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The Next Step for Health-Care Reform


This post was published last week, but in the aftermath of the Finance Committee's vote, a number of people have asked me to write about what comes next for health-care reform. This is the answer. The only real update needed for this post is that Olympia Snowe is going to have a more central role in the negotiations than was originally thought.

Tuesday's Finance Committee vote is considered such a sure thing that most Hill staffers are already looking past it. When you hear about compromises like an opt-out public option, you're not hearing about a potential amendment to the Finance Committee's bill. You're hearing about a potential addition to the "floor bill." That's where the action is now.

The floor bill will not be the Finance Bill, exactly. And it will not be the HELP Committee's bill. Instead, it will be a blend of the two. The merger will be overseen by Harry Reid's office, and Hill sources expect the room to be fairly small beyond that: Max Baucus, officially representing the Finance Committee, but unofficially representing Senate moderates. Chris Dodd, representing the HELP Committee, but unofficially representing Senate liberals. A few White House staffers (Peter Orszag's name comes up frequently). Finally, Tom Harkin, the actual chairman of the HELP Committee, will have some involvement but isn't expected to be a key player.

Other members of the Senate will have less official roles. The rest of the Senate Democratic Leadership team, for instance, Olympia Snowe. Key liberals and moderates with whom Dodd and Baucus will be in constant communication. But the room itself is expected to be quite small.

The base bill is going to be the Senate Finance Committee's bill. That bill, unlike the HELP Committee's bill, is complete. It has revenues and Medicare and Medicaid. The HELP bill, due to the committee's constrained jurisdiction, lacks all those items. Moreover, everyone wants to keep the Finance Committee's CBO score, or at least something like it. Calling this a merger, then, isn't really accurate. It's more like a bigger company buying out a small rival. The question is what they keep.

The main items under discussion are the public plan and affordability. To secure the support of liberal members, there will need to be some sort of public plan. To retain the support of moderates, the plan will have to continue to bend the spending curve in both the first and second decades. To secure the support of the Democratic caucus more broadly, there will need to be more subsidies, or some other measure to make insurance a bit more affordable. That, however, will require more revenue. No one quite seems to know where that revenue will come from. In fact, the main revenue change under discussion is to soften the excise tax, which would mean the bill raises less, rather than more, money. So that's going to be tricky.

What emerges from this process is expected to look a lot like the final compromise. As a smart Hill source explained to me, the final legislation is hard to change. It won't take anything but the agreement of the members in that room to add something to the bill. But after the bill leaves that room and goes to the floor, it will be very difficult to make any changes. Harder even than in the committee process, where a bare majority of committee members could add an amendment.

On the floor, you'll need 60 votes to add anything. You also need 60 votes to remove anything. If some group of senators dislikes one of the features, they'll need to beat a filibuster to reform it. Indeed, that means Republicans might not be the only ones employing the filibuster. Eleven moderates and all the Republicans could partner to weaken an element of the bill and still be foiled by 40-some liberals.

The flip side of that, of course, is that you need the entire Democratic caucus to break the final filibuster on the bill. You can't have anyone angry enough that they're willing to scuttle the final legislation. That means the compromise coming out of the merger has to be basically acceptable to all Democrats, and then a core of 41 Democrats needs to be ready to defend every major element from attack (even as some Democrats vote for those attacks). It's not going to be easy. But that's the next step.

Photo credit: By Andrew Harrer -- Bloomberg

By Ezra Klein  |  October 14, 2009; 2:00 PM ET
Categories:  Health Reform  
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Next: Harry Reid Gets Tough With the Insurance Industry


"To secure liberal support, you're going to need some sort of compromise on the public plan..."

Again! Again supporting what two thirds to three fourths of Americans support, supporting what two thirds of physicians support, is cast as "liberal." Nonsense!

Now here's what it comes down to, and it's critical, and the media isn't covering because it so central to winning this and they're obviously in the tank to defeat a public option:

Both parties traditionally vote procedural votes in unison. That means, when Baucus and Nelson and the rest of the insurance goons yammer like baboons about not having sixty votes, and the media blithely follow suit as done here yet again, they are stating that there are Democrats (presumably themselves) who will not follow that tradition, because the sixty vote margin applies only to ending a filibuster to bring the bill to a floor vote.

We need to let Reid know that we're expecting that any Dem who votes against cloture will be stripped of his or her leadership positions in committee and of any and all perquisites that can possibly be stripped.

If these Republicrats want to vote against the bill on the floor because it has a public option, fine. If they want to stand on the wrong side of history, that's their prerogative - my guess is they won't.

But they view voting against cloture as their ace in the hole to stop a public option and not have to take a shameful stand against it with a direct vote against a bill. It's a stealth maneuver aided and abetted by the media who refuse to explain this clearly.

So we cannot let a handful of turncoat Republicrats stand in the way of 200 million Americans. It's not 40 Republicans standing in the way, it's about five or six Democrats. Seriously.

We need to let Reid know that enforcing the tradition of block voting procedural votes must be enforced with consequences they wouldn't want to endure. No mercy.

And let Obama know that if Reid cannot or will not enforce this tradition, Obama the party leader needs to start a movement to to oust Reid from his Senate leadership position for malfeasance.

It's time to start knocking some heads together. This kumbaya nonsense doesn't fly. We are at a decisive moment and victory is clearly within our grasp.

Posted by: trippin | October 9, 2009 1:51 PM | Report abuse

Maybe we could end a war... or two. Funny, how there's always money for these adventures.

Posted by: uberblonde1 | October 9, 2009 1:56 PM | Report abuse

The next step ought to be passing a Constitutional Amendment giving the federal government the authority to manage healthcare and to require all citizens acquire health insurance.

But no, much easier to ignore the Constitution and hope that your fellow citizens will continue to not notice.

Posted by: MDLaxer | October 9, 2009 1:57 PM | Report abuse

I take it the remark about the Democratic leadership team including Olympia Snowe was meant as a sly witticism?...

Posted by: chrisj2 | October 9, 2009 2:28 PM | Report abuse

"The next step ought to be passing a Constitutional Amendment giving the federal government the authority to manage healthcare and to require all citizens acquire health insurance."

Except the public option is not managing health care, it is providing health insurance run by the government as an option. As I recall, social security is providing retirement that is run by the government, except social security isn't even optional, yet it is still constitutional. If you argue that social security is unconstitutional, then I suggest you look at the court cases where it was decided that social security is constitutional. You should realize it is up to you and others with your opinion to change the fact that social security is constitutional by amending the constitution, not up to those who have already been justified by the courts.

There is little difference, in regards to constitutionality, between requiring citizens to purchase health insurance and requiring citizens to purchase retirement, except in the case of the latter you have no choice but to purchase it from the government while in the former you can choose to purchase it from a private company or from the government (if the public option is included). In fact, part of Bush's social security reforms were to allow you to divert some of your social security taxes, which you would still be required to pay, to private accounts for investing in retirement on your own, making it a lot like the health insurance mandate.

Posted by: paulflorez | October 9, 2009 2:35 PM | Report abuse

To PaulFlorez:

I really don't care whether healthcare reform passes or not, but I must point out that just because there are Supreme Court rulings that say something is "constitutional" does not mean that it actually does follow the Constitution. The SCOTUS is fallible and political. By one estimate, 60% of the federal budget is spent on powers not allowed to the federal government by the Constitution.

Posted by: pmendez | October 9, 2009 2:50 PM | Report abuse

You might be right. Helvering v. Davis did decide that SS was constitutional. Of course, I'm sure that FDR's court-packing threat had nothing to do with that.

Of course, to reach that decision, one had to completely re-interpret the constitution.

Alas, that is where we are today and our Constitution becomes less and less relevant.

Posted by: MDLaxer | October 9, 2009 3:01 PM | Report abuse

To keep it around $900B they're going to have to leave most of the major funding issues to be settled on the floor. "It's not going to be easy" may be the understatement of the millenium.

Posted by: bmull | October 9, 2009 3:32 PM | Report abuse

Nancy Pelosi's comments on the Baucus Senate Bill.

"I am very pleased to see that the Baucus bill raised the allowable annual medical duduction from 7.5% of AGI to 10% of AGI. There are just too many Americans writing off their medical expenses. That has to be stopped. We need to raise that deduction to 15% of AGI so no one can write off their medical expenses. You see, that will make it more affordable. Then, we need a value added tax - it's the latest and greatest craze in Europe and someone has to pay for our spending because we aren't finished yet."

Posted by: Patriot12 | October 9, 2009 3:43 PM | Report abuse

"a core of 41 Democrats needs to be ready to defend every major element from attack"


Posted by: rmgregory | October 9, 2009 5:00 PM | Report abuse

I'd like one of those right-wingers in Congress tell the truth for once. They object to health care reform because it would damage their personal relationships with health insurance companies. All other considerations and claims take a back seat to that. Even the one that goes if Democrats produce a social program that costs less and delivers more, that'll put Republicans in a position of having to oppose popular government programs. Then where will they be? Connect the dots. Free market rape, plunder, and pillage froze the money center banks in their tracks. They'd still be frozen if Uncle Sugar hadn't provided them with fresh cash. Republicans would be happy to see USA in a Deep Depression. Oh, and fighting Iran and North Korea with nukes.

Posted by: BlueTwo1 | October 9, 2009 5:03 PM | Report abuse

Had a similar thought EK. Wondered why a Republican in a blue/purple state wouldn't look to see how aggressively Collins/Snowe/Nelson were being courted wouldn't want in on the action. Tough political gambit.

Posted by: etdean1 | October 9, 2009 5:12 PM | Report abuse

If the final bill is fiscally sound and increases coverage to more Americans, all the more important that the GOP pull out all the stops to kill it. If any such bill passes, the President will get the credit and this will sink the GOP in 2010 and 2012. They must stop healthcare reform at all costs or they will not be able to gain politically.

Posted by: bpai_99 | October 9, 2009 5:54 PM | Report abuse

Who says Dems need 60 votes??
TWICE, Bush's tax cuts for the wealthy passed with LESS THAN 60 VOTES!
Bush pushed through Medicare D with LESS THAN 60 VOTES!

Dems have 51 votes for the Public Option - PASS IT NOW!

Posted by: angie12106 | October 9, 2009 6:31 PM | Report abuse

Without the public option, it would be hard to mandate for lack of affordability.

Posted by: dummy4peace | October 9, 2009 7:03 PM | Report abuse

Enough with the 60 vote nonsense! If we don't get a public option it will be because "moderate" Democrats oppose it. We all understand: moderate=bought-and-sold.

Posted by: rusty3 | October 9, 2009 7:13 PM | Report abuse

Congress represents the rich for campaign donations and the poor for votes. That is why Public Option isn't very popular as it is for the Middle Class, which lacks representations in Congress.

If we need more non-profit health care entities, look no further in your state. Blue Cross and Blue Shield is not-for-profit. Would you want more of it?

We also need to outlaw charging much different prices for the same policy between a group policy and an individual policy.

Health Insurance is not the same commodity as corn or airline tickets. It has zero elasticity in its demand. Without it, we can die. If we regulate electricity, why do we wait this long to regulate health care? Lobbyists have tangoed with Congress for too long...

Posted by: dummy4peace | October 9, 2009 7:31 PM | Report abuse

I am just getting tired of all this health care nonsense. I am going to say one last thing, and then let it go. The following is a prediction of the future.

The Democrats will pass a bill that will reform healthcare that includes a public option. For a short time (~2 or 3 years) Americans will see it as a benefit because of the lagging economy. Once the ecnomy begins to turn around, more americans will begin working again. They will realize that the costs of healthcare have not significantly reduced in the short term. Some have noticed that their premiums have still been increasing, but not at the same pace they were before reform. Unfortunatly, those who are still without a job will realize that the public option is still too costly for them and pay the penalty.

This will be about the time everyone will begin to realize the unintended consequences of the Democrats push for reform. The news will claim a victory for the Democrats, similar to NAFTA. Yet in the longer term, some healthcare jobs will be lost, costs will not be significantly impacted, and there will still be millions of Americans without insurance, but this time by choice and they will have to pay for it.


Posted by: sanmateo1850 | October 9, 2009 8:30 PM | Report abuse

The Democraps say that the Reps want you to die quickly but the Democraps plan is for us to committ suicide now!

The Baucus bill charges Americans who were born with severe medical problems 200X more than illegal aliens who pay nothing. Sounds, looks and smells like national suicide.

Maybe they're just after Sarah Palin's kid who was born with Downs syndrome. Nannie P and Harry Reid and Barrack Obama are going to make that child pay for being born! As they say, "Suicide is cheaper and to the benefit of the State." F-ing Nazis!

Posted by: Patriot12 | October 9, 2009 8:37 PM | Report abuse

Clearly, the people do not want this Congress to work on or pass anything else.
Their work so far, has placed the debt on unrepresented unborn. A big no no in this Country.
They refused to listen on bailout, and stimulous when the majority said no.

They are all unwelcome and leaving, so their work will be voided.

BEAR REVOLT was started by Veterans ( Czar nick named terrorists) seeking to empower the active troops with a clear documentation of the majority's will of the people, via petitions (signatured by all men women and children who have No Confidence this 2009 Federal Government), being entered into County recordations offices as a recorded document, then pooled, and placed as a" Document" into the Library of Congress by the people..
The well documented majority "will of no confidence " can allow the defenders of the US Constitution the ability to carry out the will of the majority, and allow an emergency election to void all signatures of the current one.
This Redress call was named when Pelosi went to THE BEAR REPUBLIC California , threw imported ACORNS at their heads,
then called them astroturf , and walked on their backs with her spikey heels out the door , refusing to listen to them.


The REDRESS of the 2009 Federal Government of the United States of America
By the recall of :
The Congress, (all names listed both Partys)
The Hill , ( all names listed both Partys)
The Cabinet, (all names listed)
The Czars, ( all names listed)
Barack Hussein Obama ( all "currently" known names listed: Barack Hussein Soroeto, Barack Hussein Dunham )

Posted by: dottydo | October 9, 2009 8:48 PM | Report abuse

EXACTLY, WHO is writing the final version of this Healthcare Takeover Legislation???

AGAIN, EXACTLY WHO specifically is writing the FINAL version of THIS Legislation !!!

Posted by: thgirbla | October 9, 2009 9:17 PM | Report abuse

so it's socialism that you don't like ?

private insurance dump sick policies on the gov systen and keeps the healthy ones.

they socialize the sick
and capitalize the healthy

its called lemon socialism ... of its a lemon its your if it a cherry its mine...just like wall street is lemon socialism.

single payer is the only way out of this twisted mess!

Posted by: ryan_heart | October 9, 2009 9:21 PM | Report abuse

Taxation is constitutional, but congress cannot tell citizens they must purchase products they don't want. This will never pass muster with the high court.

Posted by: davideconnollyjr | October 9, 2009 9:35 PM | Report abuse

Baucus has taken the chance to actually make a change for the better and created a psuedo bill that does nothing but create taxes and does not address the problems with health insurance, its abuses and the failing system we already have in place that makes competition, therefore competive pricing and has only compounded the problem. First of all unless every state is uniform in the basic standards of adherence to contracts, basic benefits and payments systems, this waste of time that he and others blue dog dems have put into this bill that serves no one but big health insurance is another stab in the backs of the public and is little more than another abuse of our tax dollars for paying his and their salaries.

Posted by: bonnieblue12 | October 9, 2009 9:45 PM | Report abuse

These morons are realizing that the majority of citizens do not want the government option. The anger they saw during the town hall meetings is the tip of the iceberg. Many of these nimrods that continue to debate and waste time on health care and cap and trade will not be in office after the 2010 elections.

Fix the economy and restore jobs. Stop creating more debt. No more spending start cutting. The government is broke and the stench of corruption is reaching a level that the EPA is going to have to respond to.

If the Spendocrats are able to push through some nonsense it can be fixed after 2010 elections. The defection of the Blue Dogs is they have to decide do they want to vote for this or do they want to stay in office.

Watch the upcoming elections, particularly the races for governor in Virginia and New Jersey. Even the idiots in Washington will be able to read the tea leafs.

Posted by: Bubbette1 | October 9, 2009 11:27 PM | Report abuse

For all you Democrats who actually believe that the government is going to give you affordable healthcare, I have Obama's Nobel price to give to you. The proposed healthcare will effectively control every American from cradle to grave. Mass rationing and higher costs will prevail for one reason alone, the government estimates are always 50% to 100%+ higher in real life. Not to mention that every government program is broke. Wake up and smell the rotten stench. This will not be good for America. It will just take us faster to a Chavez type of government. Welkome to the United States of Social America.

Posted by: aaniko | October 10, 2009 7:14 PM | Report abuse

Great question, thgirbla! EXACTLY, WHO is writing the final version of this Healthcare Takeover Legislation???

Where's the bill? Obama and his accomplices are going to approve a bill whose contents have not been divuldged. All we have is the Orwellian propaganda from Obama and his accomplices.

So, WHO is writing the final version of this Healthcare Takeover Legislation? From what we know so far, the final bill will be written by Obama, his communist czars, his ACORN-type community organizers, and other U.S. enemies helping Obama enslave us.

Posted by: AntonioSosa | October 10, 2009 10:52 PM | Report abuse

I fully agree with you, aaniko. Obamacare has NOTHING to do with improving our health care system. It's just a sam, another power grab that will further destroy our health care, destroy our economy, steal money from our children and grandchildren, multiply our deficit, and enslave us through lies, manipulation, intimidation and coercion.

Imitating Hugo Chavez, Obama wants to nationalize everything, including our health care system! "Hey, Obama has just nationalized nothing more and nothing less than General Motors. Comrade Obama!" Chavez cheered on Venezuelan TV. He added that he and Cuba's Fidel Castro would now have to work harder just to keep up.

Fortunately, as we can see in the town halls and marches, most Americans have NOT been dumbed down and DO NOT WANT to put the power of life and death in Obama’s ACORN-type bureaucracy. They will do whatever necessary to defend themselves, their children and grandchildren from the abomination of Obamacare and socialism/communism.

Posted by: AntonioSosa | October 10, 2009 10:55 PM | Report abuse

Going back to your question, thgirbla, EXACTLY, WHO is writing the final version of this Healthcare Takeover Legislation???

Americans have reasons to be terrified about who will likely decide on the final health care bill.

Will it be Obama’s Health Care Czar Dr. Ezekiel Emanuel? Dr. Emanuel (also called Dr. Death) has said that “Medical care should not be given to those who are irreversibly prevented from being or becoming participating citizens.”

If doctors report to Dr. Emanuel, they will have to refuse medical care to the elderly and the handicapped because they are “irreversibly prevented from being or becoming participating citizens.”

Obama and his Czars, including Science Czar John Holdren, seem to share Dr. Emanuel’s thinking. As a Senator, Obama voted in favor of abortion and infanticide (late-term abortion). And Science Czar John Holdren has called for population-control policies such as forced abortions, mass sterilizations, and mandatory population controls.

We DO NOT want Obama and his accomplices to “take care of us.” We DO NOT want the abomination of Obamacare!

Posted by: AntonioSosa | October 10, 2009 11:00 PM | Report abuse

All those who want socialized medicine and a socialist/communist country should move to Cuba or Venezuela. We would be happy to pay one-way tickets for them all and ask them to take their comrades Obama, Pelosi, Reid, etc. with them.

They have no right to transform the U.S. in another failed socialist country like Cuba or Venezuela.

Posted by: AntonioSosa | October 10, 2009 11:03 PM | Report abuse

Since health reform is such a huge issue that affects all Americans, we should be allowed to Vote for or against the final proposal. If congress doesn't figure out
how to truly Reduce costs, such as hospitalization, surgery, doctor visits,
prescription drugs, equipment, etc., we will never be in a position to do real reform. Our family was notified that our individual insurance is increasing 17% !
Americans like us cannot afford anymore premium increases or new taxes.

Posted by: ohioan | October 10, 2009 11:39 PM | Report abuse

A scenario:
1. With the help of Blue Dogs, Repubnicans succeed in keeping public option out of final bill (or employ some other method of rendering bill meaningless enough to satisfy them). If unable to accomplish this, prevent cloture.
2. Obama accepts the meaningless bill, thus not only losing any further progressive and liberal support, but also the support of a great many of those who are neither but nonetheless are among the 75% polled who favor public option. Or, at Obama's behest, reconciliation invoked to ensure a meaningful result.
3. If the latter, Repugs scream "dictatorship" (even though Bush used this tactic several times, including tax cuts for the wealthy).
4. Repugs incite more 9/12/09 demonstrations of rage, fear, and hate on the part of the ignorant and the stupid.
5. Thus emboldened, Repugs are either able to water down into meaninglessness all further important legislation (such as re. finance, energy, environment), or if not, prevent cloture on all of them.
6. Obama boxed in: Either accept defeat each time and lose support of enough of those who elected him to prevent his re-election, or invoke reconciliation each time.
7. If the latter, each reconciliation ignites further Repug incitement, resulting in more 9/12/09 public displays of mania, each more intense than the previous.
8. Due to combination of factors described in 1. through 7., nation rendered ungovernable.
9. Obama blamed, becomes lame duck.
10. Repugs regain power.
11. Democracy ends, replaced by replication of 1920s fascist Italy, which married totalitarianism to unfettered capitalism.

Posted by: ronaldoroso | October 11, 2009 2:29 AM | Report abuse

You can tell when Ezra's posts are clear and persuasive, because they bring out the wingnuts in braying unison!

Look, "government take-over"!
Look, "socialism"!
Look, "where was Obama born"!

The confusion of such loud but minority voices is reinforced by their claim -- disproven by poll after poll -- that American voters are against having there be a public option among the choices for purchasing health insurance for individuals. Polls show consisentely that a substantial majority of voters is cautiously supportive of this idea...but deluded by the noise of their own teaparties, the minority insists that can't be so!

Posted by: PQuincy | October 11, 2009 12:49 PM | Report abuse

The process, as you have described, is far closer to an aristocracy ruling the government than anything remotely "democratic." Such a small group of Senators having such enormous power in shaping a health care bill is a mockery of any pretense of the Senate being part of a "democratic" government. So much for the leaders of this country hectoring other nations to become a "democracy."

Posted by: Aprogressiveindependent | October 11, 2009 10:12 PM | Report abuse

Over 60% of All US Bankruptcies Attributable to Medical Problems
Most victims are middle class, well educated and have health insurance

August 2009 issue of The American Journal of Medicine

In 2007, before the current economic downturn, an American family filed
for bankruptcy in the aftermath of illness every 90 seconds; three-quarters of them were insured. Over 60% of all bankruptcies in the United States in 2007 were driven by medical incidents.

The share of bankruptcies attributable to medical problems
rose by 50% between 2001 and 2007.

They are crushing the overall markets from coast to coast - skimming as much of the froth off the top of the middle class as they can so much so that we can't even afford movie tickets anymore. And they have an anti-trust exemption (like baseball) - the whole insurance industry is an albatross around the neck of the entire economy.

Posted by: JourneyHomeBurke | October 13, 2009 4:28 PM | Report abuse

Can't comment boards at reputable websites have stronger filters? In other words, do I really have to wade through the opinions of people who actually post things like "Spendocrats," "Repugnicans", "WAKE UP, AMERICA!" and "Obama and his accomplices?" How about gems like "[Predicted thing will happen] GUARANTEED!" or "Petition of Redress!!!" It's not biased journalism to prevent interest trolls from posting their detrimental nonsense. Failing to do so robs thoughtful people of their voice because reasonable folks don't read the comment board much anymore because they don't want to read some crackpot's opinion of "the abomination of Obamacare and socialism/communism."

Posted by: arbutus1440 | October 13, 2009 4:49 PM | Report abuse

You missed the part that goes on outside the official negotiations, in which Serious Senate Centrists preen for the cameras, talk about how it's going to be hard for them to support a floor bill that contains X, Y and Z, and basically hog cablenews to demand that their bottom be kissed in public with more relish than the bottom of the senator to their left.

What a travesty of democracy.

Still, to pick up on what Ezra told Charlie Rose, it needs to be made clear to the Blue Dogs in both chambers that what's being written for the Senate bill is, in essence, the platform for the mid-terms, where those most vulnerable to defeat will be even more vulnerable if the final bill is watered down. The question then becomes whether those members of Congress are planning their corporate-funded futures.

Posted by: pseudonymousinnc | October 14, 2009 2:07 PM | Report abuse

Two questions, Ezra:

1) Is there a quick summary somewhere of what was actually in the Senate Finance Committee bill?

It's of interest because Sens. Snowe, Conrad, Lincoln, Carper, etc. might VOTE against a bill only slightly different than the SFC bill. But they'd look pretty stupid if they chose to FILIBUSTER a bill that wasn't very different from it. And it doesn't look like the final Senate bill, or even the conference committee bill, will be seriously different from the SFC bill.

2) Where's the House in all this? Do they just sit back and wait until the Senate's done, before voting on their own bill?

Posted by: rt42 | October 14, 2009 2:09 PM | Report abuse

I'd second rt42's second question: where's the House bill fit? Without the HELP bill providing the liberal backstop to Snowe's "improvements," is the House bill the last chance to make this a good bill?

The 60-vote thing is driving me batty. The Dems should be feeling like they are 2 inches from the finish line, so why not make this thing *better*?? Getting Snowe on board seems like a way for the bill to later become extremely unpopular (no structure set up for public option, subsidies that'll be "cut back" in name of future deficit reduction)...

One doesn't ensure a bill's long term success by claiming it's bipartisan, one gets it by making a good bill that has a constituency that will defend it from cuts and help it improve. With SS and Medicare, there are people fighting for the programs. With this bill and all it's behind-the-scenes fixes, we need something to show people in their daily lives, not just charts and graphs. Carper's compromise is good, but there still needs to be some push back against the Baucus bill. All this moving the goal posts back seems just seems so pre-orchestrated by Obama/Messina, and it's incredibly frustrating.

Posted by: Chris_ | October 14, 2009 2:34 PM | Report abuse

'Without the HELP bill providing the liberal backstop to Snowe's "improvements," is the House bill the last chance to make this a good bill?'

Amid all the well-meaning hot air about merging Senate bills and the conference, I think my earlier point stands that the Gang of Six made sure that Senate Finance got the last word out of committee, making Senate Finance (with all of its deficiencies) the base text and everything else the revisions. As such, you're going to find a whole lot of turd-polishing spin from people who have argued that Baucuscare is the rightward edge of the final bill, as opposed to its leftward edge.

At the same time, Nancy Pelosi and the House leadership will not be impressed with a situation in which all 256 of their caucus face mid-terms on the back of a Senate-dictated bill, while only 18 Democrats in the Senate have that task.

Posted by: pseudonymousinnc | October 14, 2009 3:51 PM | Report abuse

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