion through 2019.

Mr. Reid accused Republicans who opposed the legislation of “living in a different world.” He and several other Democrats also used their speeches to assail perceived abuses by private insurers. “The health insurance industry has an insatiable appetite for more profit,” Mr. Reid said.

Senate Republicans countered with an impassioned denunciation of the measure as an ill-conceived budget-busting expansion of government and a threat to the health and economic security of all Americans, especially the elderly.

The Republicans sought to portray the vote on Saturday — on whether to end debate on a motion to bring up the health bill — as tantamount to a vote on the bill itself, and to shake the confidence of Democrats who had wavered in recent days.

In his closing argument, just ahead of the vote, Mr. McConnell implored at least a single Democrat to vote no. “If we don’t stop this bill tonight,” he said, “the only debate we’ll be having is about higher premiums, not savings for the American people, higher taxes instead of lower costs, and cuts to Medicare rather than improving seniors’ care.”

“The American people are looking at the Senate tonight; they’re hoping we say no to this bill,” Mr. McConnell added moments later, holding up a single index finger. “All it would take,” he said, “is just one member of the other side of the aisle, just one, to give us an opportunity not to end the debate but to change the debate in the direction the American people would like us to go.”

Mr. McConnell warned of the political consequences for senators who voted to move ahead. “Senators who support this bill have a lot of explaining to do,” he said. “Americans know that a vote to proceed on this bill, to get on this bill, is a vote for higher premiums, higher taxes and massive cuts to Medicare.”

Republicans also said that the vote was a proxy for a larger dispute over abortion, because they said the bill did not sufficiently restrict the use of federal money for insurance covering abortions. Senator Mike Johanns, Republican of Nebraska, described the vote as “the key vote on abortion in the health care debate.”

Saturday night’s vote was required because Senate rules and precedent have long granted a right of virtually unlimited debate, or filibuster, to the minority that can be curtailed only by a supermajority vote of 60 senators to move ahead. Currently, there are 58 Democrats in the Senate and two independents who routinely align with them. If the Democrats had lost the vote, they could have tried again, presumably after changing the bill to try to attract more votes.

Senator Patrick J. Leahy, Democrat of Vermont assailed the Republicans as obstructionists on Saturday morning. “I will vote today to end the filibuster so the Senate can begin the historic debate to improve and reform our nation’s health insurance system,” he said. “Let’s not duck the debate, let the debate begin. Let’s not hide from the votes.”

While Democrats generally agree on the broad goals of the legislation, to cover the uninsured and to slow the growth in health care spending, there are potentially serious disagreements over any number of provisions that could sink the bill.

Ms. Landrieu, in her speech, methodically cataloged provisions of the bill that she liked and those that she said needed improvement.

Under the bill, she said, owners of small businesses would no longer face “volatile costs” for health insurance. In addition, she said, the bill would “encourage employers to move away from high-cost benefit plans” and shift some compensation to wages.

But more needed to be done to improve the bill, she argued, particularly to help small businesses and the self-employed. And she issued a stern warning about the public option, one of the most contentious features of the sweeping health care legislation.

Source: http://www.nytimes.com/2009/11/22/healt ... ealth.html
And ...
Thrust and Parry on the Senate Floor
By DAVID M. HERSZENHORN

New York Times, November 21, 2009

Unless the Sunday morning news programs are buzzing about how the Senate health care bill was unexpectedly blocked on a procedural vote Saturday night, lawmakers have all headed home for Thanksgiving, and to rest up for what is likely to be a legislative floor fight of galactic proportions through much of December.
But even if they haven’t headed home, senators will be readying every parliamentary weapon for use in the debate by the full Senate, whenever that begins.

Some of the clashes will be for show, intended to appeal to various constituencies watching on C-Span. But much of the parliamentary arsenal will be employed with a purpose — stripping out the proposed government-run insurance plan, for instance, adding tougher language on medical malpractice lawsuits, or tightening restrictions on insurance coverage for abortions.

There are tactics designed to force votes on pet issues, and other tactics to avoid votes when lawmakers do not want to go on record with a position.

Simple as it might sound, the most fearsome tactic available to any senator is the ability to burn time, to drag out the debate in ways that can grind legislative business to a halt and leave the Senate caught in an interminable purgatory.

“This is one of those cases where it’s far easier to be obstructionist than it is to get something done,” said Martin Paone, a former chief of Senate floor operations for the Democrats.

But whether it’s stalling maneuvers or rhetorical bomb-throwing, engaging on the parliamentary battlefield can carry a price. At each step, senators must calculate the probability of success: the benefits of making a point versus the risks of aggravating colleagues.

There is also the larger political and public perception question of how the tactics will be viewed by voters. Will senators be seen as taking a principled stand, or as obstructing the legislative process?

So, aficionados of legislative war-games, grab this playbook and settle in.

Source: http://www.nytimes.com/2009/11/22/weeki ... nhorn.html
Last edited by roxybeast on November 22nd, 2009, 6:56 am, edited 2 times in total.

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