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Cloture vote on health care scheduled for Saturday. Also on the agenda: Cruel, cruel irony.


Today, the Senate debates. I've been watching all morning. Not sure what it says that the level of debate in my comments is a whole lot higher than in the world's greatest deliberative democracy. Either way, tomorrow, the Senate votes to break the GOP's filibuster and move forward to ... more debate.

Little will illustrate the absurdity of the filibuster as neatly as tomorrow's vote. This is not the vote to pass the bill. It's the vote to begin considering the bill. Changing the bill. Amending the bill. Recall that the purpose of the filibuster is to protect debate and ensure that members can make their opinions heard and ensure they have an opportunity to add their ideas to the legislation. Tomorrow, however, 40 Republicans are expected to use the filibuster to close off debate and ensure that no more opinions are heard nor changes considered. The right to unlimited debate has become a tool for cutting it off.

Photo credit: AP Photo/Susan Walsh.

By Ezra Klein  |  November 20, 2009; 11:17 AM ET
Categories:  Health Reform  
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Isn't the reason that this is the case because the Senate changed its rules a number of years ago to save senators the trouble of actually having to 'filbuster' in the Jimmy Stewart-Mr. Smith Goes to Washington mode when they want to stop a bill? Wouldn't it make sense for the Dems to change back to the old filibuster rules, combined with a big press conference announcing that they were doing it to ENSURE debate on important issues, not prevent it, like Republicans are doing? I understand such a change can be made by majority vote at the beginning of a legislative session - would that be after the 2010 elections, or could they do it sooner? The only arguments I can see against this are: 1) They want to preserve the lazy man's filibuster for when they are in the minority again or 2) they don't trust their ability to get past the Republican noise machine and sell the change as a way to ensure debate, not prevent it. Either reason is a pretty chicken s__t excuse for letting things go on the way they are.

Posted by: exgovgirl | November 20, 2009 11:41 AM | Report abuse

"Recall that the purpose of the filibuster is to protect debate and ensure that members can make their opinions heard and ensure they have an opportunity to add their ideas to the legislation."

It may have been instituted with that purpose in mind, but I don't think it makes sense to say that that is its current purpose.

Posted by: vancemaverick | November 20, 2009 11:51 AM | Report abuse

i agree ezra. As someone who knows (as many on here do) that this bill is pretty worthless in the areas of cost control we need to have the debate on it. Let Democrats come out and say that this will control costs and help people. We need to have a moment in time when Democrats will be accountable in 2010 and 2012 when costs are still skyrocketing and little is being done to help. In those elections we'll need to hold someone accountable and the American people can and will come out in droves to show how angry they are.

And the rest of us will be saying "I told you so."

Posted by: visionbrkr | November 20, 2009 12:26 PM | Report abuse

If it's not serving its intended purpose, and has significant deleterious consequences, it should be restructured.

This isn't complicated.

Posted by: adamiani | November 20, 2009 12:58 PM | Report abuse

I'm with visionbrkr. I am an independent who voted, somewhat enthusiastically, Democratically last year. I thought the whole "socialist" rhetoric was merely unwarranted scare tactics. Less than a year later, I think our government is currently being run by raging socialists, with Obama leading the pack. Bring on 2010 and 2012, PLEASE!

Can somebody please help me understand HOW it is possible to expand the people eligible for Medicare/Medicaid by millions AND cut the funding to it by billions?

Oh, wait, because when they further reduce physician reimbursement rates (making it even FURTHER below their costs to provide the care) that saves money because even MORE doctors stop accepting those patients - so much less care is given to pay for.

Posted by: Jodigirl | November 20, 2009 1:15 PM | Report abuse

"Can somebody please help me understand HOW it is possible to expand the people eligible for Medicare/Medicaid"

There isn't any change in eligibility for Medicare. It's possible to cut money because many, many health care dollars are spent on things that are either useless or harmful. And the House just voted not to cut physician reimbursement rates if that's really worrying you.

Posted by: steveh46 | November 20, 2009 1:28 PM | Report abuse

any discussion of filibuster is worthless without an understanding of the current concept of filibuster

bernie sanders on rachel madoff show last week (my recollection) spoke of the senate gop setting a record this term for use of filibuster and point of order, i think he said 87 times

it seems to me that there are legislative tactics being employed that are not broadly understood and are generally not discussed

it must make writing about health care reform battles a more arduous task

Posted by: jamesoneill | November 20, 2009 1:29 PM | Report abuse

Jodigirl, what exactly did you expect to happen when you voted for a candidate who ran on a platform of universal health care? I honestly suspect that your whole comment is trolling and you didn't vote Dem at all, because your questions have been answered if you actually read this blog, but please prove me wrong.

Posted by: Chris_O | November 20, 2009 1:48 PM | Report abuse


They are expanding Medicaid through this legislation. Do you know of any state that will currently be able to absorb those costs?

I love how non-health-care people just look at things and say "well that is not necessary to do". I love it mostly because the people who are free to say those things, are also NOT the ones getting sued if they miss something!!

Right now, when a physician orders a catscan on 7 out of 10 people who have chronic headaches, and only 2 of those people have an aneurysm or brain tumor that needs treatment, people say, "that doctor performed those unnecessary brain scans for money!! He should have been able to just see into their brains to know they did not need those scans."

In a few years when only 2 out of 10 patients with chronic headaches gets a scan, and the 2 who had disease die from undiagnosed aneurysms, people will say to doctors, "you did not do a scan on them because you wouldn't make money at it!! You need to be sued for a lot of money. You should have been able to just see into their brains to know they needed that scan."

It's just like the new mammogram advice. It may save many lives to do regular screening starting at 40, but somehow that does not outweigh the fact that it causes others unnecessary anxiety, scans, and biopsies? One persons useless test is another persons life saving test - AND THE DIFFERENCE IS NEVER BLACK AND WHITE.

Posted by: Jodigirl | November 20, 2009 2:00 PM | Report abuse


My memory of Obama's campaign on health care reform was not about a public option. If you have video that proves otherwise, please share it. I am very much in favor of health care reform, but not bad health care reform. I WISH I could say I didn't vote Democratically last year, but sadly, I did.

When Obama campaigned he said he would create an independent commission of doctors and medical experts to identify waste, fraud and abuse in the health care system. Yet, MANY doctor groups have felt completely disenfranchised from the discussion. They have gone to Washington, sent letter after letter, and have been ignored.

He also said that his reform would order immediate medical malpractice reform projects that could help doctors focus on putting their patients first, not on practicing defensive medicine. He has not only wavered on that promise, big time, but he has actually attacked doctors by telling people in the public that doctors are removing tonsils strictly for profit, or amputating limbs because they get 35K for that, but only a pittance for managing someone's diabetes (NOT ONLY are his figures grossly inaccurate - or a total lie - but doctors who manage diabetes DO NOT PERFORM amputations, so they would not even be the beneficiaries of the reimbursement for that amputation). We in the health care industry believe that was his way of propelling fear into the American public, making them afraid of their motives and wanting the government to protect them from their greed mongering physicians.

Posted by: Jodigirl | November 20, 2009 2:19 PM | Report abuse


just remember too the lawyers will be able to line up to sue the docs and hospitals and make sure they get their 33.3% Talk about making a bad system, WORSE.

also listening to the blowhard Senator Harkin right now. He just said that "health insurance policies right now have provisions called recision in them that allow them to be cancelled". No they don't. I'd love him to quote the ACTUAL recision clause. My plan in NJ has NO LIFETIME LIMITS.

talk about scare tactics. This time it's not death panels. Its the democrats scaring people. PATHETIC.

Posted by: visionbrkr | November 20, 2009 2:20 PM | Report abuse


Lawyers and doctors provide fundamental services to society.

Society is fortunate that physicians don't assess their patient's future income and slap monetary values on their quality of life and then bill 45% + expenses.

Unfortunately for physicians, lawyers do.

Posted by: Jodigirl | November 20, 2009 2:29 PM | Report abuse


that's a sad reality. I wonder if they'll be taking statistics to see how much comparative effectiveness research affects MedMal lawsuits in the future. I'd expect the advent of "WebMD" had a similar negative impact. I'd expect people showing up in doctor's offices with a printout explaining their condition has to be VERY frustrating for medical providers. I know it annoys me when congresspeople act like they know anything about insurance, risk management, etc.

Posted by: visionbrkr | November 20, 2009 2:34 PM | Report abuse


By the way...The end of life piece in HR 3200 was a really great thing, at least to me and others I know in health care. It's really unfortunate that it has been removed.

This would be another thing to compare with other countries - when we compare how much we spend, etc. How often do their people spend hundreds of thousands of dollars prolonging an inevitable death?

Over my years as a critical care nurse, I have seen people have prolonged deaths in the ICU with expensive life prolonging measures because family members are busy arguing or just can't let go. Living wills can help prevent that from happening. I really do think it could have helped a little for the cost containment part, and even a little helps a lot.

Posted by: Jodigirl | November 20, 2009 2:39 PM | Report abuse


I was just talking about the "WebMD" phenomenon with a friend the other day. It's really amazing. I think it helps create a whole new pool of hypochondriacs (and hypochondriasis is expensive!!).

One of the cardiologists I worked for had received a patient from one of his partners who had retired. The retired guy had patients who had stents place get annual echocardiograms. The dr I worked for thought that was unnecessary and told these people that he would not be ordering those tests for them. Several of them were PEEVED, and made threats, saying he was incompetent. They went elsewhere, I am sure to someone who order their annual echocardiograms for them. The money WILL get spent, in that case. Still, those who stayed with him, if they ever have complications they will blame him for not having an annual echo. They're damned if they, damned if they don't.

Posted by: Jodigirl | November 20, 2009 2:48 PM | Report abuse

What I meant to say was, "had received a patient load from one of his partners who had retired", not just one patient.

Posted by: Jodigirl | November 20, 2009 2:49 PM | Report abuse

yes its a shame that the end of life care took on the "death panel" talk. Another reason I'm not a Palin fan. Although I would also assume most good doctors were speaking with people about it before and will continue to do so. At that point in the person's life (almost death) receiving a stipend from Medicare or an insurer wouldn't change how the doctor handles that either before or now.

Posted by: visionbrkr | November 20, 2009 3:18 PM | Report abuse

I stole this:

"To say that “Republicans in Congress are on record against health care reform” is simply not true. Specifically, Republicans are on record supporting legislation for medical malpractice reform, allow for the purchase of insurance across state lines, expand insurance coverage for small businesses and their employers, and expand tax-free Medical Savings Accounts, among many other common sense reforms. I would also note that under Sen. Reid’s bill, the U.S. Preventative Services Task Force (which recommended against yearly mammograms for women under age 50) would be empowered to decide on the kind of health care coverage that Americans receive. Specifically, Section 2713 of the bill would require every health plan in America to cover, without cost-sharing, prevention services recommended by the Task Force. Section 4105 would authorize the HHS Secretary to modify benefits under Medicare if consistent with Task Force recommendations and deny payment for prevention services the Task Force recommends against. There are at least 12 other similar provisions in the Reid bill which give faceless bureaucrats more influence over health care decisions than doctors and patients, which is one of the main reasons why Republicans oppose the Democrats’ version of health care reform."

Posted by: Jodigirl | November 20, 2009 3:28 PM | Report abuse

Jodigirl, you've confirmed my guess that you don't usually read this blog. Ezra tackled the subject of Obama running on a public option just yesterday:

The fact that you're in the health care industry is an interesting data point. Quite frankly, I hope y'all get rolled in this debate. It's pretty obvious that many people in the health care industry will have a distinct interest in protecting the status quo. And if you don't think doctors do things with a profit motive, I suggest you listen to the recent health care episodes of This American Life.

Posted by: Chris_O | November 20, 2009 3:49 PM | Report abuse

And reading your posts after the one I just responded to, are you SURE you're not a Republican? Allowing insurance to be bought across state lines is a TERRIBLE idea. It would mean that the companies would all congregate in the state (or territory!) with the loosest laws, and use that to be as awful to their customers as possible. It is not a common sense idea, it is a horrific idea.

Posted by: Chris_O | November 20, 2009 3:53 PM | Report abuse


that's not the case but nice talking point.

If every state in the land is required to cover a set benefit level that is agreeable to all then the "North Dakota effect" that many people talk about will absolutely not happen.

Its funny that many liberals originally screamed about wanting to get rid of the anti-trust exemption but then quickly shut up when they realized that this would be an unintended consequence. maybe if they thought things through it would be better for them. The fact that Pelosi, Hoyer et al jumped on that before they realized the consequences is comical.

Posted by: visionbrkr | November 20, 2009 4:34 PM | Report abuse


You do like to flatter yourself, clearly.

Ezra was clever in saying how Obama did talk about the public option, has no real proof of that fact, EXCEPT a few obscurities from the New York Times - a very liberal newspaper!!! That doesn't mean it was a vocal part of his message on health care reform.

I have never said I prefer the status quo either. The notion that people against BAD legislation prefer status quo is RIDICULOUS!!!

AND - ARE YOU BLEEPING SERIOUS ABOUT YOUR REASONS AGAINST ACROSS STATE LINE HEALTH INSURANCE PURCHASING????? THAT'S WHAT COMPETITION IS!!! Companies must provided the best product at the lowest cost, or they go out of business - that's what competition is!!!! If a company cannot compete, by offering competitive policies at competitive prices, they deserve to go out of business!!!!

ABSOLUTELY doctors are out to make a profit - AS WELL THEY SHOULD!!! How long did you go to college, if you went to college? The cardiologists and neurosurgeons I work with spent 15 years in education and training to do what they do (4 yrs college, 4 yrs med school, 3 yrs residency, 4 yrs fellowship, for neurosurgery 7 years residency no fellowship). That puts them into their THIRTIES before they are making good money. Meanwhile, their professional counterparts have been working at their good wage earning jobs for many years, paying off their debt many years more, saving for their kids college many years more, saving for retirement many years more. AND their professional counterparts don't have to face the horrible possibility of getting sued with every decision they make, even if their intentions were good.

I'll tell you what, people like you make me want to become a Republican. I used to contribute to the DNC. I have gotten 3 phone calls from them, the latest was last night. I had told them to take me off their call list, but they didn't. So, last night I said "tell you what, from now, every time you call me I'm donating $20 to the RNC". I HOPE they still call me!!!

Obama is all about redistributing wealth - EXCEPT HIS OWN AND THE LAWYERS AND POLITICIANS HE PALS AROUND WITH!!!!

Posted by: Jodigirl | November 20, 2009 5:34 PM | Report abuse

I don't want to feed the trolls here but the question still is: if the health care bill is so ad, and it is so obvious that it is bad, then why doe Republicans want to prevent it from being debated? Why do they use filibuster and other procedural tricks that almost nobody understands, instead of standing up in the Senate and voicing their well-considered arguments, broadcast live into every American living room? All the propaganda you are sputtering here is completely beside the point. Please be so considerate and spare us your BS.

Oh, and one word about your "raging socialists". Ever heard of a guy named Bismarck, an ultraconservative 19th century German politician? He's the guy who established socialized health insurance, back around 1880. Some socialists.

Posted by: carbonneutral | November 20, 2009 6:18 PM | Report abuse

The fact that you're in the health care industry is an interesting data point. Quite frankly, I hope y'all get rolled in this debate.

Posted by: Chris_O | November 20, 2009 3:49 PM | Report abuse

seriously Chris? She's a critical care nurse. Do you STILL want to get her "rolled" in this debate? I sure hope you don't end up in her hospital on the wrong day. How about Dr Sanjay Gupta on CNN? Should we "roll him too".

Exactly what is it YOU DO?

Seriously though Jodi, stop watching Glenn Beck, lol!


two potential reasons:

1-Republicans are stupid

2-they know if you LET a public option in then it can be transformed later to whatever liberals want it to be. People scream all day long on here how great medicare is for seniors and it is. its "too good" a deal. Then we get back to the transfer of cost from public to private etc. I'm fine with keeping medicare just so long as we move from the current FFS system.

Posted by: visionbrkr | November 20, 2009 6:36 PM | Report abuse


I am so not into Glenn Beck!! I used to watch Rachel Maddow and Keith Olbermann, but can't stomach them right now either (though I will always love Rachel - not in the girlfriend sort of way though, not that there's anything wrong with that, LOL).

I am going with your 1. Republicans are stupid. AND 2. transforming of the public option is bad (even if it doesn't transform, it's a bad idea, in my opinion).

Posted by: Jodigirl | November 20, 2009 6:49 PM | Report abuse

Also - Thanks for the attempts to get my back, visionbrkr. Chris has been antagonistic from the beginning, with his first comment including an accusation that I was lying about my independent political status. Admittedly, I can be heated and overly impassioned, for sure. So, thanks.

carbonneutral - I have heard a lot of Republicans standing up in the Senate and voicing their opinions. You can watch them on youtube, in fact - try Mike Rogers for example.

In fact, if you watch Sunday morning political shows like Meet the Press, This Week, Face the Nation, etc., you will catch Republicans giving their ideas. Or, you can read their bill, HR 3400 (co-sponsored by three of Georgia’s doctors in the House of Representatives).

Just so everybody knows...I'm not saying I'm a Republican, for pete's sake. I am just rallying for the lesser of two evils here. If we can't have good reform, at least we can try and avoid horrible reform.

Posted by: Jodigirl | November 20, 2009 7:29 PM | Report abuse

Excuse me, Mike is a rep. Try Olympia Snowe or Susan Collins for Republicans well voice in their reasons against the public option.

Posted by: Jodigirl | November 20, 2009 7:31 PM | Report abuse


haha that's fine. Usually i get the liberal wrath as the insurance "shill" as i'm called around here. Its funny though because if i was this shill then why am I always screaming about cost control that actually reduces my income (ie higher premiums translate to higher commissions). I've also advocated that insurance agents like myself and all others should be paid on a flat fee basis as opposed to a percentage. There's way too many idiots in my business (as in most businesses) and that doesn't help to get them out. You couldn't imagine how many 70-80 year olds hold onto their license for a check monthly and sometimes a very substantial one.

I will say though that Republicans should have done something about this long ago. This isn't a problem that just came up on them. 5-10 years ago agents like myself and the group I belong to (NAHU) have been screaming for reform of the system as unsustainable and now its come true.

Posted by: visionbrkr | November 20, 2009 11:48 PM | Report abuse


Yes, it is maddening that the Republicans ignored many of the things they ignored, while also spending like drunken sailors. I hated the 8 years with Bush, and I thought it would be better with Obama. But I don't like this administration either.

The problem is, the system is not becoming cost controlled or more sustainable through this reform, it is just becoming more difficult to access, in my opinion. An unacceptably high number of people will continue to be obese, or consume alcohol, tobacco, illicit drugs, child abuse rates, etc., etc. - particularly compared with the countries everyone likes to compare our health system with. The chronic and acute illnesses from those behaviors will still need to be treated over and over and over again. But, now people just won't be able to get treatment because even fewer providers will accept Medicare/Medicaid or other public insurance, premiums for private insurers will rise and/or reduce benefits and even more claims arbitrarily denied, drugs and devices will get more expensive to offset their excise taxes - and inevitably - everybody's taxes will go up in the long run. Patients still won't feel the relationship between their own health and the costs for the amount of health care they consume. Doctors will still be practicing defensive medicine - and be at even greater risk of errors because of greater work-loads amidst a shortage. And, the worst part, we are going to make a doctor shortage even worse. There is a lot I like about the Democrats plans, but some BIG things I don't like, and some BIG and important things missing. All in all, I think their plan just makes things worse, not cheaper, and not better. That's how I see it, basically.

But, the thing that makes me the most angry. I grew up in Michigan and have two unemployed siblings. Yet, this federal government seems to be spending more time focusing on the uninsured than the unemployed. My siblings don't care about focusing on the economic benefits of health care reform that come years from now, they care about the economy and their ability to get a job NOW.

Posted by: Jodigirl | November 21, 2009 9:03 AM | Report abuse

"I have heard a lot of Republicans standing up in the Senate and voicing their opinions."

Then why are they voting against having a debate in the Senate?

"The problem is, the system is not becoming cost controlled or more sustainable through this reform, it is just becoming more difficult to access, in my opinion."

Seriously, jodigirl, you are living on planet Republica. You are sputtering outlandish propaganda like there is no tomorrow, and probably you are of the sort that would be happy if there were actually no tomorrow. If you had any clue what you were talking about, you'd be aware of how "accessible" the health care system now is for tens of millions of people: namely, zero accessible. Probably you do know this but you don't have the honesty to talk about it. You are one disgusting liar.

Posted by: carbonneutral | November 21, 2009 3:14 PM | Report abuse


I am well aware of the millions of people who need access to the health care system. I am a big advocate of correcting that problem. I have never said otherwise. Moreover, as a critical care nurse, I have participated in the critical care treatment of many people without coverage, as well as illegal aliens. It IS a problem. I have never said it wasn't. Those in the health care system have a lot of ideas about how to reduce costs while protecting access and doctor-patient relationships. Many of those ideas are represented in the current legislation.

It's very sad when someone's opinion is met with such verbal assaults. I do prefer venues that include addressing differing opinions with class and decorum. However, I also know that not everybody can rise-up to that. Very sad.

We'll see who's right in the future - if the current legislation plans become law.

I'm not a Republican and I don't know why they are voting against debate. I assume because they believe it's a bad bill altogether, and rather than voting for it before they vote against, they're voting the way they feel up front. Perhaps you could ask them?

Posted by: Jodigirl | November 21, 2009 5:29 PM | Report abuse


really republican points? Was it a republican point when the administration made a deal with pharma and PRIOR to that deal pharma jacked up rates as they've done every time reform happens (or should i say tries to happen). I'll bet Pharma wants it to be tried again next year.

How about when they backed off the MLR figures. Dems have no spine and this reform will cost us all more and it will cost them their majorities.

What they're doing is taxing the middle class to give money to the poor. The middle class votes. The poor do not. Its a noble effort but they should have required more cost controls instead of stupid pet projects that are doomed to be gamed by everyone. Idiots, one and all.

Posted by: visionbrkr | November 21, 2009 5:34 PM | Report abuse


Just so you know, it is because of verbal attacks from people like you that make it impossible for independently minded people to find either party palatable. Both parties are riddled with people who attack anybody who happens to disagree with any of their positions. Both parties are riddled with people who are irrational and unreasonable, and prefer to verbally assault and flog any opposing opinions, rather than discuss rationally and learn from each other. The words Democrat and Republican have both become derogatory terms. The words Democrat and Republican have become nothing more than euphemisms for the word "radical", as far I am concerned.

I received the same verbal abuse from the right last year when I was strongly against Sarah Palin. I was accused of being a sexist, etc. And in 2003, when I had a visceral response to the SAME URGENCY about rushing into a horrifying war, I got flogged then too. The exact same "MUST do this HUGE, GIANT, POTENTIALLY VERY DANGEROUS THING RIGHT AWAY", with health care reform is no different than Dubya's rush, rush, rush DON'T STOP AND THINK assault on Baghdad....And let's look at how much that COST us all, and how horrible, horrible, horrible of a decision it was. Both parties are filled with lemmings, willing to follow their liberal or conservative leaders over cliffs. I am sick and tired of being assaulted by one or the other side, whenever I disagree with them.

Posted by: Jodigirl | November 21, 2009 9:37 PM | Report abuse

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