Feature

Health-care reform battle advances in Senate

In a party-line vote of 60–39, senators voted to begin debate on an $848 billion measure that would expand coverage to 31 million uninsured Americans and increase insurance competition through new market exchanges and a public option g

What happened Health-care reform passed its biggest test in the Senate last weekend, fortifying Democratic leaders to face a gantlet of legislative challenges after the Thanksgiving recess. In a party-line vote of 60–39, senators voted to begin debate on an $848 billion measure that would expand coverage to 31 million uninsured Americans and increase insurance competition through new market exchanges and a public option government plan. The legislation, which secured the minimal votes required to foil a Republican filibuster, is projected to reduce the deficit by $130 billion over the next decade through a combination of $436 billion in Medicare savings and new taxes on health-care providers, “Cadillac” health plans, and wealthy households. Three moderate Democrats and independent Sen. Joe Lieberman said they would not vote for final passage of the bill in its current form, and disputes over abortion coverage, the public option, and other issues await. “We know not all 60 senators in my caucus agree on every aspect of this bill,” said Senate Majority Leader Harry Reid.

Democrats will face a second filibuster threat against the actual text of the bill next week. If Reid can hold his 60-vote coalition intact for that vote, simple majority votes on a battery of amendments—many designed by Republicans to split the Democratic caucus—will soon follow. Republicans denounced the bill as a budget-busting government takeover of health care and vowed to redouble efforts to kill it. “The battle has just begun,” said Senate Republican leader Mitch McConnell.

What the editorials said“One by one, the obstacles to a once-unimaginable overhaul of the nation’s $2.5 trillion health-care system are tumbling by the wayside,” said The Philadelphia Inquirer. Soon enough, millions of uninsured Americans could be covered, and insurers would no longer be allowed to “deny coverage at their whim” due to pre-existing conditions or serious illness. Despite “increasingly shrill” Republican opposition, there is “growing reason to hold out hope” that the Senate will pass its bill and that differences with a similar House version will be worked out.

Not so fast, said The Wall Street Journal. The more we see of this process, the clearer it becomes what a pork-laden travesty it is. When Louisiana Democrat Mary Landrieu balked at the bill’s gargantuan cost, Reid simply bought her vote outright with a $300 million “political gratuity” in the form of Medicaid subsidies for her home state. Holiday shopping has begun.

What the columnists saidDemocratic unity lasted “only as long as it took to bring down the gavel” on the vote, said Jonathan Karl in ABCnews.com. Four moderates who voted for the bill say they’ll ultimately vote to kill reform if the public option isn’t removed. Two liberals say they’ll oppose any bill that doesn’t include the option. The political “machinations” needed to advance this mess may be its undoing, said Yuval Levin in National Review Online. Since “actual arguments” in favor of the bill have unraveled under scrutiny, Democrats now cast their support in vague terms of answering history’s call. Remember back when they claimed to be “reducing costs” in the system? Haven’t heard that one lately.

Then you’re not paying attention, said Ronald Brownstein in TheAtlantic.com. The bill’s cost containment is “winning praise” from tough-minded economists like MIT’s Jonathan Gruber and leading reformers, including Mark McClellan, who oversaw Medicare and Medicaid for President George W. Bush. Most ideas to “bend the curve” of long-term costs are still intact, including the creation of an independent Medicare commission with cost-cutting authority and restructuring payment incentives for medical providers. With the bill projected to cut costs by as much as $650 billion in its second decade, many experts think it’s on the right track.

Experts are beside the point now, said Doyle McManus in the Los Angeles Times. But then again, so are voters. “The important parts of this debate have moved into the Senate’s backrooms,” where a “battle of old-fashioned special interests” is under way, including the insurance industry, labor unions, doctors, and the seniors’ lobby. Obama, who won the election on a surge of people power, is now busy cutting deals with insiders. If he prevails, it’ll be “the old-fashioned way.”

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