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Health-care experts agree: The House should pass the Senate bill

For nearly three-quarters of a century, Presidents and Congressional leaders have tried to enact legislation that would make health care accessible to Americans. Although pieces of this dream have been realized -- health care for the elderly, the disabled, and children in low-income families -- universal coverage itself has proved beyond reach.

We are now on the cusp of realizing this goal. Both houses of Congress have adopted legislation that would provide health coverage to tens of millions of Americans, begin to control health care costs that seriously threaten our economy, and improve the quality of health care for every American. These bills are imperfect. Yet they represent a huge step forward in creating a more humane, effective, and sustainable health care system for every American.

We have come further than we have ever come before. Only two steps remain. The House must adopt the Senate bill, and the President must sign it.

Those are the opening paragraphs of a here (warning: Word document) 45 health-care experts are sending to Nancy Pelosi, Charlie Rangel, Henry Waxman and George Miller. The contents of the letter aren't very surprising. But it's another reminder that no one who studies this stuff believes the differences between the Senate bill and the House-Senate compromise bill are so great that the House should abandon the whole project if the Senate can't act. They're not even close, actually. It's like refusing to eat dinner because dessert is a confection rather than a cake.

Because of that, I think you have to see the protestations of House members who were prepared to vote for the compromise legislation as one of two things. Either they're a negotiation strategy to force the Senate to commit to making changes or they're an excuse for the members to avoid doing something they've decided they don't want to do -- namely, vote for health-care reform.

By Ezra Klein  |  January 22, 2010; 10:28 AM ET
Categories:  Health Reform  
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Comments

I think Ezra and all progressive/liberal/rightthinking bloggers should pick up Steve benen's mantra:

Pass. The. Damn. Bill.

Pass. The. Damn. Bill.

Pass. The. Damn. Bill.

Posted by: donovong | January 22, 2010 10:31 AM | Report abuse

"It's like refusing to eat dinner because dessert is a confection rather than a cake."

Ezra, have you been taking a correspondence course on the creation of counter-intuitive similes? Or is it just a hobby?

It's like going to a playground and finding out that it's completely made of Jell-O.

Posted by: Kevin_Willis | January 22, 2010 10:38 AM | Report abuse

Ezra, just curious-- how does the SotU factor into this, particularly given the administration's conspicuous lack of leadership this week? Surely Obama needs to decide on a way forward by then, and that's only five days from now.

Posted by: adamiani | January 22, 2010 10:39 AM | Report abuse

It worth noting that this list is missing a number of esteemed names on prior letters supporting certain elements of reform.

Posted by: wisewon | January 22, 2010 10:48 AM | Report abuse

I vote for negotiation strategy to win assurance from at least 50 Senators to a companion set of modifications to the bill to be passed in reconciliation. Or at least I am willing myself to believe that in order to stop from going off the deep end with despair.

As a side note - this whole morass makes me even angrier at the so-called lefty "kill-billers" - to the extent there is wavering in the House now, it is that much easier for progressive Democrats to give up because vocal elements of the party base have already said that the Senate bill is a sell out. Wankers.

Posted by: DavidDavidovich | January 22, 2010 10:49 AM | Report abuse

C'mon, Ezra. Call it for what it is.

The deal-killer here is the excise tax. It will affect only about 8% of tax-filers, and maybe a couple of million of those are union workers.

But in order to avoid those few million from receiving (shudder) slightly less expensive health insurance, the House Dems are willing to toss 30 million people under the bus. This is truly a choice between people like a single-parent waitress who works on minimum wage plus tips, and the UAW worker in Detroit who makes $20+ an hour. Now, God knows those guys need all the help they can get... but really, is cutting back to a $20,000 policy such an unbearable burden? There truly are advantages to being politically connected.

It's a craven, sickening, and immoral choice the House Dems are making.

Posted by: wagster | January 22, 2010 10:51 AM | Report abuse

"It worth noting that this list is missing a number of esteemed names on prior letters supporting certain elements of reform." - wisewon

I noticed that too. The people who have been the clearest about what universal reform really means are not on the list.


Posted by: Athena_news | January 22, 2010 10:57 AM | Report abuse

dear president obama

for the sake of the country, what is left of the frayed workings of our congress, for the health and welfare of your suffering and ill fellow americans, for the spirit, morale and hope that this country needs to move forward, and for the bond you have with those who worked so hard for your candidacy, please do everything in your power to get this health care reform bill passed as quickly possible.
though there may be other alternatives, the will, resolve and patience of the american people will not outlast the process and the consequences will be like shark-infested waters.
precious time has been spent on this, when there are so many other issues that need fixing and attention, please help us to move forward quickly and at least begin health care reform.
at this late point, a bird in the hand is worth two in the bush.please dont let hope crumble. we must act now.

Posted by: jkaren | January 22, 2010 10:58 AM | Report abuse

I just don't see why this has to be so hard. The House could pass a reconciliation patch that kills the excise tax, adds the millionaire surtax, drops the Nebraska and Louisiana Medicaid deals, and increases subsidies to assure broader participation. Send it to the Senate and dare them not to pass it with only a 51 vote threshold. If Harry and Nancy can't get that done with the substantial majorities, then they are admitting Dems can't govern and maybe the country needs Tom Delay back in charge.

Posted by: stsimons | January 22, 2010 11:09 AM | Report abuse

*dear president obama*

I am pretty sure he doesn't read the comments section of Ezra's blog.

Posted by: constans | January 22, 2010 11:10 AM | Report abuse

From what I have read, it appears to me that the problem is that even before MA, some progressives had not signed onto the excise tax compromise and still wanted to get rid of the individual mandate and are now using MA as an excuse. For goodness sake, the unions have endorsed the excise tax compromise and the individual mandate is necessary to allow persons with pre-existing illnesses to be covered. JUST DO IT

Posted by: gregspolitics | January 22, 2010 11:12 AM | Report abuse

"an excuse for the members to avoid doing something they've decided they don't want to do -- namely, vote for health-care reform"
Bingo.

Posted by: MikeR4 | January 22, 2010 11:13 AM | Report abuse

Why let the senate off the hook?

The house can do this anyday it feels. The pressure is on the senate to fix the bill via reconciliation so the house can take on both at the same time.

The next move is the Senate's. Fix the damn bill! Add a public option, as that give-away was a big part of the problem. Add a provision to negotiate under part d, as that give-away also caused much suspicion from the base.

The senate needs to decide whose side they are on here, and if thier prior actions stand -- we'll decide they are not fit to govern.

Nebraska's special deal will become law if the house goes first, another stick in the eye to people who want a reasonable gov!

Posted by: rat-raceparent | January 22, 2010 11:14 AM | Report abuse

If they are going to copy President Obama on their letter they should spell his first name correctly. Otherwise, I think it looks great. But I am skeptical on it having any impact.

Posted by: patrickbyers | January 22, 2010 11:17 AM | Report abuse

"For goodness sake, the unions have endorsed the excise tax compromise and the individual mandate is necessary to allow persons with pre-existing illnesses to be covered."

1) the excise tax compromise is not in the bill that was passed. That was added via reconciliation, which we're now being asked to scrap.

2) excise tax is not necessary for pre-existing cond's. Excise tax is a way to force the working class to pick up more taxes instead of the 'important' classes. Bankers, ceo's, over-paid... (well, basically everyone in the medical industrial complex except nurses).

Posted by: rat-raceparent | January 22, 2010 11:17 AM | Report abuse

"It's a craven, sickening, and immoral choice the House Dems are making."

And the choice to give pharma a special deal is acceptable?

The choice to give ins co's a deal is fine?

The choice to protect over paid dr's is great?

Only when it's working class stiffs getting hit is it craven, right? Propaganda is soooo very effective in this country.

Posted by: rat-raceparent | January 22, 2010 11:20 AM | Report abuse

*dear president obama*

I am pretty sure he doesn't read the comments section of Ezra's blog.

Posted by: constans | January 22, 2010 11:10 AM | Report abuse


you never know what the power of words are, or who reads them. once words go out into the universe, they have a power all of their own.
i will keep printing my letter, every chance i get.
it is the energy that i want to see in the universe, so i will keep putting it out there.
i have faith in the power of words.

Posted by: jkaren | January 22, 2010 11:23 AM | Report abuse

"Why let the senate off the hook?

The house can do this anyday it feels. The pressure is on the senate to fix the bill via reconciliation so the house can take on both at the same time.

The next move is the Senate's. Fix the damn bill! Add a public option, as that give-away was a big part of the problem. Add a provision to negotiate under part d, as that give-away also caused much suspicion from the base."

The Senate isn't off the hook - people recognize how damaged and incapable it is. Which is the point: Pelosi has forty extra votes, Reid has -1+. Adopt the public option and Bill Nelson likely gets off the bus (or perhaps someone else). And even if he stays you need to find that extra vote - is Scott Brown going to vote for it? We know his stance - Massachusetts got theirs, so no need for federal action. Olympia Snowe? That's not happening.

I understand you're general point, but unless you can point to who they should be targeting for that missing vote and why moving towards a more progressive bill won't damage that effort, I don't think it's a convincing argument.

Posted by: y2josh_us | January 22, 2010 11:23 AM | Report abuse

And the choice to give pharma a special deal is acceptable?

The choice to give ins co's a deal is fine?

The choice to protect over paid dr's is great?

Only when it's working class stiffs getting hit is it craven, right? Propaganda is soooo very effective in this country."

Unfortunately it is...if you believe the option now on the table is that or not getting millions onto health insurance and having their lives while attempting modest methods of controlling out of control spending that will ultimately bankrupt us.

On the other hand, if you honestly think you can get better at a later point in time, then no. But what makes you think that?

Posted by: y2josh_us | January 22, 2010 11:26 AM | Report abuse

That should be saving their lives, not having. Although read whatever Freudian slip you wish.

Posted by: y2josh_us | January 22, 2010 11:27 AM | Report abuse

And the choice to give pharma a special deal is acceptable?

Er, yes, on the part of the White House and the congressional leadership. Pharma is, unsurprisingly, craven, sickening, and immoral, and the fact that their support for the bill had to be bought is entirely unsurprising.

It was worth it for the people who actually wanted a bill, because it kept Pharma from opposing it.

I expect Pharma to care only about itself and to hold health care hostage to a sweetheart deal. I expect that from Ben Nelson, too. I don't expect it from liberal House Democrats.

Posted by: jlk7e | January 22, 2010 11:28 AM | Report abuse

Does the letter as sent really spell President Obama's first name "Barak"?

Posted by: Mark_Regan | January 22, 2010 11:46 AM | Report abuse

At this point the House is damned if they do and damned if they don't. If they pass the Senate bill it will be picked apart endlessly between now and the fall, and there are lots of pieces that rightly shouldn't be there. I don't see the will to hammer out corrections through reconciliation. The real solution would be to craft a better bill and then pass it--a bill people actually like. Policy matters! Unfortunately, I don't see the will to do what people want, especially now that the rush is on to the corporate campaign trough. That will be the focus of Congress for the next 10 months.

Posted by: AuthorEditor | January 22, 2010 11:50 AM | Report abuse

Misleading title, "heath care experts agree . . . ," suggesting there is a consensus among health care "experts" the House should pass the weak Senate bill. Somehow I think there may be more, probably a lot more than forty-five health care "experts" in this country.

Posted by: Aprogressiveindependent | January 22, 2010 12:12 PM | Report abuse

i would wager that most every health care expert agrees that anything is better than the status quo. and while its not just the unions they're not immune from the blame that's going around. Everybody had a stake in messing this up including them. Does it make sense to have benefits that are worth more than your wages are? At some point that nonsense has to stop.

Posted by: visionbrkr | January 22, 2010 1:06 PM | Report abuse

Wrong wrong wrong! Everything just changed!

CALIFORNIA IS TRYING TO GET SINGLE-PAYER. The California Senate Appropriations Committee just approved Thursday (yesterday) a proposal to set-up a single payer system in California. It goes to the full California Senate next week.

Google "California single-payer plan advances"

This immediately changes everything in the healthcare debate! Think!! California is the seventh biggest economy in the world and single-payer will cut into private insurers' profits in a very big way. Private health insurers are going to have to change tactics in Washington immediately, to prevent this from happening. They are going to have to go back and try to get a deal from the U.S. House.

This changes what progressives should do next. First, support the California bill.

Next, hold it up as a states' rights model and don't let the U.S. Congress pass any provision that would prevent a single payer in California or any other state.

This could not only get us all to a single-payer, and sooner rather than later. And it not only puts the corporate moderate Dems on notice.

It is also going to drive a wedge between the teapartiers and the corporate moderates in the Republican Party. What is Scott Brown going to say -- that he supported Massachusetts' healthcare reform but is against what California is doing because it goes further than the U.S. Congress' bill?!

Posted by: Lee_A_Arnold | January 22, 2010 1:41 PM | Report abuse

Pelosi would ram the bill through if she could. She's tough -- the toughest Democrat in Washington. And from the beginning, she understood Republicans better than anybody else. If she were the Senate leader, we'd have a bill, via reconciliation.

But if she doesn't have the votes in the House, she doesn't have them. A number of House members don't merely dislike the bill; they think it is without merit. The senators dallied on the bill, made it crappy enough to where no one could like it, stripped out the public option -- which had majority support in the public -- and now want the house to take the hit by passing it unaltered. The same house which, by the way, is the more vulnerable chamber in November.

As one writer said, Pelosi is not Atlas. She can't carry all the weight. They left her with nothing to work with.

Posted by: mypitts2 | January 22, 2010 2:11 PM | Report abuse

The REAL beneficiaries of this health care bill are the health care "experts"----many of whom are signers of this letter----

There are 128 or so new committees and boards established by the health care bill----adding immeasurable overhead to the administration of health care ---
Many of these guys will get fat consulting contracts either as members or consultants to this myriad of committees and boards---some of which are unaccountable to the voters---- euphemistically called "independent"-----

And several signers/consultants are already making a lot of money on health care "reform"----e.g., Gruber from MIT with $800 K of consulting from the Obama admin.

It must be devastating for these folks to see their health care consultant "jobs bill"--- aka Health Care Bill-----go down in flames.

Posted by: johnowl | January 22, 2010 2:18 PM | Report abuse

y2josh_us: "The Senate isn't off the hook - people recognize how damaged and incapable it is. Which is the point: Pelosi has forty extra votes, Reid has -1+. Adopt the public option and Bill Nelson likely gets off the bus (or perhaps someone else). And even if he stays you need to find that extra vote - is Scott Brown going to vote for it? We know his stance - Massachusetts got theirs, so no need for federal action. Olympia Snowe? That's not happening."

No, the senate can fix the bill in reconciliation -- requiring only 50 votes plus Biden.

Pelosi won her vote by 2, and some of them want to bail because they can't roll back roe v wade. It's not an easy haul there, either.

It's made much easier by holding the progressives and giving dems something to say 'we fought against special interests'.

Everyone can see that corporate money caused the senate bill to suck, badly. They can't believe how dirty (a few, but that is not the perception) senate dems are. It's so obvious, which explains losing in a strong blue state. They are revolting from the left!

Do dems really want to move into 2010 with no base, at all?

Here's the basics: http://www.dailykos.com/story/2010/1/22/828934/-Strategy-memo-to-Senate-Chiefs-of-Staff

Posted by: rat-raceparent | January 22, 2010 3:33 PM | Report abuse

To further rat-raceparent's point, the House voting for the bill removes much of the power behind a push for reconciliation. With the House passing the Senate bill, the senate IMO will not even attempt reconciliation. So unless your only point is to give the President a "win" before the SotU. Pressuring the House now or more than the Senate is foolish and will probably backfire

Posted by: williamcross1 | January 22, 2010 7:28 PM | Report abuse

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