Hold Your Nose

[Jeff In Milwaukee]

The Health Care Bill that came out of the U.S. Senate two weeks ago has frustrated those who wanted it to be more progressive. The lack of a Public Option – either a new government-run healthcare plan or an expansion of Medicare – is an omission that constitutes a deal-breaker for many liberals. If the House can pass healthcare legislation that includes a Public Option, why can’t the Senate do likewise?

But in its recalcitrance, the Senate is working precisely the way the Founders had intended. One purpose of the Senate was to act as a control device to prevent legislation that might be enacted in the heat of the moment or in response to transient public pressure. In the Federalist Papers, the authors acknowledge that this arrangement may often be an impediment to passing legislation, but it was a feature that they deemed necessary.

So how is that playing out today, more than 200 years later?

In addition to the basic structure of the Congress, there is also the issue of the Senate Rules. The Senate Rules are not enshrined in the Constitution, but are nearly as difficult to change once they have been agreed upon by its members. For our purposes, chief among those rules is Senate Rule Number 22, which was adopted in 1917 and requires a (now) three-fifths majority of Senators to vote to close debate on a bill before the Senate.

Prior to 1917, a Senator had the prerogative to hold the floor for as long as he had a mind to, effectively suspending all other work of the United States Senate until the offending legislation had been pulled from any further consideration. The Cloture Rule put a substantial limit on the powers of an individual Senator, but it STILL requires 60 Senators to agree to proceed with a vote. Given the current composition of the Senate, this is no small hurdle.

We currently have 40 Republicans in the Senate who will, it appears, vote against any legislation supported by the White House. In practice, this requires that all 58 Democrats and two Independents MUST AGREE on any piece of legislation before it can proceed to a vote. If only ONE of these sixty Senators defects to the other side, then the Bill cannot advance.

Let that sink in for a moment – The Democratic Caucus is entirely beholden to Joe Lieberman to pass a motion for Cloture. And if that’s not bad enough, the Senate Leadership has to keep people like Ben Nelson and Mary Landrieu in line. One defection – ANY DEFECTION - effectively kills any legislation.

The other side of this coin is that if the legislation is sufficiently watered down to make it palatable to the “lowest common denominator,” there’s then the risk that any one of a dozen or more liberal Senators might defect just to kill what he or she might consider legislation that is insufficiently progressive. The simple truth is that in many respects, Harry Reid is one of the least-powerful members of the United States Senate.

In the run-up to the vote on Cloture, many on this board were recommending that the Senate Bill be killed rather than passed in its current form. This really begs the question: Why? Given the conservative opposition to even this lackluster version of reform, does somebody REALLY think that adding a robust Public Option is going to get a member of the Republican Caucus to defect? Is Mitch McConnell just biding his time and waiting for his chance to finally vote “YES” to a Canadian-style, single-payer system?

Given the composition of the current United States Senate, this is the best bill that we’re going to get. I don’t really expect you to like this Bill – there’s plenty about it to not like. There should be a Public Option, there should be greater emphasis on cost control, and the profits to be made by private insurers should be more restricted than they are right now. But each of those elements would have been grounds for one or more Senators to vote against Cloture, and there would have been no legislation at all.

It’s frustrating. The American people clearly expect Congress to do something about the massive costs of healthcare and the spiraling cost of insurance. Businesses are struggling with the cost of providing health insurance to their retirees, and families are losing their life savings while struggling with bills no honest man could pay. There is urgency to this matter that cannot be ignored.

But the political reality is that getting “Everything We Wanted” is not an option. It’s not, and there’s nothing that anybody on this Board can do to change that. Our only two remaining Options are “Some Of The Things We Wanted” and “None Of The Things We Wanted.”

You’re about to say, “Yes, but...”

Nope. Sorry. Senate Rules don’t allow for that. That’s why bona fide progressive Senators like Bernie Sanders and Tom Harkin and Al Franken are going to hold their nose and vote in favor.

This Bill, warts and all, is the only option on the table for this year. Now it’s possible that after the 2010 Election, we could have a larger Senate Majority. David Vitter (and his diaper) is up in Louisiana. Richard Burr just squeaked through in 2004 in North Carolina, as did John Thune in South Dakota. There are also 3-4 Republicans retiring in states that we could win (Missouri, New Hampshire, Ohio, and Kentucky).

But it’s also possible that we could lose seats in the next election. Michael Bennett is an unknown factor in Colorado. Harry Reid is in trouble in Nevada and Chris Dodd is looking shaky in Connecticut. Despite his longevity in the Senate, Arlin Specter’s job is up for grabs in Pennsylvania. A loss of even one seat in the Senate means that even with the “assistance” of Joe Lieberman, the Democrats can’t break a filibuster.

And so, quite literally, we’re given the choice between taking what we can get now and running the risk that we might get nothing in the future. Given the current composition of the Senate, the Bill could not possibly be any more progressive than it is. And given the uncertain future of our majority, we’re playing with other people’s lives if we simply trust that the next session of Congress will be more receptive to progressive legislation.

Hold your nose and take your medicine. It's going to taste awful.

[endless october]

1. both houses of congress should be locked in chambers.

and they should be forced to watch "Sicko" beginning to end until they get it fucking right.

or leave them in there forever.

[Jeff In Milwaukee]

4. Locked in chambers with limited oxygen(nt)

[Kaleva]

2. rec'd

[BeFree]

3. A realist, eh?

Don't you realist know that you can take your realism and stick it where the sun don't shine? You know where, in the same place the unrealist have their heads stuck. They want company, they do.
^^^^^^

So, this bill is progress? That's how I see it.

Frankly, if the system collapsed 200 million people would be screwed, so, can't have that. And if this bill keeps the system propped up for a few years then lets do it.

HNY!

[Jeff In Milwaukee]

6. The Reality Based Community...

Remember when we use that as a knock against the conservatives? Now people are tossing around "realist" as though it were a bad thing.

[BeFree]

7. It's like Fox News

I do realize that reality is f'n scary. So to ignore it is fashionable.
But the reality of this political system is what it is. Adapt, or die.

[Jeff In Milwaukee]

11. I can understand the frustration

even the rage people have on this issue. We ALL want to have every American to have access to affordable health care, and it's galling to have a caucus of 60 Senators and still not get what we want. But as you said, it is what it is.

[RaleighNCDUer]

5. I'd take the chance.

Rather than get locked into legislation which is BAD, we should do nothing now and get better later.

This is NOT reform.

The few good items in the bill which help can be added to other legislation. There is NO reason to pass a bill which does not include even a weak public option, much less single payer.

KILL THE BILL.

[SeattleGirl]

8. As someone who is uninsured, I must disagree with you.

I have always been insured, but a few months ago, I lost it because I don't have enough work to bill enough hours to keep it. My husband is unemployed, so no insurance there either.

Yes, there are a lot of problems with the senate bill (and the house version too), but to say "kill the bill" is to say that you don't care if more and more people die every day for lack of insurance, or go bankrupt because of medical bills (that happened to us), or any of the other things that people are currently facing because they 1) don't have insurance, or 2) are barely getting by because of the cost of their insurance.

I do not disagree with you for wanting a public option or single payer; I would love to see those in the bill too. But I just can't sit here and join in your kill the bill call.

[Jeff In Milwaukee]

10. Just out of curiosity, are you currently covered by an insurance plan? (nt)

[johnaries]

9. Well-stated. It's not a Great bill, but it is a good bill.

I supported a mandate, but I opposed a mandate without a robust public option. When I look at the rest of the bill, there are simply too many other good things in there to kill it. As Obama said earlier, the PO is (was) just a tiny piece of it.

It's not the giant leap forward we all wanted, but it is a big step forward.

If we gain more seats, then we can pass something better. But we may lose seats, and then there would be no chance to get even this bill passed. We can't afford to take that chance. We must pass this bill NOW.

[Edweird]

12. Sorry. I'm not going to 'just shut up and take it'.

I think you would be wise not to as well. There are billions upon endless billions for already wealthy criminal/predator/fuck-ups. Need money for jobs? Go beg the private sector.
The credit card reform got us %79.99 default interest rates.
The mortgage 'help' gave billions to the banks while millions are losing their homes or are in trouble. Less than 1% are getting real help. Everybody else gets the run-around and then loses their home.
Now we have this corporate giveaway to the very scumbags that brought about the need for health care reform in the first place. I can't think of any serious problem that is solved by MORE of what is causing the problem. This RW bullshit bill pushes us further from other developed countries. It will mean more of the same, except worse. I dare you to try to convince me that the bloodsuckers that profit from denying you care will suddenly become angels when we are FORCED to buy from them. If anything, it will get worse. In the end we will have even further to go before reaching any kind of real health care reform. I refuse to accept regression simply for the sake of passing legislation.

[Jeff In Milwaukee]

13. I agree with you, but only in part....

With regard this specific legislation, you don't don't get a third option. It is what it is.

That being said (and recognized), we go to work next year to get close the loopholes and expand the coverage offered by this bill. The reforms offered in the Bill are imperfect (do I win "Understatement of the Decade"?), and we shouldn't be satisfied them as they are. We've got work to do.

[laughingliberal]

15. Here's where I disagree with the underlying premise of the hold our nose and live with it for now

This thinking comes from the assumption that it is this bill or nothing. It presumes if this bill is defeated we will see no attempts again for many years. Of course, we think that. It's what happened before so we think we've seen this movie before and we think we know how it ends. There are key differences today that were not the case in 1993 and these differences are very powerful. The push for reform will not go away with defeat of this bill. Here's why.

Health care is now 17% of our economy and growing. This is draining every sector of the economy to some extent and will get worse. Business concerns are now pushing for reform of the system. It is hurting industry's chance at competitiveness on the world market and they can not afford to let it go as it has been. Other industries are not going to sit idly by and let the insurance cartels take all the money while people are left with nothing to spend on their products.

The insurance industry for all their bluster needs the system reformed. There are fewer people working and fewer of those who are working have employer sponsored benefits. They are losing large numbers of customers annually. They stand to lose vast numbers of customers over the next years as a huge part of this population turns 65 and escapes their grasp by becoming eligible for Medicare. The only way they are propping up their profits now is by charging higher premiums on those left in their clutches. Very soon they will have so few customers left the premiums they will need to charge to stay profitable will become unsustainable. There is a level at which they price themselves completely out of the market. They are very close to that level now. This is the reason health care reform is being addressed now. It is the number one reason it is being addressed now. The private, for-profit insurance companies are doomed if nothing is done in the very near future. After all, they can't move on to other countries and wave bye bye to us. The United States is, essentially, the only market they have. We have been looking at this backwards. We are not captive to them unless we allow it. They are captive to us. This bill is a bailout for this industry and they will not survive without it. I know they have made a good show of acting as if the status quo is what they want and pretending they do not want reform. It is a show for our benefit. They want reform and they can not survive without it. We do hold all the cards. The only thing keeping us from getting good reform is we haven't figured that out, yet.

[Jeff In Milwaukee]

16. I appreciate your comment...

And the points you raise in your last paragraph are all very good and worth remembering.

Let me see if I can paraphrase you. Because of changing demographics (we're getting older) and because of economics (high premiums), insurance companies are chasing after fewer and fewer potential clients. As a consequence, their premiums are getting higher because the pool is shrinking. If this reform doesn't happen, the industry is likely to crash as some point in the not-too-distant-future.

There's a chapter in "Moby Dick" where Ishmael and Queequeg go through the process of cutting into the whale after it has been taken. They are tied together by what's called the "Monkey Rope" and if one of them falls in, they'll both fall in. I think there may be something like that dynamic going on here, except that, you're entirely correct, the insurnance companies need us more than we need them.

A Public Option will ultimately drive the health insurance industry out of business (at least as we know it today). I'm sure there will be some "niche" markets with gold-plated plans for those who can afford them (those exist in other countries). But make no mistake about it, a Public Option will will encompass 80% or more of the insurance market as we know it.

What we want: Affordable health insurance for everybody that is gauranteed and completely portable.\

What they want: To stay alive.

I'm like the Swiss on the subject. I don't care if the insurance companies survive or not. If we can provide adequate covereage through some kind of government-regulated marketplace, that's fine with me; the insurers and stick around and make a (reaonsable) profit just like any other government contractor or any olther government-regulated utility. A problem that I see with this debate (particularly here at DU), is that a certain number of individuals have TWO agendas (agendae?). They want healthcare coverage for all AND they want to destroy the insurance industry for their past sins. I'm not there.

If it turns out that we can't go the Werner Von Braun route with the insurance companies, then a Public Option it is. The reform that we have on the table right now is the companies' last chance to prove that they can serve the public interest and make a profit. If they balk at the regulations, try to find loopholes, try to cheat their customers (and the government), they we bring the whip down.

[laughingliberal]

18. Agree completely with all of this except:

I do not believe we have enough in terms of regulation here and definitely not enough in terms of enforcement. I'm also very leery of leaving the Secretary of HHS to evaluate their premium increases, etc...for appropriateness. After watching the industry roll our elected officials on this, thus far, I am of the opinion they got everything they wanted in this bill. I see no reason to believe they will not continue to get everything they want going forward. I think we call their bluff now. I truly believe we will not wait another generation before this is revisited. Call their bluff now. They will be back asking to revisit it very quickly. Probably more quickly than most of the reforms would be kicking in anyway.

[Jeff In Milwaukee]

19. From the inside...

I work for a non-profit healthcare provider, and I can tell that the policing by DHHS is pretty effective in our neighborhood. All I have to say to may leadership is, "This is a compliance issue" and I get their swift and immediate cooperation.

I can't vouch for how that would play out on the insurers side, but I can say that we're really damned careful what we bill to Medicare and Medicaid, and we're constantly vigiliant about non-kickback issues.

[Edweird]

17. "I'm getting 95% of what I want"

IOW, those 'loopholes' aren't mistakes. They are features. After the way the other 'help' has played out, I am unable to believe for a second that there will be any 'going back to fix it'. There is no way on this earth that they are unaware that people are losing their homes even after the so-called 'reform'. The banks got tax payer money AND they still get 99% of the houses too. Nobody is 'fixing' this. Nothing is happening.

I firmly believe that people are intentionally being sold a seductive lie. They WANT to believe that 'it will get fixed'. Hell, I WANT to believe. But, given the track record, I can't reconcile it. (They were gonna go back and fix NAFTA, too)

If the problem is, as they claim, a lack of votes (btw single payer is preferred by a 2-1 margin among citizens, so I suspect this is a blatant lie) , then wait till after midterms and let's see if the balance changes in our favor. If so, then we can get, at the very least, a public option. If not, then we should kill it and try again later.

[Jeff In Milwaukee]

20. With regard to NAFTA...

Since it's been enacted, we've had either a Republican President or a Republican Congress in place - so it's no surprise that it hasn't been fixed yet.

In another thread I pointed out the closure of a big loophole in the Family and Medical Leave Act. FMLA was passed in 1993 (or thereabouts) and the fix of the loophole came last year. In other words -- and this would be a huge caution to my argument -- those loopholes will be fixed BUT there must be a Democratic Congress and Administration in place.

Now is the time to fix NAFTA.

Fixes to healthcare will come more quickly, I believe, because even Republicans can have their insurance cancelled and even those corporate Republicans still have to provide healthcare for their workers and retirees. If the insurance comapanies are scamming IBM and General Motors, they're not going to sit still for it.

[Edweird]

26. If it's worth doing, it's worth doing right the first time.

1993 was 16 years ago. FMLA isn't really a big deal in the grand scheme of things in any event.

In case you missed it, Obama made sure Canada knew he was lying to us about revisiting NAFTA. It isn't going to happen.

Who will fix the 'health care reform'? The same people that are putting a friendly face on corporate ass rape? Not likely. "I'm getting 95% of what I want"

When will it get fixed? My money is on 'don't hold your breath'. NAFTA has decimated the middle and working classes. But it's good for corporations. So it's not going anywhere. Coincidentally, this HCR also just happens to great for insurance corporations, but potentially nightmarish for the middle and working classes...

The other 'reforms' that have passed have been totally pro-corporate. They have, as far as I can tell, made things worse for citizens and better for the predators. "But he's OUR guy and we'll just go back and fix it later" looks like a recipe for disaster. HCR is, literally, life and death for a lot of people. I can't think of one issue that needs to be done right the first time more than this.

[laughingliberal]

14. +1 nt

[mmonk]

21. Change never comes through acceptance.

I feel we are fighting the same battles after a huge change election.

[sendero]

22. I'm so tired of this spin..

... Obama has better majorities to work with than Bush did for all kinds of odious legislation.

The idea that Obama has no leverage, no power to rein in miscreants like Lieberman is PURE FICTION.

[Le Taz Hot]

23. Thanks for the lecture, er, history lesson

but most of us didn't need it. Eighteen paragraphs devoted to, "Bend over and take it." No thanks.

[Cetacea]

24. Don't read it.

[Le Taz Hot]

25. Too late.

:shrug:

[Cetacea]

29. :) nt

[Tierra_y_Libertad]

27. My nose holding days ended after Chicago '68.

“Always vote for principle, though you may vote alone, you may cherish the sweetest reflection that your vote is never lost." --John Quincy Adams

[anonymous171]

28. I WANT FEDERAL RECALL ELECTIONS!