The numbers may not lie, but Howard Fineman, eh

Newsweek's resident sage, Howard Fineman, talks to a Democratic Congressman whom he can't name of course, who voted for the health care bill "because of party loyalty and admiration for President Obama," but now regrets his decision.

A Democratic senator I can't name, who reluctantly voted for the health-care bill out of loyalty to his party and his admiration for Barack Obama, privately complained to me that the measure was political folly, in part because of the way it goes into effect: some taxes first, most benefits later, and rate hikes by insurance companies in between.

Besides that, this Democrat said, people who already have coverage will feel threatened and resentful about helping to cover the uninsured—an emotion they will sanitize for the polltakers into a concern about federal spending and debt.

On the day the president signed into law the "fix-it" addendum to the massive health-care measure, two new polls show just how fearful and skeptical Americans are about the entire enterprise. If the numbers stay where they are—and it's not clear why they will change much between now and November—then the Democrats really are in danger of colossal losses at the polls.

Yeah, I don't know what "sanitize for the polltakers" means either. But anyway, first let's put that in to perspective. A man paid to punditize American national politics thinks that poll numbers taken in March will be fixed until November, and who also believes he can predict in which direction those numbers will take in the next eight months, well, that man should not be paid to do so.

But let's look at his basic contention, that the law is all pain now (in the form of taxes and higher premiums, all before November) for a little gain later. Um, I think debaters have a Latin term for that: Bullshitius Ignoramitus.

While the biggest changes will not take effect until 2014, some important provisions will begin as early as June, while others will kick in by the end of the year. These include significant new restrictions on the insurance industry and new protections for consumers who already have health insurance. There are also perks for Medicare recipients and help for young adults. And in just 90 days there will be new coverage for people who have lost health insurance and can’t qualify for an individual policy.

“The basic thrust of this law is that all of these nooks and crannies, all these gaps where private insurance has left you without any option, those are going to be taken away,” said DeAnn Friedholm, the campaign director of health reform for Consumers Union, the nonprofit publisher of Consumer Reports. “It’s complicated, but it does establish a very key, important policy that you’re going to have options, regardless of your health situation or your employment situation.”

[...]

If you haven’t had insurance for six months, and you can’t afford or don’t qualify for insurance because of a pre-existing medical problem, you may be eligible for a new federal “high risk” pool to be offered by the end of June.

[...]

Beginning in September, the new law is expected to stop insurance companies from rejecting children or excluding coverage because of pre-existing medical problems. That’s what happened to Diane Knight, 52, of Orem, Utah, when she tried to get health insurance for her 17-year-old daughter.

Although Ms. Knight and her husband had family insurance in the past, they lost it when they left their jobs to start a small business. When they discovered that they were unable to get new insurance because both had a past cancer diagnosis, they sought an individual policy just for their daughter. But she was rejected, too, because she had used expensive prescription acne cream when she was younger and the insurance company did not want to pay for that in the future.

[...]

This year Medicare recipients with high drug costs will get a rebate of up to $250. And in 2011, the plan will pick up a larger share of brand-name drug costs. In addition, Medicare recipients won’t be charged co-pays or deductibles for preventive care like immunizations and cholesterol screening.

[...]

Starting in September, adult children younger than 26 can be added to their parent’s health policy. Some plans already extend coverage to adult dependents as long as they are full-time students. Although Health and Human Services still must announce the exact eligibility requirements, Congress deleted a restriction related to marital status.

[...]

Beginning in September, insurance companies will no longer be able to rescind a policy once someone gets sick, nor can they impose lifetime limits on coverage.

Today, honest mistakes on a lengthy insurance application — like forgetting to disclose a parent’s high blood pressure — could be grounds for losing your insurance.

Under the new rules, companies generally can’t rescind a policy for a minor application error. “The law takes away the incentive for insurance companies to look for application mistakes,” said Marian Mulkey, senior program officer with the California HealthCare Foundation. “There have been some egregious examples of someone getting cancer triggering a review of years of health history that seems very targeted and punitive.”

[...]

How the changes will affect existing insurance costs is a source of fierce debate. Over all, the Congressional Budget Office has said that by 2016, the provisions in the new law will result in little if any increase in premiums for people with employer-sponsored plans. People with nongroup plans (those not offered by employers) may see increases, but more than half the enrollees in nongroup plans will qualify for federal subsidies, lowering costs for middle- and moderate-income families on average by about 60 percent, the C.B.O. said.

Beginning in September, insurance firms will face new limits on administrative costs and executive compensation. Violations will trigger rebates to consumers. In addition, the overhaul package includes additional money for states to review unreasonable increases in insurance rates.

[...]

This year tax credits as high as 35 percent of premiums will be available to many small businesses that offer health coverage to employees.

As for these immediate taxes, not sure what he means by that, unless he's referring to eliminating tax breaks on federal subsidies to huge corporations. In 2013, by the way.

As for taxes on the middle class, there is a lot of talk, such as in this hit piece for Business Week, about "hidden taxes" that may come to pass at some point in the future:

True, most won't see direct tax hikes, per se. Few believe Obama will go back on his vow to keep income tax rates the same for all but the top brackets when the Bush tax cuts expire at the end of 2010. And top White House economic adviser Lawrence H. Summers says Obama can keep his pledge while finding more than enough cost cuts and revenue elsewhere. "There is substantial scope for expenditure reductions in health care and for raising enough revenues from people with incomes over $250,000 and from companies," he says.

A key question, though, is whether over the next couple of years, middle-income families will face a host of surcharges, fees, reduced tax breaks, or other increased costs. Daniel Clifton, a Washington-based policy analyst for Strategas Research Partners, argues that Congress has purposely loaded onto the corporate sector the increased taxes needed to pay for the reforms to avoid politically unpopular individual tax hikes. But the added costs will eventually be shifted to customers. "It all depends on what your definition of 'tax' is. Everyone is mincing words here," says Clifton. "There isn't enough money available in just extracting more from corporate taxes or rich Americans."

But beyond all that nonsense stands Fineman's main area of concern trolling for Democrats, that the health care bill is wildly unpopular and a killer for Dems in the fall. First, if you look at the polling data, many respondents who say they don't like the bill say they don't because it doesn't go far enough. I doubt that will send them into the arms of Republican candidates. But even more broadly, as we expected, once the legislative process ended and the bill signed into law, people stopped hating it so much and Dems are now seen as having accomplished something, particularly among their base voters.

I'm not sure that there's yet been enough time to assess whether the Democrats' passage of health care reform seven days ago could mitigate -- or broaden -- their losses. Most polls suggest that the health care reform bill itself has become somewhat more popular since passage. But President Obama's approval ratings are little moved, and there has thus far been little new polling on the generic ballot or perceptions of the Democratic congress. Moreover, any changes in the polling may prove to be temporary.

Still, there is one set of numbers that potentially contain relatively good news for the Democrats. These concern the enthusiasm gap, which may be lessening. Daily Kos / Research polling has found that while Republican voters remain exceptionally engaged by the midterm election cycle, Democrats are becoming increasingly engaged as well. Rasmussen, meanwhile, has found that about 5-7 percent of voters nationwide have gone from being somewhat approving of to Obama to strongly approving of him -- and almost all of the movement is accounted for by Democrats. (Obama's disapproval -- including his strongly disapprove numbers -- are little changed in the poll).

I don't want to say that health care legislation is going to be the wave that gives Democrats their permanent majority, but it is worth noting that people's views change as time goes on, that enacting legislation is typically better than cravenly refusing to because of bad poll numbers, and that Obama and the Dems are only now beginning to make the case for the legislation, while Republicans have had well over a year to denigrate it.

Quinnipiac found about a 4-5 point bump in support for the health care bill itself, although a larger bump (8 points) in Obama's handling of the issue. Obama's overall approval rating, on the other hand, was little changed.

What's a bit more surprising is that Quinnipiac also found a decent-sized bump in approval of the Democrats in Congress: from a pathetically low 30 percent to a not-quite-as-awful 36 percent. And most of the bump came from independent voters, among whom approval increased from 19 percent to 33.

Fineman, you know, comes from a long line of fools.

I worry for his job security

How long can Ezra Klein get away with calling his Kaplan Daily colleagues, as evidenced by their almost magisterial lack of empathy, "clinically disordered?"

For Robert Samuelson, the fact that the Affordable Care Act is fully paid for and in fact reduces the deficit isn't good enough. "If the administration has $1 trillion or so of spending cuts and tax increases over a decade, all these monies should first cover existing deficits -- not finance new spending," he writes. "Obama's behavior resembles a highly indebted family's taking an expensive round-the-world trip because it claims to have found ways to pay for it. It's self-indulgent and reckless."

"Self-indulgent." Wow. Jon Chait puts his back into it:

What an interesting phrase. Let's consider both words, starting with the end. It contains the assumption that some basic health insurance is an "indulgence," rather than a necessity. I defy anybody to make a careful study of the actual conditions of people who lack health insurance -- such as can be found in Jonathan Cohn's book "Sick" -- and come to this conclusion.

Next, there's the word "self." Self-indulgent is when you spend money to indulge yourself. The Bush tax cuts, which massively enriched George W. Bush and Dick Cheney, could be described as self-indulgent. Samuelson supported those, incidentally. President Obama and the Democrats who enacted health care reform all have insurance. Even if you consider providing basic medical care to people who lack it an "indulgence," they are not indulging themselves. They are "indulging" others.

And before you think this is all about Samuelson, consider that Charles Krauthammer calls coverage "candy." There's an absence of empathy here that borders on a clinical disorder. But even to play on their ground, let's be clear: There were no votes for cost controls in the absence of coverage expansions. Democrats accepted the excise tax, the increase in the Medicare payroll tax, the Medicare cuts and commission, and all the other pieces as part of a deal including near-universal coverage. No coverage? No deal. The deficit will be smaller because of health-care reform. The realistic alternative was not more deficit reduction, as Samuelson implies, but no deficit reduction.

Ezra goes on to argue that this is partly Democrats' fault. They chose to appease these fiscal "elites" by focusing on cost control, not simply universal coverage. They should have instead argued that achieving the latter is the ideal, the former is simply a nice bonus.

Mission not accomplished

It is indeed a "big fucking deal" that, after last night's vote in the House, the health care legislative process is done for the time being. But Jonathan Cohn points out that now the real work begins -- implementing the law.

Joe Biden -- true that

"Remember the dignity of the House"

It's difficult to discern where Rep. Boehner's cynicism meets his ignorance.

Congratulations to the 219 Democratic Congressman who passed legislation that is both relatively incremental and historic at the same time.

And special congratulations go out to Nancy Pelosi, who should go down as one of the most effective Speakers in many years.

GPS for health care reform

We're in the home stretch, except that it's less a stretch than a maze. The NYT has a useful road map.

Brooks: Amuse me

Two columnists. One paper.

Krugman:

So what did we learn from the summit? What I took away was the arrogance that the success of things like the death-panel smear has obviously engendered in Republican politicians. At this point they obviously believe that they can blandly make utterly misleading assertions, saying things that can be easily refuted, and pay no price. And they may well be right.

But Democrats can have the last laugh. All they have to do — and they have the power to do it — is finish the job, and enact health reform.

Brooks:

Fourth, you got to see how confident Republicans are. Obama’s compromise offer is one the Republicans can happily refuse. In their eyes, he is saying: If you don’t make some concessions now, I’m going to punch myself in the face. If you don’t embrace parts of my bill, I will waste the next three months trying to push an unpopular measure through an ugly reconciliation process that will probably lead to failure anyway.

While the writers don't write their own headlines, in this case, their columns' respective headlines says it all. For Krugman, it really is about "Afflicting the Afflicted." And for Brooks, it's always, always about the show -- "Not as dull as Expected."

I really never appreciated quite how cynical Brooks is. He doesn't seem to have much appreciation for all those Applebee diners he claims to understand so well. Republicans looked pretty good! The bill is going to die! And while he claims that Republicans have a lot of great ideas -- exchanges, market place solutions, etc. -- he doesn't seem to understand what's driving up the cost of health care in this country, and he doesn't care to try. And he's either not been paying attention or he doesn't really care, that, as the president said, much of what Coburn had to say -- who did in fact know what he was talking about -- were valid and addressed in the Senate bill.

And while Brooks claims to understand that the health system is a mess, he sides with Republicans' obstructionism because...well, just because.

Somerby blames "the media" and, most acidly, Maddow, for the stupidity of our discourse and the stunning arrogance of Republican leadership. I'd say the blame falls more squarely on our "serious, thought leaders" like Brooks (not to mention Friedman, Rose, Hiatt, et. al.).

Health care chat

TNC and EK. Worth a read.

Stop whining

Shorter Krugman: Pass the fucking thing already.

Longer Krugman:

Finally, some Democrats want to just give up on the whole thing.

That would be an act of utter political folly. It wouldn’t protect Democrats from charges that they voted for “socialist” health care — remember, both houses of Congress have already passed reform. All it would do is solidify the public perception of Democrats as hapless and ineffectual.

And anyway, politics is supposed to be about achieving something more than your own re-election. America desperately needs health care reform; it would be a betrayal of trust if Democrats fold simply because they hope (wrongly) that this would slightly reduce their losses in the midterm elections.

Now, part of Democrats’ problem since Tuesday’s special election has been that they have been waiting in vain for leadership from the White House, where Mr. Obama has conspicuously failed to rise to the occasion.

But members of Congress, who were sent to Washington to serve the public, don’t have the right to hide behind the president’s passivity.

Bear in mind that the horrors of health insurance — outrageous premiums, coverage denied to those who need it most and dropped when you actually get sick — will get only worse if reform fails, and insurance companies know that they’re off the hook. And voters will blame politicians who, when they had a chance to do something, made excuses instead.

Ladies and gentlemen, the nation is waiting. Stop whining, and do what needs to be done.

And kudos to Jon Stewart. We need progressive voices on the teevee that actually counter the bullshit coming from the other side, not add to the miasma.

"You never call"

For those of you who never call your Congressman's office, it's easy. Just go here and enter your zip code. I did, called the number, and an aid picked up after one ring. Took only a few seconds to relay the message to support the Senate Health Care bill and get this thing done. The guy seemed happy to hear a constituent voicing support, especially since I think the most vocal of our citizenry tend to be batshit insane. Just sayin'.

UPDATE: I'd be remiss if I didn't add that if you happen to be represented by a Republican, I guess you can save your nickel.

Solving problems is why they're there

Obama previews his campaign for health care reform and the 2010 midterms.

So, I know everybody in the media is all in a tizzy -- "Oh, what's this going to mean politically?" Well, let me tell you something. If Republicans want to campaign against what we've done by standing up for the status quo and for insurance companies over American families and businesses, that is a fight I want to have. (Applause.) If their best idea is to return to the bad policies and the bad ideas of yesterday, they are going to lose that argument. What are they going to say? "Well, you know, the old system really worked well; let's go back to the way it was"? That's not going to appeal to seniors who are now seeing the possibility of that doughnut hole finally closing and so they can finally get discounts on their prescriptions. (Applause.) That's not going to appeal to the small businesses who find out all the tax credits that they're going to get for doing right by their employees -- something that they have been wanting to do, but may not have been able to afford. It's not going to be very appealing to Americans who for the first time are going to find out that they can provide coverage to their children, their dependents, all the way up to the age of 26 or 27.

And that's why I'll be out there waging a great campaign from one end of the country to the other, telling Americans with insurance or without what they stand to gain -- (applause); about the arsenal of consumer protections; about the long-awaited stability that they're going to begin to experience. And I'm going to tell them that I am proud we are putting the future of America before the politics of the moment -- the next generation before the next election. And that, after all, is what we were sent up here to do: standing up for the American people against the special interests; solve problems that we've been talking about for decades; make their lives a little bit better; make tough choices sometimes when they're unpopular. And that's something that every one of you who support this bill can be proud to campaign on in November.

Now, I know that some of the fights we've been going through have been tough. I know that some of you have gotten beaten up at home. Some of the fights that we're going to go through this year are going to be tough as well. But just remember why each of us got into public service in the first place -- we found something that was worth fighting for. There was something we thought was important enough that we were willing to stand up in the public square, risk loss, risk embarrassment, because we knew in our hearts that something wasn't right, that we weren't in some measure living up to the American ideal, and that we thought that if we got involved and engaged in the democratic process, somehow we could make it a little bit better.

Echoing Ezra, I have no idea how persuasive this is to the public at large, but the Democratic base needs to hear stuff like this. As for the general public -- getting something done and solving problems is exactly what many voters feel isn't happening in Washington. Having a huge piece of legislation under their belts, regardless of how much their opponents will rail at it, is a lot better than having come this far and failed going into November.

Robot nurses

Denmark's use of medical technology, particularly technology that allows elderly patients to conduct tests at home and send the results to their doctors over the internet, is certainly intriguing and one of the more exciting possibilities of health care reform in this country. One of my biggest peeves is the need to fill out reams of data about myself every time I visit a different health care provider, and imagine if those who require health monitoring don't have to find a ride to the doctor or spend the day waiting in hospitals.

COPENHAGEN — Jens Danstrup, a 77-year-old retired architect, used to bike all around town. But years of smoking have weakened his lungs, and these days he finds it difficult to walk down his front steps and hail a taxi for a doctor’s appointment.

Now, however, he can go to the doctor without leaving home, using some simple medical devices and a notebook computer with a Web camera. He takes his own weekly medical readings, which are sent to his doctor via a Bluetooth connection and automatically logged into an electronic record.

“You see how easy it is for me?” Mr. Danstrup said, sitting at his desk while video chatting with his nurse at Frederiksberg University Hospital, a mile away. “Instead of wasting the day at the hospital?”

He clipped an electronic pulse reader to his finger. It logged his reading and sent it to his doctor. Mr. Danstrup can also look up his personal health record online. His prescriptions are paperless — his doctors enters them electronically, and any pharmacy in the country can pull them up. Any time he wants to get in touch with his primary care doctor, he sends an e-mail message.

All of this is possible because Mr. Danstrup lives in Denmark, a country that began embracing electronic health records and other health care information technology a decade ago. Today, virtually all primary care physicians and nearly half of the hospitals use electronic records, and officials are trying to encourage more “telemedicine” projects like the one started at Frederiksberg by Dr. Klaus Phanareth, a physician there.

Several studies, including one to be published later this month by the Commonwealth Fund, conclude that the Danish information system is the most efficient in the world, saving doctors an average of 50 minutes a day in administrative work. And a 2008 report from the Healthcare Information and Management Systems Society estimated that electronic record keeping saved Denmark’s health system as much as $120 million a year.

Now policy makers in the United States are studying Denmark’s system to see whether its successes can be replicated as part of the overhaul of the health system making its way through Congress. Dr. David Blumenthal, a professor of health care policy at Harvard Medical School who was named by President Obama as national coordinator of health information technology, has said the United States is “well behind” Denmark and its Scandinavian neighbors, Sweden and Norway, in the use of electronic health records.

Denmark’s success has much to do with the its small size, its homogeneous population and its regulated health care system — on all counts, very different from the United States. As in much of Europe, health care in Denmark is financed by taxes, and most services are free.

Privacy about medical records is certainly an issue. As an aside, it's interesting to note the different aspects of privacy concerns in the U.S. and Europe; here, we worry (in addition to financial information) about medical records more than just about anything; in Europe, things like political persuasion and union membership are considered highly sensitive, probably because health insurance isn't an issue, while civil and labor unrest often are.

But there seems to be a lot of other daunting things to overcome:

• Our level of access to broadband, relative to countries like Denmark, is pathetic
• Our education levels, particularly among a broad swath of older Americans, is likely hard to overcome

And those are the reasonable concerns. Add to that fears that "Obamacare" is about the government "taking over health care" and wants to compile data on you for nefarious purposes, and the possibility of electronic medical records seems like a far-off dream.

Mandates work both ways

James Surowiecki explains the basic contradiction at the heart of the health reform bills -- members of both parties want to see an end to private insurance companies behaving like private insurance companies while still insisting on the supremacy of private insurance companies -- and explains why it's still worth doing.

So where’s the contradiction? Well, Congress’s support for community rating and universal access doesn’t fit well with its insistence that health-care reform must rely on private insurance companies. After all, measuring risk, and setting prices accordingly, is the raison d’être of a health-insurance company. The way individual insurance works now, risk and price are linked. If you’re a triathlete with no history of cancer in your family, you’re a reasonably good risk, and so you can get an affordable policy that will protect you against unforeseen disaster; if you’re overweight with high blood pressure and a history of heart problems, your risk of becoming seriously ill is substantial, and therefore private insurers will either charge you high premiums or not offer you coverage at all. This kind of risk evaluation—what’s called “medical underwriting”—is fundamental to the insurance business. But it is precisely what all the new reform plans will ban. Congress is effectively making private insurers unnecessary, yet continuing to insist that we can’t do without them.

The truth is that we could do just fine without them: an insurance system with community rating and universal access has no need of private insurers. In fact, the U.S. already has such a system: it’s known as Medicare. In most areas, it’s true, private companies do a better job of managing costs and providing services than the government does. But not when it comes to health care: over the past decade, Medicare’s spending has risen more slowly than that of private insurers. A single-payer system also has the advantage of spreading risk across the biggest patient pool possible. So if you want to make health insurance available to everyone, regardless of risk, the most sensible solution would be to expand Medicare to everyone. That’s not going to happen. The fear of government-run health care, the power of vested interests, and the difficulty of completely overhauling the system have made the single-payer solution a bridge too far for Washington, and for much of the public as well. (Support for a single-payer system hovers around fifty per cent.) That’s why the current reform plans rely instead on a mishmash of regulations, national exchanges, and subsidies. Instead of replacing private insurance companies, the proposed reforms would, in theory, turn them into something like public utilities. That’s how it works in the Netherlands and Switzerland, with reasonably good results.

One could recoil in disgust at the inefficiency and incoherence of the process—at the fact that private insurers will continue to make billions a year providing services the government has shown, via Medicare, that it can provide on its own. But, messy as the reform plans are, they can still dramatically transform the system for the good. Reform would guarantee that tens of millions of people who don’t have insurance will get it, and that people who have insurance now won’t have to worry about losing it. And, by writing community rating and universal access into law, Congress will effectively be committing itself to the idea that health care, regardless of risk, is a right. If a little incoherence is the price of that deal, it’s worth paying.

Merry Christmas America

Thank a progressive.

First, there’s the crazy right, the tea party and death panel people — a lunatic fringe that is no longer a fringe but has moved into the heart of the Republican Party. In the past, there was a general understanding, a sort of implicit clause in the rules of American politics, that major parties would at least pretend to distance themselves from irrational extremists. But those rules are no longer operative. No, Virginia, at this point there is no sanity clause.

A second strand of opposition comes from what I think of as the Bah Humbug caucus: fiscal scolds who routinely issue sententious warnings about rising debt. By rights, this caucus should find much to like in the Senate health bill, which the Congressional Budget Office says would reduce the deficit, and which — in the judgment of leading health economists — does far more to control costs than anyone has attempted in the past.

But, with few exceptions, the fiscal scolds have had nothing good to say about the bill. And in the process they have revealed that their alleged concern about deficits is, well, humbug. As Slate’s Daniel Gross says, what really motivates them is “the haunting fear that someone, somewhere, is receiving social insurance.”

Finally, there has been opposition from some progressives who are unhappy with the bill’s limitations. Some would settle for nothing less than a full, Medicare-type, single-payer system. Others had their hearts set on the creation of a public option to compete with private insurers. And there are complaints that the subsidies are inadequate, that many families will still have trouble paying for medical care.

Unlike the tea partiers and the humbuggers, disappointed progressives have valid complaints. But those complaints don’t add up to a reason to reject the bill. Yes, it’s a hackneyed phrase, but politics is the art of the possible.

The truth is that there isn’t a Congressional majority in favor of anything like single-payer. There is a narrow majority in favor of a plan with a moderately strong public option. The House has passed such a plan. But given the way the Senate rules work, it takes 60 votes to do almost anything. And that fact, combined with total Republican opposition, has placed sharp limits on what can be enacted.

If progressives want more, they’ll have to make changing those Senate rules a priority. They’ll also have to work long term on electing a more progressive Congress. But, meanwhile, the bill the Senate has just passed, with a few tweaks — I’d especially like to move the start date up from 2014, if that’s at all possible — is more or less what the Democratic leadership can get.

And for all its flaws and limitations, it’s a great achievement. It will provide real, concrete help to tens of millions of Americans and greater security to everyone. And it establishes the principle — even if it falls somewhat short in practice — that all Americans are entitled to essential health care.

Many people deserve credit for this moment. What really made it possible was the remarkable emergence of universal health care as a core principle during the Democratic primaries of 2007-2008 — an emergence that, in turn, owed a lot to progressive activism. (For what it’s worth, the reform that’s being passed is closer to Hillary Clinton’s plan than to President Obama’s). This made health reform a must-win for the next president. And it’s actually happening.

So progressives shouldn’t stop complaining, but they should congratulate themselves on what is, in the end, a big win for them — and for America.

Meanwhile, I know every column by The Dean can be summarized as "a pox on both their houses," but really, he's caricaturing himself here.

Reconciling the House and Senate bills

Improvements on cost reforms and speeding up implementation makes a great deal of political and practical sense to me.

House Speaker Nancy Pelosi and her colleagues are clearly in a tough spot. They already seem poised to yield on abortion and the public option to get a bill through the Senate. Now the Senate and the White House will be asking them to be more serious about holding down costs, too.

But the health experts I spoke to this week thought there was room for a sensible compromise. The House’s liberal leaders have a few realistic demands to make in exchange for accepting the cost-control measures in the Senate bill. Ideally, the House would also accept a couple of additional measures being pushed by John Rockefeller, Ron Wyden and other Senate Democrats.

After all, as Mr. Rockefeller and Mr. Wyden have shown, there is nothing that says liberals need to be in favor of high medical costs.

[...]

For starters, they can hold firm to their start date for the main provisions of the bill: Jan. 1, 2013, a year earlier than in the Senate bill. That would help the uninsured. It would also help deflate the argument that health reform is going to ruin health care — just as the start of Medicare, one year after its passage in 1965, beat back the argument that it equaled socialism.

Two, the House can push for a national insurance exchange, rather than the 50 different state exchanges envisioned by the Senate. State-by-state experimentation has its place, and giving the states no say over the exchange would be a mistake. But 50 exchanges, with 50 Web sites and 50 sets of rules, seems like a recipe for duplication and waste.

Finally, if House leaders are tired of watching senators preen as fiscal conservatives (and are tired of being called profligate by pundits), the House can call out the Senate on its own weakness. The Senate, like the White House, has been somewhat deferential to hospitals, drug makers and doctors’ groups. What if the House pushed for bigger discounts on prescription drugs, as its bill calls for — saving the government $10 billion a year in the process? Or what if the House insisted on bigger penalties for hospitals that don’t do enough to prevent hospital-borne infections?

Speeding up implementation would raise the price tag, but offsetting that with stronger cost controls could help to frame this as real reform and real benefits for the American people.

10 reasons* to support the bill

If you are dreading the holidays because of an anticipated argument over the Senate and House health care bills -- not with your tea partying Uncle Norbert who wants to kill the bill for some inchoate reasons having to do with a black Muslim man, but rather with your progressive cousin Lorelei who wants to kill the bill because it doesn't include a public option and doesn't hurt insurance companies -- than be sure to read Ezra's take down of Jane "It's a Bad Bill" Hamsher.

* Nine actually. Hamsher has a point on one of them.

Capra-esque

I don't recall being so excited about a series of cloture votes.

In the reception room just outside the chamber, Sen. Ted Kennedy's widow Vicki embraced Sens. Chris Dodd (D-CT) and John Kerry (D-MA). Health and Human Services Secretary Kathleen Sebelius, standing alone in the corner of the room, shouted a hearty congratulations to Dodd.

Still a ways to go, but...

Joining the club

Joe Biden:

I share the frustration of other progressives that the Senate bill does not include a public option. But I’ve been around a long time, and I know that in Washington big changes never emerge in perfect form.

Joe Biden considers himself a progressive? Welcome to the club, Joe.

The Senate we have, not the Senate we wish we had

From today's Krugmaniad:

Bear in mind also the lessons of history: social insurance programs tend to start out highly imperfect and incomplete, but get better and more comprehensive as the years go by. Thus Social Security originally had huge gaps in coverage — and a majority of African-Americans, in particular, fell through those gaps. But it was improved over time, and it’s now the bedrock of retirement stability for the vast majority of Americans.

Look, I understand the anger here: supporting this weakened bill feels like giving in to blackmail — because it is. Or to use an even more accurate metaphor suggested by Ezra Klein of The Washington Post, we’re paying a ransom to hostage-takers. Some of us, including a majority of senators, really, really want to cover the uninsured; but to make that happen we need the votes of a handful of senators who see failure of reform as an acceptable outcome, and demand a steep price for their support.

The question, then, is whether to pay the ransom by giving in to the demands of those senators, accepting a flawed bill, or hang tough and let the hostage — that is, health reform — die.

Again, history suggests the answer. Whereas flawed social insurance programs have tended to get better over time, the story of health reform suggests that rejecting an imperfect deal in the hope of eventually getting something better is a recipe for getting nothing at all. Not to put too fine a point on it, America would be in much better shape today if Democrats had cut a deal on health care with Richard Nixon, or if Bill Clinton had cut a deal with moderate Republicans back when they still existed.

As Krugman rightly points out, only a few years ago G.W. Bush and Senate Republicans were able to block a modest expansion of health care for children.

Re-start would mean no start at all

Kevin Drum speaks sense to those (I'm looking at you, Howard Dean), who think that since the Health care bill does not achieve all that we'd like it to, specifically a weakened public option, that Congress should start over.

If healthcare reform dies this year, it dies for a good long time. Say what you will about the Democratic leadership, but Harry Reid, Barack Obama, Rahm Emanuel, Nancy Pelosi, and Steny Hoyer all know this perfectly well. So do John Boehner and Mitch McConnell. (Boy do they know it.) But if it passes, here's what we get:

* Insurers have to take all comers. They can't turn you down for a preexisting condition or cut you off after you get sick.
* Community rating. Within a few broad classes, everyone gets charged the same amount for insurance.
* Individual mandate. I know a lot of liberals hate this, but how is it different from a tax? And its purpose is sound: it keeps the insurance pool broad and insurance rates down.
* A significant expansion of Medicaid.
* Subsidies for low and middle income workers that keeps premium costs under 10% of income.
* Limits on ER charges to low-income uninsured emergency patients.
* Caps on out-of-pocket expenses.
* A broad range of cost-containment measures.
* A dedicated revenue stream to support all this.

What's more, for the first time we get a national commitment to providing healthcare coverage for everyone. It won't be universal to start, unfortunately, but it's going to be a lot easier to get there once the marker is laid down. That's how every other country has done it, and that's how we did it with Social Security and Medicare, both of which had big gaps in coverage when they were first passed.

But if we don't pass it, we don't get any of this. Not now, and not for a long time. Instead of being actual liberals, we'll just be playing ones on TV.

This is not the "collapse of health care reform," as Dean so hysterically puts it. There's still a great deal of heavy lifting to do, especially if they hold firm to getting it out of the Senate by Christmas. Let's get this thing done and stop carping about.

UPDATE: Nate Silver is also speaking sense to those that would kill the bill.

UPDATE 2: As for Dean, he may be implementing his diabolical plan to get the bill passed by fooling the Liebermans of the world into thinking he hates it. My brain hurts.