Faced with the very real possibility of default less than seven days away, the current favorite GOP talking point presents President Obama as a politically calculating fear-monger, trying to scare old people and markets with tales of what will happen if we don’t raise the debt ceiling. The markets are less sentimental. Math doesn’t have a partisan spin and you can’t convince creditors that refusing to pay your bills is a brave stand for fiscal responsibility.

via Debt Ceiling Crisis: Boehner’s Hypocritical Response – The Daily Beast.

Even if the bill does a better job than CBO projects, health-care costs will still bankrupt us. This is one small step for cost, one giant leap for coverage. My great hope is that the bill makes the next steps easier. But there’s still no guarantee we’ll take them. And the debate and difficulty Congress had passing a bill that was too small and deeply compromised has left me very pessimistic about our system's capacity to make harder decisions. The danger is not that we can’t solve our problems, but that we won’t. And that’s the biggest risk of all.

via Ezra Klein – The risk of health-care reform.

There’s no constituency and little reward for tough choices in Washington. It breeds a town full of cowards. Our legislative branch is broken.

Some of these guys will lose their jobs for voting yes. There may be a modicum of courage left in Congress.

Update: 216 votes with 1:42 to spare. The final vote is 219 to 212, with 2 no votes from Republican members.

What the New Health Care Legislation Will Mean to Consumers’ Wallets

This would form a floor for benefits, with an opt out for those who have other coverage. A mandate is a must. Spend more on effectiveness research, the Pharma lobby and medical device makers be damned. We need to know what actually works best, not what’s most profitable. Couple that with medical education reform that encourages people who actually want to practice medicine to go into primary care specialties like family practice and pediatrics, by relieving them of 6 figure student loan burdens. Begin slowing the growth of reimbursement to expensive sub-specialties.

Some years ago I worked at a small community hospital in St. Pete. I thought it interesting that an ophthalmologist would come on surgery days twice week and line up eight cataract cases, spend about 15 minutes each and get over $1000 each before lunch.

On another floor we’d have elderly patients in heart failure and diabetics with uncontrolled blood sugar. Both can easily be prevented by relatively inexpensive in-office care and regular follow-ups. We need to spend more on primary care and reimburse less to the guys like the ophthalmologist example.

But I digress, back to the flawed real world plan. Here’s the take I thought the most realistic on it’s chances:

And so Democrats in Congress find themselves facing an uncomfortable but clear choice. Although they may not reap political advantage from the legislation, most of them recognize that failing to pass it would be worse. The devastating aftermath of their party’s inability to act on health care in 1994 remains a vivid, cautionary lesson.

via Will It Pass? The Odds on Health Care – Room for Debate Blog – NYTimes.com.

Pass the plan or you democrats get it, death by circular firing squad. If they had anything remotely similar to party discipline, the whole thing would be a boring fait accompli. At least they keep drama going and going and going.

Maybe not. Hedge fund managers get a massive tax break worth billions because of a tax loophole that allows them to pay only 15% on the great majority of their income. I know I pay a helluva lot higher rate, but then again I’m not a downtrodden hedge fund manager. Despite a fix being passed by the House three times in three years the Senate may not even take it up.Why would this happen when approval of the financial industry is ranked just above convicted pedophiles and lepers?

If we were starting from scratch, after all, it seems unlikely that the Senate would choose this particular moment to pass a bill subsidizing money managers to the tune of billions of dollars a year. But, because the tax break already exists, it exerts a kind of gravitational pull that makes it hard to get rid of. In part, that’s simple economics—those who benefit from the tax break have more money to lobby for it to be kept in place. Furthermore, while the cost of subsidies is spread out among all taxpayers, the benefits are highly concentrated, so, naturally, opposition is generally diluted and diffuse while support is intense. If you work in private equity, it’s possible that nothing the government does matters more than keeping this tax break intact. And this pattern is true not just of subsidies but of government programs in general: every government action creates a constituency with an interest in keeping that action going.

…the Democrats’ bill more closely resembles Richard Nixon’s health-care proposal—the one that Ted Kennedy went to his grave regretting he hadn’t embraced—than it does Bill Clinton’s, to say nothing of Harry Truman’s. Nor are all its Republican features archeological. “Our bill contains over a hundred and forty-seven distinct Republican amendments,” Senator Tom Harkin, of Iowa, reminded his summit colleagues. The health-care reform bill—which, despite everything, is still alive—is an ambitious piece of legislation, however modest it may be by the measure of the rest of the developed world. Ideologically and substantively, it is centrist. It has Republicans, and Republicanism, in its family tree.

via Bipartisanship and your health : The New Yorker.

The GOP caucus simply wants to block reform by any means necessary. It’s not about the relative merits of reform proposals or who came up with them. It’s not about tens of thousands who die annually because they delay care for a lack of coverage. It’s not even about wild shrill, misused accusations of socialism or fascism. It’s about electoral politics, pure and simple. If they can deny Obama a victory, they feel like they’ll do better in the mid-terms. If thousands more die, well they probably didn’t have the money to contribute to their campaigns anyway.

Sen. Michael Bennet’s effort to revive the public option in the reconciliation process is gaining steam, with almost 20 senators signing on to the idea. Among them are Dianne Feinstein and Chuck Schumer, who are not, shall we say, possessed of a whimsical or quixotic temperament.

Of course, you don’t need almost 20 senators. You need 51, or more. And complicating that project is that the question here is not simply “public option: yes or no?” It’s whether you want to jam a public option into a bill that Senate Democrats already passed without a public option. Not only are you throwing out any hope of appearing even slightly bipartisan, but you’re also increasing internal dissension and adding unpredictability into a process that’s collapsed into chaos already.

via Ezra Klein – Is the public option making a comeback?.

The Center for Responsive Politics has taken a look at lobbying expenses for 2009 and found that we have a new record. $3.47 billion was spent by 13,741 registered lobbyists to lobby the Congress in 2009. In 2008 $3.27 billion was spent. And this is only the spending for those folks who have to register under the extremely weak Federal lobbying disclosure laws. Billions more have been spent by PR firms, think tanks, front groups, shadow groups and other entities and individuals operating with carefully designed work-plans crafted to escape oversight and disclosure.

The recent Legislation enacted by the Bush/Roberts Court will flood the zone with even more money. This is another indication of just how deep in the shit our Democracy finds itself in these days.

It has been almost six years since the Abramoff scandal broke on the front page of the WaPost. The story was followed for a while, but now it is just old news. Except that it isn’t. The system of corruption that Jack Abramoff helped to build is as strong today as it ever was. All the scams that Jack used to run are still being run today. The only difference is that Washington is now filled with “Baby Jacks” running these cons. And this corruption is a bipartisan project—perhaps the only bipartisan project that functions inside the beltway.

The only bipartisan project that functions is a joint effort to hide and extend the influence of lobbyist money in Washington? We are quickly becoming the world’s largest Banana Republic. The truly sad part is that for every buck spent, many more comeback in the form of pork barrel projects, targeted tax relief and other shit that we don’t need and I personally don’t want to pay for.

OK, here’s the new plan, finish raising my daughter here because I can make a better living right now. About the time she gets to college age I’m off for retirement in the Philippines. Then I plan to renounce my US citizenship and tell Uncle Sam to take his tax forms and piss off. The Philippines has a definite culture of corruption with public officials. But at least you know you need to slip a little something to public servants to get things going. There’s no false veneer of honesty that hides a more pernicious form of deeper dishonesty and outright theft. We aren’t any better here, I’d argue we’re worse. We just lie about it to ourselves.

That’s the end of today’s bitter diatribe. I’ll probably feel better after a glass of wine and dinner with my little family.

That’s why we call her boogie…

This fantasy that there are Republican votes for a more moderate bill really needs to end. There are no Republican votes for healthcare reform, no matter how moderate or conservative it is. They’re opposed to healthcare reform. They’ve always been opposed to healthcare reform. They’e Republicans! There’s nothing wrong with them being opposed to healthcare reform. And they are. Full stop.

Going down this path would be dangerously delusional. It would waste time, piss off voters even more, and accomplish nothing. It's time for House liberals, labor unions, lefty activists, Blue Dogs, Democratic pro-lifers, and fence-sitting centrists to all face reality: the only way to pass healthcare reform of any kind is for the House to pass the Senate bill as is and then work to improve it later during the budget reconciliation process. It's not perfect, but it will work. Nothing else will.

via Facing Reality | Mother Jones.

I think he’s dead on, pass the Senate version of HRC and fix what you can in reconciliation and with future legislation. There’s really no point or percentage in it for Democrats to abandon the entire project when the goal line is literally in sight. They’ll lose a considerable amount of support from progressives and the Democrats can’t win based on the president’s ever waning popularity or his leadership.

Obama has not led on any of this. He’s been the careful centrist he always was.  Let’s not get all wobbly over the loss of one seat in the Senate, that’s 1% of 1/2 the legislative branch, which is 1/3 of the 3 branches of government (to paraphrase last night’s Daily Show).

As for the intra-party food fight over who’s to blame for Coakley’s loss of what should have been an easy win, there’s plenty to go around. She was an awful candidate, but no worse than many an empty suit currently existing in Congress (editors note, I considered “working” instead of “existing”, but that seemed to bit of a stretch). The national part didn’t seem to pay any attention to the special election in Mass. until the final week and that was just too little and waaay too late. The president didn’t do much until the last minute either. Plus, there was absolutely no message prepared in case of a lose, just a lot of surprised people winging it. They’ve yet to recover balance.

Flashback: ‘The Night The Clocks & Scoreboard Stood Still’ | Fired Up! Missouri. (h/t Ezra Klein)

Note that it was, and still is, completely unfunded and added 100% to the deficit.  Furthermore its ten year costs are about a $1 trillion vs roughly $900 billion for current reform package.  The health reform bills now before Congress actually reduce the deficit by $100 billion. Explain to me again which party is the party of fiscal sanity and responsibility?

If you hear anyone complaining about the process, show them that link and ask them to justify those tactics. If you hear any bitching about how this effects 16% of the economy, point them to this bit from Ezra Klein:

…this idea that the health-care bill affects “16% of GDP” is inane. That 16% of GDP captures people in private insurance, Medicaid, Medicare, and assorted other arrangements purchasing medical care. This bill will not stop them from purchasing medical care nor will it change the way they purchase medical care nor is it likely to change how much medical care they purchase.

To put this even more clearly, in 2008, the country spent $2.3 trillion on health care. In 2016 — so, after implementation — this bill will spend about $150 billion helping people buy health care. Assume that national spending that year will be about $3 trillion, then the health bill is accounting for about 5 percent of our spending that year. The idea that this bill, which is going to cost fairly little in the scheme of things and do virtually nothing to people who are already insured, is somehow transforming the provision of 16 percent of GDP is misleading at best.

For those of you missed it, this is one of our articles today that I really got a kick out of. Why has Michele Bachmann suddenly gone mum on bashing the census and telling people not to participate? It turns out that Minnesota is right on the cusp of losing one of its House seats. And the most logical outcome of an undercount of state residents would be to eliminate Bachmann's seat in Congress. Self-interest, all-powerful, can even defeat the Crazy …

via Learning to Love the Census | Talking Points Memo.

Maybe progressives should encourage wingnuts everywhere to ignore the census, that should impact wingnut heavy states and make them lose seats.

After a long day of acid, partisan debate, Senate Democrats held ranks early Monday in a dead-of-night procedural vote that proved they had locked in the decisive margin needed to pass a far-reaching overhaul of the nation’s health care system.

via Health Bill Passes Key Test in the Senate With 60 Votes – NYTimes.com.

Something is better than nothing. While this bill lacks a great many things, the insurance reforms and subsidies are extremely important.

It is odd to read things like this:

The Republican leader, Senator Mitch McConnell of Kentucky, lashed out at Democrats in his closing speech, charging that they were defying the will of the American people, and that Mr. Obama was breaking numerous campaign promises. “If the people who wrote this bill were proud of it, they wouldn’t be forcing this vote in the dead of night,” he said.

It’s odd because if not for a long series a parliamentary maneuvers designed to delay things by the Republican minority, it would have long since been done. He’s complaining about votes in the middle of the night when their tactics are what necessitates it. It’s the same disingenuous bullshit that’s marked the GOP approach to the subject of health reform from the beginning of the process. Their standard process is to simply lie about things, stamp their feet and act like badly behaved 2nd grade children. Good luck with that.

Nate believe the blue dog type conservative democrats staked out their ground during the summer and stuck to it. The votes were never really there to get a public option. Leiberman gave it a swift kick in the nuts on the way out the door, it’s effectively dead. The result is a weaker bill that will cost more money, have less effective cost controls and cover fewer people, perhaps that’s what the opposition was after all along.

I’m of the opinion that after Lieberman’s opposition to the Democrat’s top domestic priority and after having campaigned for McCain/Palin during the last election cycle he richly deserves being stripped of his committee chairmanship. He desperately needs another well financed primary challenger from the left-center next time around. There’s probably a few of his colleagues who’d like to line up to give him a swift kick in the nuts on the way out to door.  Democrats don’t need him if he’s unwilling to support the party’s priorities. Either you caucus with Democrats and support the party’s initiatives or you find yourself another party willing to put up with all the maverickiness. Party discipline anyone?

Most support public option for health insurance, poll finds – washingtonpost.com.

A new Washington Post-ABC News poll shows that support for a government-run health-care plan to compete with private insurers has rebounded from its summertime lows and wins clear majority support from the public.

A clear majority of 57% supports a public option, despite a massive disinformation campaign. Support has been firming up since bottoming out in August at 52%. I believe the ONLY reason there isn’t broader support, particularly among Democrats in Congress, is because of the money being spent by lobbyist to defeat meaningful reform. Congress seems much more interested in protecting the interests of insurance companies than they are in protecting you from bankruptcy from medical expenses or death from a lack of access to timely care. People die because of our distorted priorities:

Nearly 45,000 people die in the United States each year — one every 12 minutes — in large part because they lack health insurance and can not get good care, Harvard Medical School researchers found in an analysis released on Thursday.”We’re losing more Americans every day because of inaction … than drunk driving and homicide combined,” Dr. David Himmelstein, a co-author of the study and an associate professor of medicine at Harvard, said in an interview with Reuters.

It’s a national shame. We can do better. We deserve better. Timidity will allow people to die, it’s just that simple.

Anderson Cooper of CNN did a report last night that echoes the NY Times piece.

Cooper: After negotiating with republicans, conservative democrats and seemingly themselves over parts of a plan CNN has learned that the administration could be getting closer to a very big change. Namely crafting a health care bill and try to ram it through the Senate even if it passes by only a single vote.

Henry: Well Anderson there is no final decision, but Democrats close to the White House are saying that they are now actively considering the possibility of doing a go it alone strategy. It’s a budget maneuver, very obscure known as reconciliation where they would only need a simple majority, 51 votes instead of 60 votes to push through health reform. Republicans would scream that this is a power grab, it’s an underhanded move but White House officials privately are already laying out the ground work by saying look, we’ve been working with republicans for months. If they don’t get something done in the next weeks we’re going to have to take drastic measures….”If we’re going to have to push it through no ones going to remember how messy it is, but they’ll remember at the end of the day that we got health care reform done,” his ad visors have said, “a win is a win.”

The Democratic Party won a mandate in the general election so how can it be a power grab, Ed?

via White House may ditch Republicans after all on health care reform | Crooks and Liars.

Good question, as republican were fond of saying in 2001 and 2005, elections have consequences and we won. Money quote from the NY Times article:

Rahm Emanuel, the White House chief of staff, said the heated opposition was evidence that Republicans had made a political calculation to draw a line against any health care changes, the latest in a string of major administration proposals that Republicans have opposed.

“The Republican leadership,” Mr. Emanuel said, “has made a strategic decision that defeating President Obama’s health care proposal is more important for their political goals than solving the health insurance problems that Americans face every day.”

Who do you think is on your side?

Frank: When you ask me that question I’m going to revert to my ethnic heritage and answer your question with a question. On what planet do you spend most of your time?

[....]

You want me to answer the question? Yes. As you stand there with a picture of the President defaced to look like Hitler and compare the effort to increase health care to the Nazis, my answer to you is as I said before, it is a tribute to the First Amendment that this kind of vile, contemptible nonsense is so freely propagated. Ma’am, trying to have a conversation with you would be like trying to argue with a dining room table. I have no interest in doing it.

via Frank Confronts Woman With Obama as Hitler Picture at Town Hall: On What Planet Do You Spend Most of Your Time? | Video Cafe.

That’s one pissed off old Queen. He does what most Congressmen would not, he speaks truth to crazy. Here’s the video:

Best Wonkette comment:

The “oh shit, I just became a youtube celebrity for the wrong reasons” look on her face was priceless

The Senate is trickier. But the conference report can’t be amended. It can’t be changed, or held up in committee. It can be filibustered, and it can be voted against. Those are the options. If three Democrats opposed the legislation and wanted to kill it, they would literally have to filibuster it (this is assuming that Democrats have 60 votes, which is not certain given Kennedy’s health). That would be a very hard thing to do at that stage in the game. It would isolate the obstructionists, ensuring funded primary challenges and the enduring enmity of the Senate leadership and the White House. Kent Conrad can say that there aren’t enough votes for a public option and imply that he’s just protecting the final bill from defeat. But is he willing to be one of those “no” votes? Is he willing to filibuster? That’s a different game indeed.

The White House has worked hard to imply to its liberal supporters that they need to be patient with the disappointments of the Senate process but confident in the outcome of conference committee. On July 20, Obama spoke to a group of liberal bloggers on a conference call and articulated the strategy quite explicitly:

“Conference is where these differences will get ironed out. And that’s where my bottom lines will remain: Does this bill cover all Americans? Does it drive down costs both in the public sector and the private sector over the long term? Does it improve quality? Does it emphasize prevention and wellness? Does it have a serious package of insurance reforms so people aren’t losing health care over a preexisting condition? Does it have a serious public option in place? Those are the kind of benchmarks I’ll be using. But I’m not assuming either the House and Senate bills will match up perfectly with where I want to end up.”

This strategy, of course, relies on a lot of trust, and that’s not something the White House has these days. But that’s the administration’s argument: Phase one is not a negotiation, and you can’t demand a perfect product out of both chambers. In this period, the White House will do whatever is necessary to clear a bill out of the Senate, and if that means bargaining away the public option, so be it. Phase two is a negotiation, and you should trust the White House to produce a good piece of legislation. And phase three, well, that’s the easy part. That’s passage. Hopefully.

via Ezra Klein – When Health Care Does Become a Negotiation.

So the President to hold the course and wait for things to progress to the conference committee and trust that Sen. Reid will stack the Conference committee with liberal leaning Senators, plus the required committee chairs, to iron out the final version. Then we’ll see if the Blue Dog Democrat types in the Senate have the stones to vote against cloture on a certain Republican filibuster.

If all this parliamentary maneuvering seem unfamiliar to you, perhaps you should review some old School  House Rock:

Grassley drew strong rebukes from Democrats after he seemed to suggest at one town hall that conservatives were justified in worrying that a provision in the House version of the legislation that pays for end-of-life consultations would lead to the federal government playing a role in deciding when to “pull the plug on Grandma.” Grassley says he opposes that counseling as written in the House version of the bill, but a spokesman said the senator does not think the House provision would in fact give the government such authority in deciding when and how people die. The House bill allows patients to decide for themselves if they would like such counseling.

via Iowans Closely Watching Sen. Grassley on Health-Care Reform – washingtonpost.com.

What a slimy spineless piece of crap Grassley is. He doesn’t actually believe the bill would ” give the government such authority in deciding when and how people die”. I can only assume he opposes it to appease the adamantly ignorant wing of the GOP. In fact he voted for a very similar provision as part of the Medicare Part D benefit a few years ago. What a gutless bastard.

I might actually go back to watching him again…

The footage in the link is from the Rachel Maddow show (I can’t directly embed it, phooey). She shows footage from meetings in various Congressional districts where organized groups are intentionally disrupting the event with the purpose of intimidating the  Congressional Representatives ans suppressing any real discussion and debate. Is shouting people down and intimidation a just exercise of democracy? I don’t think so, I think they should have Police on hand to eject people who are disruptive. Hooliganism isn’t protected speech.

Certainly people should be allowed to speak their mind, but disruption and intimidation organized by Washington lobbyists and astroturf groups isn’t part of the deal. It’s an unholy marriage of teabagger nuttiness and manipulation by those with a stake in maintaining the status quo, because they profit from a system that’s inefficient and leaves million of Americans without health coverage. They may regret their cleverness, in the end.

This is the kind of thing they can start moving, but may not be able to control once it has it’s own inertia. It has ugly overtones, and should violence breakout those of us who favor intelligent reform need hang this around their necks like an albatross.

Here’s where they get their instructions, directly from Freedom Works, Dick Armey’s lobbying firm. It’s not grassroots action. It’s front organizations trying to (almost literally) strong arm Congress into agreement with moneyed health care interests represented by DC insiders using tactics one would normally see at soccer games in Europe.