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The Senate begins to pass health-care reform


On Monday morning, at 1:17 a.m., the Senate voted to break the filibuster on the manager's amendment to the health-care reform bill. This wasn't the final vote on the bill. It wasn't even the final vote on the manager's amendment. But then, the question is no longer whether the Senate can vote to pass something. It's whether the Senate can vote to vote on something.

There were no surprises in the roll call. Democrats got to 60 by combining the 58 members of their party with Joe Lieberman and Bernie Sanders, the two independents who caucus with the Democratic Party. Olympia Snowe and Susan Collins, the Republican moderates most likely to join voices with the Democrats, voted against ending the filibuster on a bill that both had enormous influence in shaping.

Surprisingly, the Senator who did the most to emphasize the absurdity of the situation was Mitch McConnell, the Republican minority leader. He recalled the votes on Social Security and Medicare, both of which passed with substantial Republican support. Social Security and Medicare, of course, were government-run programs paid for by straight tax increases. They were far more offensive to conservatives than the current legislation, which funds a mostly-private sector health-care expansion by trimming the budget of Medicare, America's largest single-payer health-care system.

Even as the bills Democrats pursue have become more moderate, the roll calls have become more partisan. Medicare could not be passed today because there would be no Republican votes, and too few Democratic votes. Social Security would be similarly hapless. Medicare buy-in, in fact, almost sunk this bill. Tonight's vote was a moment of enormous progress for social justice, but evidence of enormous regression in our political system.

Photo credit: AP Photo/Haraz N. Ghanbari.

By Ezra Klein  |  December 21, 2009; 1:12 AM ET
Categories:  Health Reform  
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Next: Remembering Obama's campaign health-care plan


i think your last paragraph misreads the historic evolution.

the reason there were republican votes for medicare 45 years ago is because the republican party was much broader ideologically 45 years ago (as, for that matter, was the democratic party). with the post-civil rights legislation reshaping of the parties on ideological lines, and with senate rules as they are, what you see is what you get. it's only a "regression" insofar as you think the parties should be less ideological as a matter of course.

i, for one, don't: i think the filibuster should go away instead and i'll live with a very stark ideological divide.

Posted by: howard16 | December 21, 2009 2:21 AM | Report abuse

Ezra, I think you accidentally italicized your blog :)

Posted by: rmrice1 | December 21, 2009 2:40 AM | Report abuse

"Even as the bills Democrats pursue have become more moderate"
This copy of Romneycare, moderate??? This is a conservative bill! And if the GOP hadn't moved to the far right, they would support it.

Posted by: Gray62 | December 21, 2009 3:16 AM | Report abuse

testitalics gone?

Posted by: Gray62 | December 21, 2009 3:17 AM | Report abuse

It has always been about costs. Debt for social programs was not as big an issue in the past. When Social security passed, US life expectancy was below retirement age. You worked until you died. Workers paying for retirees was a feasible plan. See, .

Medicare started as universal health, but became a senior health plan to pass and life expectancy was about 6-7 years less than now and doctor and hospital usage was much lower. The 65 year olds at that time were before baby boomer retirees' bulge and before the retirees of US population growth of the immigration influx of early 1900s and there was the belief the Medicare tax would pay for it.

Finding the money for social programs is much more difficult now. We have expanded the numbers and percentage of the population we include and are much less willing to tax those workers who will benefit as we did with social security and Medicare.

Now we want to tax the rich to pay for an ever-expanding list of needs of the rest of the population.

Every economist recommended eliminating the employer deduction for worker health benefits. The new tax receipts would have funded the entire plan. President Obama took off the table the ability to do the most economically sensible thing to reform health care. Obama also committed to not taxing the middle class, eliminating the ability of Congress to tax those who would benefit, such as taxing workers before they lost their health insurance to unemployment and middle class individuals before they got pre-existing conditions.

Much of the Congressional health care spectacle is because Obama tied the hands of Democrats and prevented them from doing the most sensible things to achieve their goal of universal health care. Obama turned it into class warfare and a conservative versus liberal war through the removal of many of the best options for independent, conservative and republican agreement with the plan.

In doing so, Obama's initial actions resulted in many bad compromises and provisions in the final reform that would not have been there otherwise. Obama will get credit for passing health reform, but he should also take the credit for being the cause of many of the bad provisions in it.

Posted by: MiltonRecht | December 21, 2009 3:56 AM | Report abuse

Very well written Ezra, especially the end. Consider this; the reason why the partisanship exists today has to do with a breakdown in the dissemination of information to the electorate. Ever since we lost the fairness doctrine, its like we have two versions of reality!The right's truth and the left's truth. Nothing is in place to hold anyone accountable, the fairness doctrine required broadcasters to show all perspectives, so voters were better informed about issues than they are today. With talk radio on the right, and internet blogs on the left this intense partisanship is very well instigated. Its quite sad, how can this be fixed?

Posted by: martiask | December 21, 2009 3:59 AM | Report abuse

The CBO has said this bill will reduce gvmt spending and advance the cause of health reform in America.

Is it a perfect bill? No.

Is it a bill that will help most Americans? Clearly yes.

Is it a bill reasonable Republicans should support? Again, yes.

And that is why all Republicans should be voted out of office. Not one of them supported this bill. They have used every dirty trick and lie in the book to hurt the American people by trying to kill health care reform in its tracks, though a malfunctioning health system is a clear and present danger to the financial and physical health of most Americans as well as our entire budget.

Posted by: Lomillialor | December 21, 2009 8:05 AM | Report abuse

This legislation is going to hurt the hard working tax payers in the State of Illinois when we have to raise state taxes to pay for the mandates relating to Medicaid.

Senators Durbin and Burris should of obtained the same breaks that Nebraska and Louisiana are going to receive in exchange for their support.

Posted by: mwhoke | December 21, 2009 8:41 AM | Report abuse

Milton Recht: I am sorry but you are living in a fantasy land if you think *any* Republicans would have supported a health care bill if only Obama would have added eliminating the employer deduction. Republicans were simply not willing to compromise and have at every step of this process shown they were only interested in obstruction. If Republicans wanted a more conservative bill they could have gotten it.

Posted by: Safron | December 21, 2009 8:41 AM | Report abuse

Republicans have shown again and again that they only type of handouts they like are to military contractors, big business, themselves and their families. When it comes to helping poor people, working people or sick people, they become fiscally conservative all of a sudden.

Posted by: LiberalForReal | December 21, 2009 9:19 AM | Report abuse

IMO the far right senses they are becoming passe and are acting desperately. By definition, the universe is progressive. Some conservatism in human conduct is required because as sentient beings, we can and do act beyond the normal progression of things and as such may take a dangerous or unsustainable path. So conservatism is not an active function but simply a brake on progress. When this is your creed and the world is losing its need for your brand, your reaction is retrenchment, purging-of-the-ranks, strict idealism. Look at our earliest conservatives, Hamilton and his ilk. Their plan was to conserve the idea of royalty. They are long dead and gone. So my point is that this current conservatism will die or morph because their ideas are too incorrect to survive. The upshot may be civil war or a viable 3rd party but eventually these stuffed shirts will be shelved.

Posted by: BertEisenstein | December 21, 2009 9:29 AM | Report abuse

woo hoo! you should see how the insurance companies are up in the market this morning! wow! And I have some, knowing as an investor that this bill would shovel huge amounts of workers' dollars into the pockets of big insurance. yes, "social justice" works that way. It always enriches some at the expense of many.

Posted by: truck1 | December 21, 2009 9:40 AM | Report abuse

Wellpoint, united healthcare, medco health, all continue up on high volume. Investors know where the money is going! your money, extracted on the pious claims of "social justice" made by kids who do not know what those two words were used for in the past.

Posted by: truck1 | December 21, 2009 10:33 AM | Report abuse

I think one reason for the partisan vote is that Republicans, once the party of ideas, no longer have serious proposals to deal with the problems of the day. One can't have a real debate with those who don't offer any alternatives. And since they don't offer any serious alternatives, their strategy is reduced to blocking anything the other side offers.

I think Jonathan Chait's article in The New Republic is pretty good on the subject. What was the Republican proposal to deal with the financial crisis? Many would have let the banks fail even though they never really made the argument that we'd be better off that way. On climate change, many of those that believe the science think we can't do anything about it, so we may as well capitulate or engage in speculative geo-engineering projects, but there are precious few pushing for reducing emissions. And on health care, there is no stomach for the risk-spreading that is necessary to keep premiums affordable for all.

As the party has shrunk, it is increasingly dominated by those who believe in principles regardless of their actual effects in the world. "Markets" must prevail even in the face of an economic disaster. "Liberty" must prevail even if people die because they can't get health insurance. If ideology conflicts with reality, reality must be, somehow, wrong. It's very hard to get votes from a group like this, especially when they perceive any success by the opposition as antithetical to their own political interests.

Posted by: dasimon | December 21, 2009 11:18 AM | Report abuse

"Even as the bills Democrats pursue have become more moderate, the roll calls have become more partisan. Medicare could not be passed today because there would be no Republican votes, and too few Democratic votes. Social Security would be similarly hapless."

"Too few Democratic votes" seems less partisan, not more.

Basically, we've been screwed by politicians willing to promise our money to others to get elected and re-elected too many times. I have never voted anything but Democrat, but the absolute forced economic naivete of many liberals, or perhaps it simply the hubris to think they can control human incentives, makes it quite embarrassing.

Posted by: staticvars | December 21, 2009 11:19 AM | Report abuse

"When Social security passed, US life expectancy was below retirement age. You worked until you died."

This is completely untrue. The designers of social security were not mentally impaired. They could read a life table. And they knew full well that while life expectancy at birth might be low because lots of BABIES died, if you were a white person who lived to be 45, you were expected to live to 71 (and remember, social security was designed so only white people could use it).

They fully expected millions of people to use social security, even if there were no improvements in lifespan.

"Finding the money for social programs is much more difficult now."

No, it's not. We are a spectacularly wealthy nation compared to 1935 or 1965. Our national productivity is orders of magnitude higher. And we've spent the better part of 20 years sending all the GDP gains from productivity to the top 1% of earners. We could easily redirect a huge share of that money to social programs, and 99% of people would not notice.

Now, we CHOOSE not to. But that's not because the money is particularly hard to find. We're a much, much wealthier nation--in absolute terms, in relative terms, in efficiency, any way you want to cut it--than we were in 1930. And we know where the gains of the past 30 years have all gone.

Posted by: theorajones1 | December 21, 2009 11:23 AM | Report abuse

staticvars: "the absolute forced economic naivete of many liberals, or perhaps it simply the hubris to think they can control human incentives, makes it quite embarrassing."

I don't think there's economic naivete on the part of most liberals, or at least no more naivete that there is among conservatives.

I think it's pretty well established that to keep health insurance premiums available to all, everyone has to participate. And that means the young subsidize the old, and the rich subsidize the poor. It's my understanding that that's how just about all our peer countries do it. And it seems to work: they spend far less GNP on health care than we do, cover everyone, and get as good results.

So I don't think its naivete; I think it's reality.

As far as overall fiscal responsibility goes, neither party has been a paragon of virtue. But that's partly our own fault. When we stop demanding free lunches, then both parties will stop offering them to us.

Posted by: dasimon | December 21, 2009 12:22 PM | Report abuse

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