Last Call for Health Care: Dems Reach 60 Votes

The end is in sight for Democrats pushing through health care reform. However, Olympia Snowe is opting out, Nelson's compromise is making pro-choicers and anti-choicers tear out their hair, and Politifact explains that "reducing costs" really depends on the metric.

Senator Ben Nelson's vote for health care reform was locked in Friday night, after what was described as "a 90-minute nail biter." What was he doing? Making a call to "a Nebraska based anti-abortion activist' about the proposed compromise around abortion restrictions in the final bill. However, the final results infuriated both sides.

The Washington Post has the details on the compromise:

Under the new abortion provisions, states can opt out of allowing plans to cover abortion in the insurance exchanges the bill would set up. The exchanges are designed to serve individuals who lack coverage through their jobs, with most receiving federal subsidies to buy insurance. Enrollees in plans that cover abortion procedures would pay with separate checks — one for abortion, one for any other health-care services.

Pro-choice Senator Barbara Boxer also stands by the Nelson compromise, saying:

[T]his compromise ensures there is a firewall between private and public funds, and does not prohibit women from using their own private funds for their legal reproductive health care."

Anti-choice groups are already mobilizing against Nelson. The Susan B. Anthony list, in particular, demonstrates its measured reasoning and understanding of the right to choose:

Americans – women included – reject the radical feminist vision of an abortion for every home, at government expense.

Still, Nelson cleaned up during the proceedings. In exchange for his vote, the state of Nebraska will have the federal government fund their Medicaid expansion (in perpetuity) and got Nebraska non-profit insurers an exemption from a proposed industry wide tax. No wonder the Republicans are blasting this as " a sweetheart deal."

The deals extended to Nelson, as well as other moderate Dems, paved the way for the magic number 60, which has effectively stopped a Republican filibuster, allowing the bill to move forward before Christmas. Sen. John McCain lamented on Fox News that there is probably nothing the GOP can do to stop the bill.

But despite this small concession, many on the left are left with a lingering bitter aftertaste from the whole health care debacle. Paul Krugman used his column today to point out how the United States Congress has become "ominously dysfunctional:"

Now consider what lies ahead. We need fundamental financial reform. We need to deal with climate change. We need to deal with our long-run budget deficit. What are the chances that we can do all that - or, I'm tempted to say, any of it - if doing anything requires 60 votes in a deeply polarized Senate? [...]

The political scientist Barbara Sinclair has done the math. In the 1960s, she finds, "extended-debate-related problems" - threatened or actual filibusters - affected only 8 percent of major legislation. By the 1980s, that had risen to 27 percent. But after Democrats retook control of Congress in 2006 and Republicans found themselves in the minority, it soared to 70 percent.

Outside of the nuts and bolts of productivity, other progressives are becoming increasingly concerned with what we are actually buying. The anxieties expressed last week over the ultimate costs and benefits of health care reform are still in full effect. Politifact recently waded into the health care debate while evaluating Obama's campaign promises. Using their popular "truth-o-meter," editors rank the claim "Obama said health care reform will reduce the cost of health care" as half true:

First, we need to acknowledge that when it comes to characterizing the "costs of health care," there are several ways to look at it.

The first is how much people would pay in health insurance premiums. The nonpartisan Congressional Budget Office (CBO) studied the health care bill proposed by Sen. Harry Reid, D-Nev., and concluded that if passed, most people would see a very modest decrease in premiums by 2016 (compared to what they would pay under the current system). How modest? Best-case scenario - for those in group plans with large companies - about 3 percent better. For a small percentage of people (less than 8 percent of the insured) who would buy insurance on the individual market, and who wouldn't be eligible for federal subsidies, they might actually pay 10 to 13 percent more, though with new federal minimum standards, they'd also be getting more insurance coverage as well.

The second way to look at cost is its effect on the national deficit. And here again, the CBO has weighed in on the Reid plan. The CBO concluded that while the plan would be very expensive, the bill is also more than paid for with new taxes and plans to reduce health care spending over time. The net effect, according to the CBO, is that over 10 years, the plan would end up reducing the national deficit by $130 billion.

Which brings us to a third way to look at cost, whether the plan would lower the rate of health care inflation over the long term. Republicans are correct when they say that based on the CMS report, health care spending would increase by $234 billion over the next 10 years. [...]

It's also worth noting that while the CMS is a legitimate nonpartisan source, there's lots of difference of opinion among respected economists about how various cost-cutting proposals in the plan will shake out. In other words, these projections are all highly speculative.

"There's a tremendous amount of uncertainty about whether what's in the bill will be enough to lower health care inflation," said Josh Gordon, policy director for the Concord Coalition, a group that advocates fiscal responsibility. "No one knows for sure."

In light of these insecurities, it should come as no surprise that Senator Olympia Snowe of Maine backed out of supporting the Senate bill and has pledged to join the Republican filibuster. Her reasons depart from the rest of her party, however: While most rank and file Republicans seem to be opposing the bill just to spit in the Obama Administration's collective eye, Snowe's statement shows a thoughtful engagement with the issues in play:

This bill has taken a dramatically different direction since the Finance Committee bill - it is now 1,200 pages longer and includes a new employer mandate that could annihilate the job growth potential that is so vital to our economic recovery. As the Small Business & Entrepreneurship Council has stated, this mandate "will only burden firms with more costs and red tape which means they will not grow, invest, or create jobs."

This bill also creates the CLASS Act on long term care insurance, a brand new program which the Medicare Actuary has said is projected to go into the red just five years after it begins paying out benefits. And the legislation requires a $90 billion increase in Medicare payroll taxes - a provision that was not part of the bill I voted for in Finance Committee - that predominately affects the self-employed and the very same small business owners we are counting on to create new jobs and lead us out of this recession. And that's just to name a few of the vital issues.

Furthermore, we still don't have answers to some of the most fundamental questions that people will be asking at their kitchen tables. These are the critical questions relevant to peoples' daily lives, such as, what does this mean for me? How much will my health insurance plan cost? How much will my deductible or my co-pay be? How much am I going to have to pay out of pocket? Not one single member in Congress - Republican or Democrat - can answer those questions, and that is why I wrote to the Congressional Budget Office on December 3rd requesting a complete analysis of these and other key issues as it is imperative that we have those answers before proceeding.

Ultimately, there is absolutely no reason to be hurtling headlong to a Christmas deadline on monumental legislation affecting every American, when it doesn't even fully go into effect until 2014.

Snowe took her plea to Face the Nation:

Unfortunately for Snowe, the health care reform train is leaving the station. Hopefully, the public will start getting some answers before it becomes too late to chase it down or change course.

Health Deal Hinged On Abortion [Politico]
To Sway Nelson, A Hard-Won Compromise On Abortion Issue [The Washington Post]
Boxer Affirms Support For Abortion Deal [Politico]
Pro-Life Group Blasts Nelson Compromise [Politico]
Health Care Bill Clears Key Senate Test [AP/Time]
McCain: GOP Can't Stop Health Care [Politico]
A Dangerous Dysfunction [NY Times]
Obama Said Health Care Reform Will Reduce The Cost Of Health Care [Politifact]
She's A No! Snowe Confirms Opposition To Health Care Bill [TPM]
Sen Olympia Snowe To POTUS: Give Us More Time On Health Care [Politico]

Earlier: "Kill The Bill": Is Real Health Care Reform Still Worth Fighting For?