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Winning ugly, but winning


On Dec. 24, in an early morning vote, the United States Senate passed health-care reform. It was the first time the body had been in session on Christmas Eve since 1963. That's fitting, as it's arguably the most important piece of legislation the body has passed since 1963.

H.R. 3590, the Patient Protection and Affordable Care Act, passed with 60 votes, and though that sounds a razor-thin margin given the odd rules of the Senate, it is a landslide in the more normal context for major choices in American politics. The last time a president won with 60 percent of the vote, for instance, was when Lyndon Johnson trounced Barry Goldwater in 1964 [Correction: Nixon hit 60 percent in his reelection.]. Health-care reform passed the House with only 50.5 percent of the body voting for it. And the senators making up this morning's 60 votes actually represent closer to 65 percent of the population. Harry Reid has much to be proud of today.

For all the historic force of the vote -- Ted Kennedy's widow, Vicki Kennedy, was in the chamber, as was the elderly John Dingell Jr., whose father introduced the first national health-care plan into the Congress almost a century ago -- it has become difficult to write these milestone posts. Health-care reform, by this point, has had a lot of milestones. It has cleared five committees. It has come through the House of Representatives. It has been merged into a single bill in the Senate. It has passed through the Senate. No previous health-care reform bill has come anywhere near this far. But there are more milestones left to achieve: The House and Senate need to agree on a bill. That bill has to pass both chambers again. And then the president has to sign the legislation.

Passing legislation, it turns out, is a long and ugly process. God, is it ugly. The compromises, both with powerful special interests and decisive senators. The trimming of ambitions and the budget gimmicks and the worship of Congressional Budget Office scores. By the end, you're passing a compromise of a deal of a negotiation of a concession.

But bad a system as it might be, it's the only one we've got. At least for now, this is what victory looks like. The slow, grinding, ineluctable advance of legislation that is quite similar, albeit not identical, to what you began with. It's not pretty, and it doesn't necessarily feel like winning is supposed to feel. But this bill will do most of the things supporters hoped it would do: cover about 95 percent of all legal residents, regulate insurers, set up competitive exchanges, pretty much end risk selection, institute a universal structure that we can improve and enhance as the years go on, and vastly reduce both medical and financial risk for families.

It's been a long time since the legislative system did anything this big, and people have forgotten how awful the victories are. But these are the victories, and if they feel bad to many, they will do good for more. As that comes clearer and clearer, this bill will come to feel more and more like the historic advance it actually is.

Photo credit: By Manuel Balce Ceneta/Associated Press

By Ezra Klein  |  December 24, 2009; 7:50 AM ET
Categories:  Health Reform  
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Next: Vacation's all I ever wanted


If that's winning, I'd hate to see losing. Obama and his campaign are just one big lie: DADT, EFCA, universal health care, public option, mandates, torture, winding down the wars, renegotiating NAFTA, holding fat cats accountable. What did I miss? Obama and the Democrats are the fat cats that need to be held accountable. It is time to throw all of the bums out.

Posted by: dkoakland | December 24, 2009 8:10 AM | Report abuse

Well said.

Watching sausage made is really tough. From killing the pig to grinding the meat to forming the sausage. It creates rifts, anger, disappointment, sadness, etc. But in the end it will taste good to the 30 million Americans who finally have health care and the millions more who will find health care more affordable.

Posted by: maritza1 | December 24, 2009 8:11 AM | Report abuse

Thank you to Ezra for providing cogent, well-argued points for passing this bill (flawed as it might be) in the face of the histrionics from the right and left. Happy holidays to all!

Posted by: eeandoh | December 24, 2009 8:20 AM | Report abuse

It's telling that the guy to whom the sausage-making quote is attributed is also the guy who came up with the idea of social insurance in the first place. And if Otto von-freaking Bismarck thought dealing with the legislature was tough, it's no wonder that Barack Obama (whose name will someday adorn a navy ship and countless elementary schools, among many other things) had such a hard slog.

Posted by: geoffcgraham | December 24, 2009 8:27 AM | Report abuse


bless you for your tireless work over these months.
despite the myriad opportunities to become choleric, and confuse yourself with the story, as each day held more drama, you kept shedding steadfast and bright light, illuminating the way through the forest.
obama has endured much criticism, but hopefully, at the end of the day, this will be passed.
birthing anything is never easy, and no human being is perfect...but this will be a marvelous accomplishment that will help so many people.
over time, people will come to see that....and history will give president obama much credit for his courage and energy, and allow him his frailties.
thank you, ezra, for casting a bright light.

merry, blessed christmas!

Posted by: jkaren | December 24, 2009 8:45 AM | Report abuse

thanks for all the great reporting and analysis. I have one question I never see answered which is, Who are the 5% or the 20 million who will remain uninsured?

Posted by: laurie21 | December 24, 2009 9:02 AM | Report abuse

Yes, who are the 20 million that will be left uninsured after the economy and the healthcare system is destroyed?

Posted by: WrongfulDeath | December 24, 2009 9:03 AM | Report abuse

Well articulated Ezra. To put this in perspective. I administer a health coverage access program in Western, Massachusetts. Before our landmark health reform law in MA (on which the national law is modeled), for every 100 uninsured indivuduals we interviewed, we got 60 in Medicaid, but 40 remained uninsured. Since 2006 after health reform was implemented, for every 100 individuals we assist, we enroll 96 into Medicaid or Commonwealth Care, the Massachusetts subsidized program created by by the law. These are waiters, waitresses, workers for small businesses, and others not able to access employer-sponsored coverage. Don't tell me this isn't a big deal.

Posted by: chipjh | December 24, 2009 9:09 AM | Report abuse


Since we must now start thinking of ways to fix it, what about fixing the FPL? Make it more realistic. As it is now someone in South Carolina can live decent at 150% of the FPL, but try that in NY City and you won't survive.

It seems like fixing the FPL as a way to make health care more affordable to more people would be a great way to go. It's also a perfect item to be fixed under reconciliation and one I don't think the Republicans would dare let expire later.

Posted by: intoxination | December 24, 2009 9:17 AM | Report abuse

Thanks to you, Ezra, for helping us sort out the details throughout the process. With so much anger and misinformation in the blogs and media, it was refreshing to have you as a voice of reason in this process. Kudos to you, my friend.

Posted by: LiberalForReal | December 24, 2009 9:18 AM | Report abuse

While I'm deeply unhappy about the compromises and buy-offs, I'm thrilled our team finally passed something, although one really has to blame the administration and the Democratic leadership for wasting political capital and months of more favorable polling in the hopes of securing Olympia "History calls and I must answer" Snowe's nonexistent vote and a favorable column from David Broder. (Predictably, in his latest the Dean excoriates Democrats for not doing more to win over those moderate Republicans).

Sure, Ezra, the system is deeply flawed -- but the Democrats' flaccid political strategy that unfolded since July deserves equal blame, perhaps more so. And my gut tells me more Stupak-like mischief will come into play as the two chambers try to merge their legislation. This ain't over.

Posted by: scarlota | December 24, 2009 9:19 AM | Report abuse

Time for the super-informative, super-nice Mr. Klein to finally take a break.

On the other hand, I assume there'll be no break at all for the Members of Congress assigned to develop a final bill. Or their staffers, or the staff at Congressional support organizations.

Posted by: DaveoftheCoonties | December 24, 2009 9:56 AM | Report abuse

"It's been a long time since the legislative system did anything this big,"

Pardon? Have you forgotten Medicare Part D, which was nearly as big in dollar terms (although that was only found out after the bill passed), and MUCH larger in terms of deficit impact since it had no provisions for financing whatsoever?

"and people have forgotten how awful the victories are."

This I will give you, although a few of us remember with some horror the shenanigans during the Part D vote.

Posted by: KenInIL | December 24, 2009 10:22 AM | Report abuse

Quick calculations based on latest Census estimates: Senators voting for the Senate bill represent 65% of the US population. Senators voting against represent 35%. When the Senators split, I assigned half the population to Yes and half to No. Only 12 States' Senators split their votes, which means 38 States either are only GOP or only Democratic.

Posted by: steveh46 | December 24, 2009 10:22 AM | Report abuse

Thank you Ezra Klein for the factual information. If only we can get people to look at the facts and leave their emotions at the door on this issue. But alas that is asking too much. No matter what political fallout comes from this vote (I believe the Republicans will ultimately be the losers) this bill is needed and we will look back on this vote as a historic moment.

Posted by: rubes21 | December 24, 2009 10:27 AM | Report abuse

Of course a Bolshevik like Klein would support this mess. Thats how they destroyed Eastern Europe and Russia.

Posted by: dencal26 | December 24, 2009 10:40 AM | Report abuse

This is what happens when political ideology is placed over common sense. Wait until average Americans find out their health insurance will cost more. Dems will lose elections for decades

Posted by: dencal26 | December 24, 2009 10:42 AM | Report abuse

And now Obama says it is time for him to "start work?"

Dencal26 needs some thorazine. I hope that's covered.

Posted by: pj_camp | December 24, 2009 10:57 AM | Report abuse

Here's hoping that dencal26 gets some anti-dunce medicine for Christmas.

Still, I'm not sure why one should celebrate that the institutions of American governance have been so hobbled by corporate power and institutional sclerosis to make a turd-sandwich of a bill "historic".

Posted by: pseudonymousinnc | December 24, 2009 11:18 AM | Report abuse

"most important since 1963". I think you're suffering battle fatigue and need a good rest. This is important, but in 46 years there have been lots of more important laws, not bills, passed.

Posted by: bharshaw | December 24, 2009 11:24 AM | Report abuse

@dkoakland: "If that's winning, I'd hate to see losing."

You'd hate to see losing? Look in the mirror. You've seen nothing but losing your entire political life. And you'll accept nothing but.

When Obama overturns DADT, when Obama completes the closing of Gitmo, when Obama winds down the wars in Iraq and Afghanistan, you will gnash your teeth & wail to the heavens, just as you did when Obama ended torture & illegal rendition on his first full day in office.

Progress is never good enough for political saints like you. Progress is your enemy. The instant you acknowledge that progress has been made, your reason for existing vanishes.

You are willing to sacrifice the health & well-being of 31 million men, women, and children at the altar of your alleged principles.

You & your ilk -- the Hamshers, the Naders, the Kuciniches -- are a disgrace.

Posted by: AgnesBee | December 24, 2009 11:42 AM | Report abuse

This is not winning. Its another example of the American people losing. Hopefully this farce will not become law. Unbelievable that people believe the only solution to anything is to tax it. Unbelievable.

And for those who do not think they have a Cadillac health plan subject to the 40 percent excise tax, surprise. Although valued at $23,000, that is based on 2013 valuation. This year BCBS Standard is over $18,500 a year. Not counting your FSAFEDS, you are fast approaching excise tax status. And you know what else, you have not been paying tax on that health care coverage either. In addition to the excise tax, you now will be taxed on the premium value of that coverage. That's how this BILL saves America $100 billion in 10 years. It TAKES it from you!

Posted by: WmJLePetomane | December 24, 2009 11:45 AM | Report abuse

bharshaw is on the right track at 11:24: in particular, the two most important pieces of legislation since 1963 are the Civil Rights Act (1964) and the Voting Rights Act (1965), which were, between them, transformative in that they ended legal apartheid in america.

which is not to say this isn't huge today, but not as huge as that: it's hugely important that everyone have access to health care, but even more important that we not carry out apartheid in this country.

Posted by: howard16 | December 24, 2009 11:54 AM | Report abuse

hey, WmJLePetomane: taxes were higher in the '90s than they are now. tell me all the ways that america is better off as a result: i'd love to hear them. it'll come as a huge surprise to everyone but the upper .1% of households by income, but maybe they're the only households you care about?

Posted by: howard16 | December 24, 2009 11:56 AM | Report abuse

This legislation like the last two elections were won by the democrats fair and square unlike the stolen election of 2000, and his bought election during which Bush and the GOP started this country's downward slide to the brink of depression. If you remember correctly Bush et al started a war based on lies that killed over 4,000 our military not to mention the innocent Iraqis killed or displaced many more by the war we started then by the man we were SUPPOSEDLY saving them from. This health care legislation isn't perfect but damn it it's better than anything the Republicans have bothered to do. Oh they gave nice big fat TAX CUTS to the VERY RICH thereby keeping themselves as rich as ever while everything else in this country from medical care to my rent went up exponentially. I'm really tired of the sore LOSER GOP acting hurt like little children. To hell with them and up with the American people. Bush and the republicans created a hell of a mess in 8 years and less than a year Obama has been able to start reversing and cleaning up after the previous. This is nothing more than treating the GOP the way they treated us for the 8 years they were in power, and the used far worse underhanded tactics to get their way and ignore those of us who weren't part of their blessed minority. Really the GOP should go back to their girlfriends, men's room stalls, congressional pages and do something about remedying their hypocrisy before opening their pie holes again and again with nothing but hot air.

Posted by: davidbronx | December 24, 2009 11:59 AM | Report abuse

I'm far from a Joe Lieberman fan, but we need to step back and reevaluate our view of him. Leave aside the day to day machinations and look at the bottom line. Lieberman was the 59th vote and he decided, for whatever reason, that he didn't want the public option or Medicare buy-in. So to win that 59th vote, it's out. Nelson was the 60th vote, and he wanted abortion language and help for Nebraska. They're in, and the bill passes.

Note what Lieberman *didn't* do: continue to find ways to sabotage the bill. Once his concerns were met, he supported it. Now should he have supported the public option and/or Medicare buy-in? Maybe, given what he said before, but he's a Senator and, like the other 99, can decide to support what he wants. He's not sabotaging anything just because he said something else a few months ago. Maybe he surprised everyone with an apparent turn, but that's politics.

Lieberman wound up being part of the greatest advance in social legislation in decades. He could have brought it crashing down. But, having been given what he demanded, he didn't.

So in the end, he's *not* causing or helping bring about the deaths of tens of thousands of people. He voted for a good, if not perfect, bill. As much as I hated the nefarious way he played it, in the end he did the right thing. I called him a moral sleaze bag before; I don't love him now, but I retract that. And I'm left wondering what motivates folks like Olympia Snowe who in the end couldn't bring herself to stand up for people in need of medical help, like her family was when she was young, and offers the most inane reasons why she voted no. What a shame for her and the voters of Maine and what a lost opportunity.

Posted by: robbins2 | December 24, 2009 12:03 PM | Report abuse

EK, as Glenn Greenwald pointed out today, has become quite the apologist for a shameful piece of legislation over the last couple of months.

Posted by: boxwell02 | December 24, 2009 12:08 PM | Report abuse

Has there been a time in the last few decades when Republicans were less powerful than they are now? No?

No, they are fast becoming irrelevant. They have learned nothing from what the Karl Rove, Limbaugh axis of evil has done to them. Is there a Republican moderate in the House? Nope. There are some moderate Republican Governors left, but they are under fire from their own side and are a threatened species.

You can not win elections by making the fringe happy, everyone knows that. It is a political fact of life that will never change. The moderate center's control of politics is what has kept America the stablest government in the history of the Western World.

So go ahead Republicans, keep fanning the flames on the radical right, see where it gets you.

Posted by: shrink2 | December 24, 2009 12:23 PM | Report abuse

Thank you Ezra for this incredible and pioneering work:
- wonkery on a specialized legislative topic in a national newspaper with lot of impact on how that sausage making happens;
- to make that wonkery even sexy; and
- most important not to be dogmatic and be ready to change and adopt as things evolve so as the end is achieved in respectable way.

Not just Harry Reid, you and many other folks in Media who relentlessly followed up this legislation need to be proud of.

Now we return to our regular programming:
- Since 1963 this is the most consequential bill in Senate? May be. But what about 'war resolutions'? Those are even more consequential. That ill fated Iraq War Resolution in Senate passed by 77-23 votes (better than this 60-39) eventually was instrumental in the down fall of America in early part of 21st century. America landed up losing 5K American lives, 100K Iraqi lives, Trillion dollars, lost the leverage in world affairs, lost the 'ball' in global leadership (Economic leadership) and most important got a vicious political environment along with missing a chance to correct the course in 2004. Talk about what was more consequential.
- Legislative victory? I am not sure whether you look at law making in that sense. In Politics, the only true victories are at hustings, in elections. Everything else is what Politics is all about - solving people's problems. So instead of a victory, we may want to look at this passing of a bill as a step near to solve few of our problems in some manner.
- Finally, another reasonable way to look at this bill: it is the first of series of steps to get our health care act together; considering especially weaker cost controls in this bill which will need for sure substantial changes going forward.

Posted by: umesh409 | December 24, 2009 12:25 PM | Report abuse

The bitter comments here and the lock-step negative votes of self-serving GOP obstructionists in the Senate & House reflect the losing side of history. America is steadily becoming more multicultural, and we can no longer afford a dominating class with the short-sighted, unpatriotic philosophy of "I've got mine, so every man for himself." Flawed though it may be, this legislation is stumbling in the right direction.

Posted by: merelymyopinion | December 24, 2009 12:25 PM | Report abuse

Now if they can just pass a law that requires the homeless to buy a house and
the unemployed to get a job, all will be well.

Posted by: SarahBB | December 24, 2009 12:27 PM | Report abuse

With the Gridlock Obstructionist Party operating at full steam, ugly is the only way that anything can be accomplished.

Posted by: twm1 | December 24, 2009 12:27 PM | Report abuse

boxwell02, if that's really what greenwald has been saying lately, then it's no wonder i haven't read him in a while. what a steaming pile of crap accusation that is: greenwald should be embarassed if that's really what he's saying right now.

i've been a lefty since i was a teenager, 40 years ago, and there are no self-righteous purists in the world like lefty self-righteous purists. ask greenwald if he would have voted for social security when it was established, wouldya?

Posted by: howard16 | December 24, 2009 12:27 PM | Report abuse

I sure hope the Bayh/Wyden employer opt out option gets into the bill at reconciliation.

Obama called it "too radical" because the unions hate it, but that just illustrates what a good idea it is. Letting employees get into the insurance exchanges with a voucher could become a powerful cost control driver (depending, of course, on the details of the rules).

Posted by: shrink2 | December 24, 2009 12:36 PM | Report abuse

Let me add yet another thank you for the months of consistently helpful, even-toned reportage and blogging on this subject, and for bringing us the views of the wonks behind the wonkery. It's been like a crash course in health economics for me: not always what I've wanted to spend my time reading, but necessary for me to become informed on the issues.

It's been a long, painful trek (with the last leg still to go), and I'm dreading what comes next: forced daily lessons on carbon policy. So rest up for that one. In the meantime, I'm going to make a martini and ignore the machinations of Washington for a day or two. Hope you can, too.

Posted by: JJenkins2 | December 24, 2009 12:47 PM | Report abuse

Wow. The Atul Gawande piece in the New Yorker (Think Tank #3) is the most affirmative thing I have read about this legislation in a long time. But feel free to skip the absurdly long history of the American agricultural revolution, it may or may not be relevant and it doesn't even matter.

His point is simple. The bill can't contain robust cost control measures because today, we do not know what that would mean. We do not know how to control costs while preserving good access and good outcomes.
He thinks we will figure it out as a developmental process that starts with universal access and a lot of experimentation. Hope he is correct!

Posted by: shrink2 | December 24, 2009 12:51 PM | Report abuse

Unemployment down.
Durable orders up.
Housing prices up.
New home sales up.
Stock market up.
Relations with the rest of the world up.
Obstructionist Republicans down.

Health care up.
Obstructionist Republicans down.

It's beginning to appear that the midterm elections won't come soon enough. The teabaggers had their splash, but the good guys are winning, and winning begets winning.

Posted by: russellglee | December 24, 2009 12:52 PM | Report abuse


You and Pearlstein are two of the Post reporters I still respect. I also enjoy your analysis on TV. Another good article. Very insightful unlike Broder who seems to have just discovered that congress makes deals to get legislation passed. Where has he been for the last 220 years? As we prepare to celebrate the birth of Jesus Christ, I can only think that He would be pleased that we are on the verge of providing health care for many who would die a painful death if it were not for this bill. Thank you.

Posted by: cdierd1944 | December 24, 2009 1:01 PM | Report abuse

Great piece as usual, Ezra. Nice to see your courage to speak out over there in the fantasy land of Broderworld...glad to see this bill finally passed -- and we will eventually have even more.

Posted by: drindl | December 24, 2009 1:03 PM | Report abuse

No has won. Everyone supporting this socialist healthcare manifesto is a loser regardless of the up or down vote. These fools are destroying the Republic. And those of you that really believe the Democrats won't be beaten to a pulp in November are obviously vacationing in some parallel universe.

Posted by: rplat | December 24, 2009 1:11 PM | Report abuse

SarahBB (12:27) says it all. It's also the biggest erosion of abortion rights in a generation. Definitely not something to be crowing about, Ezra.

Posted by: bmull | December 24, 2009 1:18 PM | Report abuse

dkoakland, too sad that you are still so angry and bitter at Xmas eve. When something does not go your way, somebody else could be wrong, or you could be wrong.

Posted by: ExpressReader | December 24, 2009 1:19 PM | Report abuse

rplat, a bet of any stakes you'd care to mention, payable to the charity of the winner's choice, that the person in the parallel universe about next november is you.

just to define our terms, what i expect is this: the dems will still have a majority in both houses after next november, and more voters will vote for democratic candidates than for republican ones.

now define beaten to a pulp and the bet is on.

Posted by: howard16 | December 24, 2009 1:20 PM | Report abuse

See you at the polls rplat, especially in 2012, your universe will implode like a black hole. Turn off the Glen Beck and get back in touch with the American moderate. We outnumber you right wing nut-bars by many millions. Its a good thing.

Posted by: shrink2 | December 24, 2009 1:21 PM | Report abuse

No has won. Everyone supporting this socialist healthcare manifesto is a loser regardless of the up or down vote. These fools are destroying the Republic. And those of you that really believe the Democrats won't be beaten to a pulp in November are obviously vacationing in some parallel universe.

Posted by: rplat | December 24, 2009 1:11 PM
These fools always think they are superior and the other side must be doing something bad to destroy the country.

Posted by: ExpressReader | December 24, 2009 1:22 PM | Report abuse

Dear Bolshevik Klein:

The assertion of another poster notwithstanding, your TV appearances (MSNBC)remind me far more of the great dead pan talent of George Burns than Vladimir Lenin. I'd recommend adding a cigar, although I guess one can't do that on TV anymore. (I hope you're not too young to know who Burns was). In all sincerity, I have learned as much about this issue as I could possibly ask both from Klein's intelligent and informed commentary and from his investigative reporting. Klein's piece on health care around the world is the most informative article I have seen on this subject, and should win a Pulitzer or some kind of prize. Anybody who hasn't seen the latter should really check it out in the Post archives.

Posted by: twm1 | December 24, 2009 1:23 PM | Report abuse

Thank you for your wonderful article. I am about to cry with joy.Obama has had to endure so much since the beginning of this summer with so much hype, out right lies and misrepresentation. The Democrats really stood by their principles. Yes, a lot was compromised but that is the name of the game. This is a landmark event for our great nation.

Posted by: donnajorobinson | December 24, 2009 1:29 PM | Report abuse

Wow, talk about counting your chickens before the eggs have hatched. The homestretch ain't the finish line, people.

Posted by: lostinthemiddle | December 24, 2009 1:35 PM | Report abuse

I knew Obama would be the greatest president we've seen in our lifetimes. He is.

Posted by: GeorgHerbet | December 24, 2009 1:36 PM | Report abuse


I've recently been trying to find the personal emails (and have only gotten a response from Adam Green [PCCC] so far) of the founders of the different progressive groups that are either fighting to kill the Senate bill or fighting for a public option to come out of conference.

I think it's a terrible, straight-up awful, idea for progressive groups to put it in the mind of their members that the public option that we are used to fighting for has even a glimmer of hope to come out in the conference report. When they come out of conference (I think with a stronger bill than the Senate's) and it doesn't have a public option in it, progressives are going to feel like they lost the war and already low liberal enthusiasm is going to get even worse with regards to turnout in 2010.

So I am trying to email all of these people, pleading with them to continue fighting for a better bill, but to fight on issues that are actually winnable. The examples that I've given to them so far are: (1) National Exchanges (2) More subsidies for lower-income Americans and (3) Excluding the anti-trust exemption.

I was wondering, what do you think progressive groups should fight for to come out of conference (that actually has a shot, without killing the final legislation)?

Progressives need to feel like we've won. Badly. Or we're up for a world of hurt in November. I think that if progressives can latch on to some of these issues -- and win -- they'll be much more likely to see the passage of this legislation as the victory (or at least first step to that victory) and remain engaged for upcoming policy debates and the elections in 2010.

Thanks for the help!

Posted by: rylock | December 24, 2009 1:43 PM | Report abuse

Fact #1: The senators making up this morning's 60 votes actually represent close to 65 percent of the population.

Fact #2: Approximately 65% of the voting public is now in firm opposition to the Senate Health Care reform bill

So what can we conclude from this? That the US electorate is no longer being represented by Congress, and that these politicians have gone rogue, doing whatever they want, spending as much as they want, whenever they want, with no concern or clue for the Country they originally swore to serve. No where in the US Constitution is the Federal government empowered to make decisions of healthcare. To undertake the socialist direction of this government, you have to subvert the Constitution, and that is the very definition of Treason.

Posted by: bakerdl | December 24, 2009 1:49 PM | Report abuse

Great work Ezra, keep it up.

Posted by: rocky | December 24, 2009 1:58 PM | Report abuse

It's amazing how illiterate and dislocated from reality are the educated elite of the Great Satan.

What the hell is going on, Erza?

Posted by: hariknaidu | December 24, 2009 2:00 PM | Report abuse

One foundation of the opposition to this bill,
though unstated, is two of the current components of the contemporary Repub party, namely, elitism and racism. If it becomes law and 30 million working poor are insured, some of them may start turning up at the clinics and doctors offices of the rich and well heeled. Yes, they might run into the guy who takes care of their swimming pool in their gated community at their doctors office. Awkward.
Or the plumber, in other words, their carefully constructed life as one big and very exclusive country club will suffer a few dents. Poor, poor Repubs, whats the point of having a gazillion dollars if it doesn't isolate from the little people with their annoying problems.

Posted by: rkerg | December 24, 2009 2:01 PM | Report abuse

Great job, Ezra. It is great that we have you to fight the forces of irrationality and greed with the voice of calm reason. Take a bow.

Posted by: Sanssouci1 | December 24, 2009 2:08 PM | Report abuse

Thank you Ezra !

Happy Holy Days Everybody !

...........L O V E.........

Posted by: ChipShirley | December 24, 2009 2:18 PM | Report abuse

V I C T O R Y...V I C T O R Y...V I C T O R Y...

V I C T O R Y...F O R...R E A L...L I B E R A L S ! ! !

V I C T O R Y...V I C T O R Y...V I C T O R Y...

V I C T O R Y...F O R...R E A L...L I B E R A L S ! ! !

V I C T O R Y...V I C T O R Y...V I C T O R Y...

V I C T O R Y...F O R...R E A L...L I B E R A L S ! ! !

T E D...K E N N E D Y...W E...L O V E...Y O U !

Posted by: ChipShirley | December 24, 2009 2:24 PM | Report abuse

Ezra, on June 8, 2009, you wrote: "If the public plan exists, liberals have won. If it's eliminated, or neutered, then conservatives have triumphed." So what do you say now? Or was that just spouting off to appease the masses?

Posted by: TheFritoPundito1 | December 24, 2009 2:29 PM | Report abuse

What a great day to be an American!

GeorgHerbet is right. For all the fire that Obama's taken, this is one of the most momentous domestic policy achievements in American history. With the hand he was dealt, it's hard to imagine Obama having a more successful first year.

Posted by: jeffwacker | December 24, 2009 2:31 PM | Report abuse


Have you seen these Caplan posts over at Econlog? I would love to see your response.

Exegesis, Public Choice, and the Senate Health Care Bill

Some Preliminary Political Economy of the Senate Bill

Posted by: kingstu01 | December 24, 2009 2:40 PM | Report abuse

TheFritoPundito1, you're right, this is not a victory for liberals. it's a victory for the public.

a liberal victory would have been a better victory for the public, but you can't always get what you want....

as for the moronic bakerdl, if i had been asked by a pollster, i would quite honestly have said i don't favor this bill, because i don't. but given a choice between passing this bill or passing nothing, i favor passing this bill.

which is one of a million real-world examples why your puerile little rant is so pathetic.

Posted by: howard16 | December 24, 2009 2:49 PM | Report abuse

Another, really - really bad day for the DEMOCRUDS.

Posted by: stephenwhelton | December 24, 2009 3:10 PM | Report abuse

The Republican Do Nothings tried and tried and tried to slam the door on longer and better lives for all.

But they failed and failed and failed again.

The door is now open for the struggle to achieve single-payer health care so we can join the world's nations that provide their citizens care that enables them to live longer, healthier lives.

Well done!

Posted by: apspa1 | December 24, 2009 3:11 PM | Report abuse

When Scrooge McDuck Humane Responsibility and others turn their backs on the facts, refuse to see models of success around the world, and just say “No!” to reform while offering nothing as an alternative, it’s fair to ask: Just what motivates such a wooden intellectual and emotional response to a clear problem and need? It’s a question worth asking because all answers I come up with lead to the sad conclusion that closed minds and closed hearts cannot be parties to real discussion, compromise or solutions.

So here’s my Top Ten List explaining the “No!” peoples obdurate thought processes.

Why Health Care Reform is Wrong and the Plight 10 million+++ Americans Should Be Ignored

10. Obama’s place of birth, Kenya, doesn’t have socialized medicine, does it?
9. I shop at Wal-Mart, I don’t need health insurance.
8. My local ER is even better than the one on TV.
7. If God doesn’t want me to get sick, I won’t get sick.
6. Ayn Rand told me the non-insured are losers.
5. Read the Constitution, Liberty isn’t about being healthy.
4. Taxes are for submarines and bombs, not pills.
3. If you want free health insurance, you can join the Army.
2. Insurance executives are our buddies, feed them.
1. I’ve got mine, you get yours.

Posted by: garyd63 | December 24, 2009 3:28 PM | Report abuse

RIP liberals. You have dug your grave, now you know what to do!


Posted by: cschotta1 | December 24, 2009 3:35 PM | Report abuse

The only way to WIN against RePugs & Rethugs is to get down in the mud with their nasty obstructionist corrupt arses.

It's not very becoming of Democrats to do so, but right now, there is no other way.

Posted by: lcarter0311 | December 24, 2009 3:48 PM | Report abuse

The ugly still comes from the Republicans who want everything that President Obama and the Democratically-controlled Congress do to fail. History has proved that popular social legislation is popular. The last attempt at major social legislation came under Republican rule with Medicare Part D. What a boon to the drug companies that legislation was. Now,Republicans are convinced that the costs will be far greater than the projected savings. They should know. Afterall, they lied about the cost of Part D.

The step today was a big, bold and courageous step forward in trying to provide for health coverage of all our citizens. Now it is time to eliminate the cap on Medicare contributions through the payroll tax. The superwealthy have had enough breaks since 1980.

The big lie still being pushed by the Republicans is that by paying taxes, Americans are suffering. I am suffering because of the reduction in taxes under Republicans and Democrats. When there is a national debt, a crumbling infrastructure, two wars, and on and on, we need to pay up to solve these problems. Personally, I do not want to have to engage the contractor and pay the price to fix the road in front of my house, much less sign up for my part of the highway system. With all of its flaws, government has a significant purpose in my life. At least I can vote. I have no vote with the big corporations in this country. Only the US Constitution, which provides for the Federal government, is by, for, and of the people. To be against the government as it has been contituted is to be against my own interests. Many of us won an election lest November. I did not cast my vote out of spite or because I was unhappy with Bush. I was proud to associate myself with a vision and a person who could articulate that vision. For those who lost, get busy and try to win the next election, but stop trying to throw every roadblock that you know to prevent the majority from speaking. We have spoken!

Ugly?! I have heard way too much of it from the Republicans and the far right. Not once did Jesus pounce on the government of His day. He had a lot to say about the religious rulers, whom He frequently called hypocrites. It is time for civility to return to politics and for the fringe elements of our society to return to the back of the stage. Looking for news has become so bad that even the local gathering of "teabaggers" numbering only about a dozen were interviewed on TV yesterday. A more productive use of news time would be to tell people what is actually in the Senate version of the bill.

Please see Senator Warner's webpage and read about the bill and his reason for supporting it.

Posted by: EarlC | December 24, 2009 3:48 PM | Report abuse

It is time to end those ridiculous filibuster rules, which allow Senators from small states to dictate to the majority.

Posted by: gtinla | December 24, 2009 5:15 PM | Report abuse

To sum this all up: Winner = Democrats & Losers = Republicans

You can dissect the process anyway you choose but like a football game, it all comes down to who has the highest score.

By all indications Democrats = 60 & Republicans = 39 is not only a victory but a friggin rout to boots...

Posted by: Citi__Street | December 24, 2009 8:50 PM | Report abuse

" it's arguably the most important piece of legislation the body has passed since 1963..."

But, Ezra, would you argue that it is more important than the Civil Rights Act of 1964, the Voting Rights Act of 1965 or the Civil Rights Act of 1968?

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Posted by: huangzhixian179 | December 24, 2009 9:53 PM | Report abuse

Who cares!!! My boyfriend thinks the same with me. He is eight years older than me, lol. We met online at, a nice and free place for Younger Women and Older Men, or Older Women and Younger Men, to interact with each other. Maybe you wanna check out or tell your friends.

Posted by: cougarpreycoming | December 24, 2009 11:00 PM | Report abuse

Gigantic tax increases. Gigantic amounts of new government bureacacies. Gigantic new government reach into our every day healthcare decisions. All that and it still doesn't cover 20 million people. What a great bill. Hooray!! Hooray!! Now lets get to work and bring this monstrosity down next month.

Posted by: RobT1 | December 25, 2009 12:25 AM | Report abuse

Without the Senate bill, health care costs are expected to increase 71 percent in the next ten years.

With the Senate bill, health care costs are expected to increase 71 percent in the next ten years.


Posted by: AlanSF | December 25, 2009 1:48 AM | Report abuse

PS: Congratulations to Ezra for writing yet another column listing feature after feature of the Senate bill, without ever mentioning the extraodinarily central and primary issue of exorbitant healthcare costs. (Except for the standard qualifier that Obama will totally control costs in the future even though he spent the past year negotiating secret deals to keep U.S. costs the world's highest.)

Posted by: AlanSF | December 25, 2009 1:55 AM | Report abuse

A.B, says: When Obama overturns DADT, when Obama completes the closing of Gitmo, when Obama winds down the wars in Iraq and Afghanistan, you will gnash your teeth & wail to the heavens, just as you did when Obama ended torture & illegal rendition on his first full day in office.

Guess I missed the gnashing and wailing, since illegal renditions haven't ended, torture has only been temporarily suspended but been certified as legal and all torturers exempt from punishment or even acknowledgment. I'll certainly be glad to gnash & wail if he ever does the rest of things you mentioned. I guess he's just been too busy negotiating secret deals for high drug prices to stop expelling gay people from the military and too bsuy escalating the war in Afghanistan, Pakistan and Yemen to wind it down, but any day now....

Posted by: AlanSF | December 25, 2009 2:07 AM | Report abuse

What price victory.

Posted by: sjfone | December 25, 2009 6:52 AM | Report abuse


Is your bonus from the Obama Admin funneled to you through TARP or the stimulus package? Also, do you ever think you'll ever become a reporter, instead of a Democratic Party mouthpiece, maybe somewhere down the road?



Posted by: PrettyGoPale | December 25, 2009 8:15 AM | Report abuse

Right wing nut cases and their Republican party friends have lost this battle but I am sure there are more to come. Chalk up a well deserved victory for the American People.This time Hope won over Fear and Yes won over No........

Posted by: johnnyk1 | December 25, 2009 5:08 PM | Report abuse

We need a constitutional amendment to determine prevent people from drinking but we can pass legislation that forces people to buy insurance?

Lots of interesting questions about the legality of this legislation.

Posted by: m-dos | December 25, 2009 7:53 PM | Report abuse

If this results in a bill passed by both Houses and signed by the President it will be the worse day in American history. It will be a bill that causes the bankruptcy of America while causing our health care to degrade to that of what was once called a third world nation. The incompetents from both parties that allowed such legislature to pass should be thrown out of office. The sad part will be that it will take 3-5 years for the worthlessness of this bill to become painfully apparent, until that time you will have to listen to this bunch of morons sing their own praises. I am very sad, very sad for America I had hoped to have died by the time the country had entered its final life but I just I am just not that lucky...unless of course I get a serious illness and the "state" determines that it will be too expensive for me to recieve treatment...

Posted by: staterighter | December 25, 2009 11:13 PM | Report abuse

RobT1: "Gigantic tax increases."

Gigantic? Really? On whom? Seems to me that even the highest wage earners under any program wouldn't be paying more than under Clinton. Since times were pretty good then, hard to see how those tax increase would be "gigantic."

"Gigantic amounts of new government bureacacies."

Well, the private sector seems to be doing a lousy job of keeping costs down. And the insurers remain private, and the doctors, and the hospitals.

"Gigantic new government reach into our every day healthcare decisions."

Really? Where is that "gigantic" reach in the bill? Maybe we should look at what the bill actually does instead of what some people are saying that it does.

staterighter: "It will be a bill that causes the bankruptcy of America while causing our health care to degrade to that of what was once called a third world nation."

Actually, most people think that the failure to act will cause the bankruptcy of America.

As for causing our health care to degrade, what would one say about how our peer nations do health care? Most of them cover everyone, get as good results, and spend 30% to 50% less than we do. Seems to me that moving in that direction would be a good thing.

"unless of course I get a serious illness and the "state" determines that it will be too expensive for me to recieve treatment..."

Uh, where is that in the bill?

People here die every day because they can't get insurance. Without this legislation, you lose coverage because you lost your job, then if have a preexisting condition you're essentially uninsurable because you can't get coverage on the open market. That's probably a greater chance of death than anything in this bill.

Again, perhaps it would be wise to see what this bill actually does instead of making assumptions about "death panels."

Oh, and if you're worried about those panels, couldn't you just buy supplemental insurance? No one is making private insurance illegal, you know. Really, it's a ridiculous argument.

Posted by: dasimon | December 26, 2009 1:13 AM | Report abuse

Ezra Klein

Spin Spin Spin!
Are you kidding? Do you seriously believe that the real agenda of healthcare reform was to help the poor and uninsured? You are obviously not a student of history or of current events.
Experts agree, healthcare cost could be reduced if three simple conditions would be met.
a) Allow insurance companies to compete across stateliness (as they do with auto insurance), this historically has been shown to reduce cost.
b) Significant Tort reform. This would fix perhaps the number one reason for escalating rise in healthcare cost.
c) Government (namely Congress and the president) must be under the same exact healthcare system as everyone else. This helps assure lawmakers will prosper or suffer along with the rest of America. Our Founders NEVER intended for Americans to have an elected elite, which is exactly what the Congress and President Obama just passed. If it is such a great system, why not be part of it Congress?
d) Improving Technology has historically cut cost and improved quality control. There is no measure in the healthcare legislation to invest in technology research. Medical Technology of a generation ago virtually ended the need for expensive, painful exploratory surgery. Today physicians have powerful scanners at their disposal that for a fraction of the cost and little or no discomfort can assess patients more accurately; all thanks to an investment in technology years ago. It was developed not by nations with socialized medicine, but by the for profit system of the USA. Even the poor uninsured of this nation and the world has benefited by this investment.

None of the above cost cutting measures was employed. Cost therefore truly was not the issue, Ezra.

Candidate Obama promised the healthcare discussions in Congress open for all to see. Not even the elected GOP officials who had by law a vote on the legislation were allowed to attend meetings. Obama indeed lied.
The democrat leadership in both houses used billions of tax dollars to buy votes in order pass this legislation. What is the difference between what the democrat leadership in the US Congress did with our tax dollars and former Illinois Governor Rod Blagojevich is accused?
The DNC obviously has another agenda with this legislation
Historically, without competition, quality of service and quality control drops when a nation nationalizes and industry. This is why the US is the undisputed world leader in medical breakthroughs. Nations with socialized medicine have no incentive to invest in improving medical technology.
As a media professional you, Ezra Klein are obviously incompetant or a government is always right toady; why the WA-POST printed this drivel is beyond me. I wonder if McCain was elected and passed the same medical reform legislation with a 60% GOP majority, you would have written the same article?

Posted by: dsspowaus | December 29, 2009 9:34 AM | Report abuse

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