Senate musters 60 votes for health care bill

Senator Nelson (AP Photo/Alex Brandon)

The Senate's version of comprehensive health-care legislation advanced to the next step this morning, when a "manager's amendment" to the already-massive bill was accepted by the required 60 votes. Two more such votes will be required, but the outcome in the Senate is no longer in doubt. The long-term prospects, however, are another matter.

At 1:00 a.m. EST today, the Senate accepted the "manager's amendment" by Senator Harry Reid (D-NV) by a vote of 60-40. All 40 Republicans voted against it; all the rest of the Senate, including the two independents, voted in favor.

The bill does not go to House-Senate conference yet; one more procedural vote is required, and then will come the vote for final passage. But no one believes that any Senator will change his vote between now and then. Final passage is expected on Christmas Eve.

Supporters routinely invoked the name of the late Senator Edward M. Kennedy (D-MA), who had made European-style government universal health coverage his signature issue throughout most of his career. Vicki Kennedy, the last woman to be married to him at the time of his death, watched from the Senate gallery as the vote was taken.

Supporters also made emotional appeals. The most striking was this by Reid:

On average, an American dies from lack of health insurance every 10 minutes. That means that in the short time I have been speaking, our broken system has claimed another life.

Reid supported this remarkable statement with a list of Nevada residents who, he says, had been adversely affected by insurance-company decisions. But he provided no statistics to demonstrate his mortality-rate figure. In fact, the usual experience in America is that hospitals will treat the patient first, and try to collect afterward--and many hospitals have generous financial-aid programs that in many cases will grant full fee waivers to patients who demonstrate that a tremendous bill would simply be beyond their ability to pay. The Memorial Sloan-Kettering Cancer Center in New York City is one such hospital.

The bill as it presently stands, contains no explicitly defined option for direct government-provided health insurance or health maintenance, nor even the expansion of Medicare by the lowering of its eligibility age that Reid had proposed earlier. The House-passed bill does have a government-provided health-insurance "option." That is one of the issues that will await resolution in a House-Senate conference, and many Democrats in the House, and many liberal commentators outside of Washington, have already stated that they will "fight" for such a plan.

The two bills also differ markedly on the handling of abortion coverage. The House-passed bill does not allow it. The Senate-passed bill does, though any patient desiring such coverage must send in a separate check for it, and any State that doesn't want such coverage for patients within its borders may prohibit it. That does not satisfy Representative Bart Stupak (D-MI-1), who was already said to be coordinating opposition to the Senate language over the weekend and has given no indication thus far that he is satisfied now.

The most scathing criticism heard on the Senate floor last night and early this morning was of the many deals that apparently were struck in order to secure all the required 60 votes. The most sensational of these was the deal offered to Senator Ben Nelson (D-NE), that the federal government would pay the full expenses for the expansion of Medicaid coverage provided in this bill. That deal is estimated to be worth $45 million, and is extended in perpetuity. Not every State received such a favor--though separately, Senator Mary Landrieu (D-LA) had won a $300-million subsidy for Medicare patients in her State. Senator Nelson's deal, which critics call the "Cornhusker Kickback," has already drawn blunt accusations against Nelson that he sold his vote.

But Nelson (and, for that matter, Landrieu) are not the only ones. Senator Chris Dodd (D-CT) won a $100 million grant, nominally to be administered by the US Health and Human Services department, but expected to pay for a teaching hospital at the University of Connecticut. Further Medicaid subsidies were granted to Vermont and Massachusetts. Several hospitals in North and South Dakota, Wyoming, Montana, and Hawaii won subsidies to treat Medicare or (in Hawaii's case) uninsured patients. The extensive dealing prompted Senator John McCain (R-AZ) to say that the Senate had acted like a bazaar where oriental rugs were sold, and thus had compromised its dignity.

Senator Mitch McConnell acknowledged that his caucus could not stop the measure now, but warned that the Senate had not heard the last of it. "One can stop it, or everyone will own it," he said. This was taken by the Associated Press to mean that Republicans intended to campaign against Senators who voted for the measure in the 2010 elections. Senator John Cornyn (R-TX) was more explicit:

There will be a day of accounting. Perhaps the first day of accounting will be Election Day 2010.

Perhaps compounding the adverse public perception of the bill, the Congressional Budget Office issued a revision of their Saturday analysis of the costs of the bill. The CBO admitted that they had overstated the projected long-term deficit reductionss by as much as a quarter-percent of Gross Domestic Product.

Previous articles:

• Rep Michele Bachman wants 'House call' from ordinary citizens
• 'House call' draws big crowd on short notice
• Health care reform still might not pass the Senate
• Epic healthcare reform battle in Senate
• Two recent polls spell trouble for Obama health care reforms
• Democrats struggle for 60 votes as Senate healthcare debate begins
• Public option continues to divide Senate Democrats
• Abortion, public option, price might stop healthcare reform
• Public option might be replaced
• CMS actuary warns Senate bill will cost more
• Senator Lieberman not satisfied with Democratic compromise
• White House allegedly orders Reid to deal with Lieberman
• Health care reform coalition might be unraveling
• Nelson accepts provisions--and deal--but Stupak not satisfied

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