Ron Brownstein at The Atlantic:
When I reached Jonathan Gruber on Thursday, he was working his way, page by laborious page, through the mammoth health care bill Senate Majority Leader Harry Reid had unveiled just a few hours earlier. Gruber is a leading health economist at the Massachusetts Institute of Technology who is consulted by politicians in both parties. He was one of almost two dozen top economists who sent President Obama a letter earlier this month insisting that reform won’t succeed unless it “bends the curve” in the long-term growth of health care costs. And, on that front, Gruber likes what he sees in the Reid proposal. Actually he likes it a lot.
“I’m sort of a known skeptic on this stuff,” Gruber told me. “My summary is it’s really hard to figure out how to bend the cost curve, but I can’t think of a thing to try that they didn’t try. They really make the best effort anyone has ever made. Everything is in here….I can’t think of anything I’d do that they are not doing in the bill. You couldn’t have done better than they are doing.”
Gruber may be especially effusive. But the Senate blueprint, which faces its first votes tonight, also is winning praise from other leading health reformers like Mark McClellan, the former director of the Center for Medicare and Medicaid Services under George W. Bush and Len Nichols, health policy director at the centrist New America Foundation. “The bottom line,” Nichols says, “is the legislation is sending a signal that business as usual [in the medical system] is going to end.”
Joe Klein at Swampland at Time:
There are a couple of aspects of this historic vote that deserve notice here:
1. My favorite provision requires that all members of Congress give up their federally-funded health care benefits and join the health care exchanges that will be set up by this bill. This is brilliant politics, addressing the tide of populist anger and fears of incipient socialism. But it also makes an important substantive point. The future of health care reform in this country will depend on how effectively the exchanges–health insurance super-stores–are working. If members of Congress have to participate in this system, you can bet they’ll insist on a array of choices, similar to the system they currently use, the Federal Employees Health Benefits Plan.
2. One of the ways that choice can be enhanced in those exchanges is a public option. I watched Joe Lieberman, the Senator from Aetna, slag the public option on Meet the Press this morning. He was armed with a new CBO score that has public option policies costing more than private policies in the proposed new system (I’d love to know more about that one, given the add-on private costs of corporate profits and advertising). The question David Gregory should have asked next was: So if you want more competition, as you say, are you in favor of lifting the anti-trust exemption that health insurers now enjoy? If Lieberman wants to be philosophically consistent, if he really wants to offer more choice and greater competition, he should announce that he will filibuster any bill that doesn’t end the anti-trust exemption. Right now, because of Ben Nelson, the Senator from Omaha Mutual, the Senate bill doesn’t contain such a provision. It should. (By the way, I still consider the public option a relatively small bit of business–certainly nothing that would cause me to vote for or against the bill. There are other far more important provisions.)
3. Thanks to Oregon’s Ron Wyden, the Senate bill contains a provision that will allow employees of companies that offer health care plans to go to a public exchange, if the exchange offers a plan they like better than the benefits they’re getting on the job. That’s an excellent idea…and it should be expanded. Any company that wants to offer its employees health benefits via the Exchange route should be allowed to do so. The more people involved in the Exchange system, the better the rates are likely to be and the more choices offered.
This, most health insurance experts believe, is the best way to rebuild the U.S. health care system–through regional public exchanges or one big national exchange that will offer a range of health insurance options. Such a system will make it easier to regulate the health insurers and monitor the system. I’d like to see an Exchange system that includes all Medicaid and Medicare recipients as well. True fairness demands that every American receives the same choice of benefits at the same choice of rates.
At this point, every step forward has a certain historic significance. The Senate voted 60 to 39 last night to bring a health care reform bill to the floor for the first time ever, marking the latest in a series of milestones. But that there was any drama at all surrounding last night’s vote underscores the silliness of the process — there was a lengthy, overwrought debate yesterday about whether to have an even longer, more overwrought debate in December.Or put another way, yesterday’s vote (supermajority on the motion to proceed) makes it possible to have other votes (supermajority on amendments), which will make it possible to have another vote (supermajority on cloture), which will hopefully lead to another vote (final passage).
If the Senate leadership had 59 votes lined up for cloture, finagling one lone holdout would be tricky enough. But as the bill currently stands, there are four holdouts who are all prepared to vote with Republicans to kill health care reform. Indeed, two of the four — Lieberman and Lincoln — were pretty emphatic about their intentions yesterday, leaving themselves no meaningful wiggle room.
Much of the debate will focus on the public option, of course, but votes on abortion, immigrants, subsidy rates, and medical malpractice will be nearly as contentious.
Senate Minority Leader Mitch McConnell (R-Ky.) said late yesterday, “The battle has just begun.” It was the only accurate remark he made all day.
Last night was another achievement that keeps the ball rolling. Regrettably, it’s still rolling uphill.
Byron York at Washington Examiner:
The extraordinary thing about the dramatic events surrounding the health care bill in the Senate is that there was any drama at all. Lawmakers were simply voting to begin debate on the Democratic version of health care reform. Just begin debate — not end it, and not move on to a final vote.
If Democrats, with a 60-vote majority in the Senate, had not been able to begin debate on the top Democratic policy priority in a generation — well, that would have been a devastating turn of events, both for the party and for President Obama. And yet just starting debate proved difficult, and only on the last day did the 60th Democratic vote fall in place in favor of beginning the process.
I asked a high-ranking Republican Senate source whether it was really that hard to get the Democratic votes together. Could it have been a media-fed story, with reporters looking to inject some unwarranted drama into the proceedings? No, I was told. “It really was that hard for them to get to 60 just to proceed,” the source said. “Very telling.”
And judging by the statements of four moderate Democrats — Lieberman, Lincoln, Landrieu, and Nelson — it will be far, far harder when the process comes to the really important vote, the one that would bring debate to a close and move on to an up-or-down vote on the Democrats’ health care plan. On Saturday, all four of those Democrats publicly threatened to side with Republicans and kill the bill before it can move to a final vote, unless their concerns are met.
Bruce Drake at Politics Daily:
Louisiana Sen. Mary Landrieu was one of the wavering votes Democratic leaders needed to reach the magic 60 number that would clear the way for the health care reform bill to get to the Senate floor, and her decision to vote with the party came after she was offered a sweetener of at least $100 million in extra federal aid for her state, the Washington Post reports.
Dana Milbank, the paper’s often caustic chronicler of Washington, said staffers on Capitol Hill were calling it the “Louisiana purchase,” the state Landrieu represents.
But Landrieu made clear her vote was not a sure thing as the Senate goes to work on the bill and more votes come up.
“My vote today,” she said, “should in no way be construed by the supporters of this current framework as an indication of how I might vote as this debate comes to an end.” Among the concessions she’ll seek: more tax credits for small business and a removal of the version of the “public option” now in the bill.
Asked about the sweetener for Landrieu, Sen. Charles Schumer said on CBS’ Face the Nation said “Mary Landrieu is a very good legislator, and she does two things very well. One, she delivers the goods for Louisiana. She has constantly, and I think the people of Louisiana respect her for it. “
But on ABC’s This Week, GOP Sen. Jon Kyl said, “You haven’t heard Republicans saying, here is my price. That’s the problem when you have to get 60 and people in your caucus have severe reservations about the bill. In order to get every single vote, sometimes you do resort to things that appeal to a particular senator, or in the case of the House, to a particular representative. The American people don’t like that when they see it. “