US health care bill passes the Senate

[Guardsman Bass]

This is good news, although it's far from over yet. The bill still needs to be reconciled with the House bill, and then the whole thing voted on.

WASHINGTON — The Senate early Monday voted 60 to 40 to cut off extended debate on the Democratic-authored health care overhaul bill, the first major step toward passing the measure later this week.

The vote, which saw all 58 Democrats and two independents vote to end the latest debate while all 40 Republicans opposed the maneuver, ended at 1:19 a.m. and capped a day of debate that turned partisan and often angry.

“If the people who wrote this bill were proud of it, they wouldn’t be forcing this vote in the dead of night,” Senate Republican Leader Mitch McConnell, R-Ky., said as he made a final post-midnight plea to derail the $871 billion bill. “The final product is a mess _ and so is the process that’s brought us here to vote on a bill that the American people overwhelmingly oppose.”

Senate Majority Leader Harry Reid, D-Nevada, countered: "This is not about politics. It's about people. It's about life and death in America."

The vote, the first of three planned this week aimed at cutting off different debates, found Democrats marching united and determined toward anticipated passage of historic health care legislation late Wednesday or Thursday. If that happens, the Senate bill will have to be reconciled with the version the House of Representatives passed last month.

Most of the talk on Capitol Hill Sunday centered on the difficult clashes ahead over abortion, taxes and the public option.

Resolving those differences will be up to a conference, or negotiating, committee, which is expected to be dominated by senior lawmakers from both Houses close to Senate Majority Leader Harry Reid, D-Nevada, and House Speaker Nancy Pelosi, D-Calif.

White House officials are expected to be close to the talks; Chief of Staff Rahm Emanuel, Health and Human Services Secretary Kathleen Sebelius, Budget Director Peter Orszag and top health care adviser Nancy-Ann DeParle have all been frequent visitors to the Capitol in recent weeks to discuss strategy.

Many major points in both bills are roughly the same. Insurers would be barred from denying coverage because of pre-existing conditions. Nearly everyone would have to obtain coverage in four or five years. New exchanges, or marketplaces, would be created to help consumers shop for policies.

But there are sharp divisions over abortion, taxes and the public option.

Abortion has already come closest to making the legislation implode in both Houses.

Last minute deals with anti-abortion Democrats were needed to keep the bills alive. The Senate bill is moving forward largely because of a painstakingly negotiated weekend agreement with Nebraska Sen. Ben Nelson, the last Democratic holdout on the bill, giving his state substantial new Medicaid aid, and placing strict limits on abortion.

The House version bars federal funding of elective abortions except in cases of rape, incest or where the life of the woman is endangered.

The Senate bill also will ensure that no public funds will be used for abortion, except those now allowed, and require that every state provide an insurance plan option that does not cover abortion. Plans that offer abortion coverage would have to keep an account for private premium dollars and another for federal money, and consumers would have to pay separately for the coverage. The measure also provides each state the right to pass a law barring insurance coverage for abortion within state borders.

Neither side seemed satisfied. “I am disappointed that women's access to full reproductive health care is again paying the price,” said Rep. Lois Capps, D-Calif., a leading House abortion rights supporter.

But anti-abortion lawmakers also were not pleased. Rep. Bart Stupak, D-Mich., who led the House fight to limit abortion funding, said the Senate bill was “a dramatic shift in federal policy that would allow the federal government to subsidize insurance policies with abortion coverage.”

Taxes also loom as a vexing issue. The Senate bill raises money by increasing the Medicare tax, now 1.45 percent, by 0.9 percentage points on individuals with wages of more than $200,000 and couples earning over $250,000. It also would impose a 40 percent excise tax on most high-end expensive insurance policies.

Many House Democrats, as well as some labor union officials, see the excise tax as a burden on the middle class, and prefer a 5.4 percent income tax surcharge, starting in 2011, on individuals with adjusted gross incomes of more than $500,000 and joint filers making more than $1 million.

What once seemed to be the biggest fight, though, the public option, may be cooling.

The House version would create a government-run plan to compete with the private sector, an idea the White House, Democratic leaders and liberals have all sought. And while that idea has strong Senate Democratic support, it lacks the backing of a handful of party moderates _ enough to deny Reid the 60 votes he would need to cut off extended debate.

As a result, the version now before the Senate would allow national, privately run plans, at least one of which must be nonprofit, to be supervised by the federal Office of Personnel Management.

Asked if she could “live without a public option” at a meeting with reporters last week, Pelosi said, “It depends on what else is in the bill.” After the Senate Saturday announced its compromise, Pelosi and House Majority Leader Steny Hoyer, D-Md., issued a joint statement that stayed away from endorsing or opposing anything specific.

“The Democratic Caucus is committed to middle class affordability, security for our seniors, responsibility to our children, and accountability for the insurance industry,” it said, adding, “"On that basis, we look forward to working with the Obama Administration, the Senate, and our Caucus to reconcile our bills and send final legislation to the President's desk as soon as possible."

Sympathetic senators also seemed ready to accept something less than the public option.

“I’m deeply disappointed the public option is not in the bill,” said Sen. Al Franken, D-Minn. But there were other features he liked, and said, “There is a huge victory for those of us interested in keeping costs down.”

You have to start somewhere. If they can get this passed, then they can then go on and reform it to their heart's content, like what they did with Social Security.

[Mr Bean]

Mandate
Why I'm going to get fucked by this bill. I can't afford heath insurance so my taxes are going up by a couple of hundred dollars a year because I don't buy heath care which I can't afford.
And at the present I'm SOL out for getting a subsidy as even the best version only covers about half the cost.

So no fuck them

[Coyote]

But, Bean, this will be a big help for the Companies, and we need the Companies or the whole economy goes plooey.

Won't you think of the trust fund children?

In other words, yes, as I expected, by the time the corporate blow job artists Senators got done with this, it is nothing more than a sham of "reform".

[D.Turtle]

This thing is still far from over. There is still the whole conference thing that the Bill has to go through - so still some possibility of improving it (or making it worse, though I don't think that will happen).

And the Bill isn't through in the Senate until Christman Eve, because of various obstructionist bullshit that exists in the Senate. All it needs is one idiotic "moderate" Democrat suddenly jumping ship again and bringing the whole thing to a screeching halt again.

[Count Chocula]

Well, the Democrat majority has now proved they can get their majority to pull together. Of course, it's an astoundingly expensive example of arm twisting. Bill Nelson's extortion of the other 49 states to pay Nebraska's Medicaid expansion, Mary Landrew getting a $300 million payout for her vote, and Dodd getting $100million for a hospital in Connecticut are just the ones off the top of my head.

Who knows; now that the Senate has cloture, maybe Congress and the rest of us will actually get a chance to read just what our masters have in mind for us. Maybe.

[Mr Bean]

Count Chocula I can't believe you wrote an entire post about arm twisting to get votes without once mentioning Lieberman who has to date removed all reform from the bill.

[Count Chocula]

^ I'm just going off the top of my head, on my lunch break. From what I remember, Lieberman "took a principled stand" against the legislation, then...he...didn't. Just looked up ol' Joe's antics, and it seems he's getting the credit for removed all reform from the bill the stripping of Medicare buy-in and the "public option," but I'm more inclined to see him as the front runner for a number of other Democrats and Republicans who wanted the public option removed. Nobody but Harry Reid has actually seen the Senate's proposal, though, so I'm just speculating. If anything, if Lieberman's vote was so important that Reid removed two key parts of the proposal then it was Lieberman doing the arm twisting, and not holding out for a booyah-millions payout.

[Mr Bean]

^ I'm just going off the top of my head, on my lunch break. From what I remember, Lieberman "took a principled stand" against the legislation, then...he...didn't. Just looked up ol' Joe's antics, and it seems he's getting the credit for removed all reform from the bill the stripping of Medicare buy-in and the "public option," but I'm more inclined to see him as the front runner for a number of other Democrats and Republicans who wanted the public option removed. Nobody but Harry Reid has actually seen the Senate's proposal, though, so I'm just speculating. If anything, if Lieberman's vote was so important that Reid removed two key parts of the proposal then it was Lieberman doing the arm twisting, and not holding out for a booyah-millions payout.

He also got subsidies reduced (It's why they only pay for half the heath care) the "if you don't buy heath care" penalty raised to triple it was originally. Removed provisions that said you could not be charged more across the board for having a pre-existing condition. They can't deny you for having a pre-existing condition but they can charge you three times as much as a healthy person even if your "existing condition" is not expensive or not an issue. Also the across state lines exception means that come 2014 most insurance company should be based in Connecticut due to it's weak protection laws so any laws your local state passed to do things like mandate they can only make 10 cents on the dollar in profit or they have to give you ninety days notice to any price increases to your plan will be undone since they will be outside the states control.

He's getting credit for removing all reform because he did. It's not just the Medicare buy in and the Public option he got a ton of things removed from the bill. We can go down the list of things removed from the bill that saved money and with notable exception (The buying drugs at Canadian prices which the White House killed) Joe gets credit because he got them removed be it in commit. When they combined the bills, during negotiations and during the final cloture vote.

Speaking of Canadian drugs that bits great too, Did you know we make drugs here in America which we send to Canadia and then sell them for between a ten percent to half the price they cost here in America where they were made? Despite having standards of living and medium household incomes that are very close to each other they pay far less than drugs than we do here in America. Why? Because of universal heath care. So the bill said, hey lets let American's re-import the drugs at Canadian prices back to the US. People do this small scale all the time now and it's a currently a crime so the amendment just made it official and legal. And it was killed by the White House who stormed down there and changed enough votes to make the amendment impossible to pass despite having some Republican support.

[MKSheppard]

How many pages is this beast up to? It's worth noting that Congress authorized military spending during the biggest war in history by simply saying:

That the authorized composition of the United States Navy in underage vessels, as established by the Act of March 27, 1934 (48 Stat. 503), as amended by the Acts of May 17, 1938 (52 Stat. 401), June 14, 1940 (54 Stat. 394). July 19, 1940 (54 Stat, 779), December 23, 1941 (Public Law 369, Seventy-seventh Congress, first session), and May 13, 1942 (Public Law 551, Seventy-seventh Congress, second session), is hereby further increased by one million nine hundred thousand tons of combatant ships, as follows :

(a) Aircraft carriers, five hundred thousand tons ;

(b) Cruisers, five hundred thousand tons; and

(c) Destroyers and destroyer escort vessels, nine hundred thousand tons

There's some other legalities, but it's only a page extra.

This bill is what 1,300 pages?

Dear rocket powered jesus on a rubber crutch, that's bigger than the U.S. Statutes for an entire year back in the 1940s.

[Knife]

Why is the length of the Bill such an issue. It is a national health care reform bill that has far reaching issues and policies. Frankly, I'd be scared shitless if they reformed health care and it was only 4 pages.

[Duckie]

I wouldn't, because that'd be the Canadian Health Care Bill that established single payer- it was 14 pages long, and half of those were just the French copy.

Fun Fact- Health Benefits provided to a partner are not taxed, assuming you're not gay. That's right, the bill specifically keeps taxes from being applied to your partner... if you're straight. If you're gay or lesbian, fuck you, fork over about $2000 dollars in taxes a year to have your marriage count (which, mind, you're not making up from your joint tax return since the governments says you can't have one of those). It's also not an oversight- the House removed this 'gay tax'. The Senate quite clearly did not.

Also we're going to be forced to buy insurance from a private company. I know why economically this should be done, but the anticapitalist in me is mad as all hell especially given the reforms won't actually fix the system. Huzzah for the Senate. (Fun fact: The Health Insurance Companies bought the blue dogs in the senate for under 10 million dollars in campaign contributions. That's about 1/2000 of the profits they'll be expected to make.)

The Senate is doing what they're designed to do: to be a landed aristocracy of elderly (average age 60) rural (2 senators per state, even New York vs South dakota) citizens who have complete control over the plebes in the House.

[aerius]

It's as big as it is so everyone has enough space to hide all the pork & bribes needed to buy their votes. I wouldn't be surprised if there's also a bunch of riders in there so congress critters can buy plasma TVs for their associates' businesses and other shit like that.

[MKSheppard]

Why is the length of the Bill such an issue

Because you know, it's bigger than all the bills passed for about two consecutive years in the 1940s COMBINED?

Christ, i I've read the authorizations for the military acts of the 1900s, and they're only 40-50 pages, even though they detail in excruciating detail, the pay scales for various men, how many dollars to be spent on such section of the War Department, etc etc.

EDIT: Logged onto Heim, and I mis-remembered.

U.S Statutes for 1941-1942 in two Volumes is about 1,700 pages.

[Mr Bean]

Why is the length of the Bill such an issue

Because you know, it's bigger than all the bills passed for about two consecutive years in the 1940s COMBINED?

Christ, i I've read the authorizations for the military acts of the 1900s, and they're only 40-50 pages, even though they detail in excruciating detail, the pay scales for various men, how many dollars to be spent on such section of the War Department, etc etc.

EDIT: Logged onto Heim, and I mis-remembered.

U.S Statutes for 1941-1942 in two Volumes is about 1,700 pages.

Bit of an issue here MKSheppard is that the longer our congress goes on the bigger the bills will get. If you crack open the heathcare bill lots of pages are taken up by bits that modify existing bills. The Heathcare bill does not establish new things but modifies existing government groups and programs. When you do that, it adds a bunch of legal sentences to say simply "this program shall now be at 5% instead of 10%".


As well it's the new model congress, to say it's double spaced and has a ton of white space is an understatement. The total number of words in the longer House bill was 363,086 if you count table of contents and the index. Minus that you end up in the 250k word range. Which is the same word count as... your average Harry Potter book. It comes under your average Wheel of Time book. But the page count is inflated by the large font (Standard 18 on the pages and 24 for headers) and the amount of whitespace.

*Edit
Your average wheel of time book which is 340k words long which weighs in at 800 pages.

[Serafine666]

This bill is what 1,300 pages?

Dear rocket powered jesus on a rubber crutch, that's bigger than the U.S. Statutes for an entire year back in the 1940s.

Senate version: 2079 pages. House version: 1990 pages. I wonder what's in the 1700+ pages that WEREN'T needed to create this reform...
Seriously... this reform isn't particularly complicated. Canada did it in what, 14 pages (as Duckie points out)? No matter how much other countries expand it, the underlying structure is pretty damn simple. Yet according to the Democrats, we need over 100x the number of pages of blathering before they can create utopia. Why can't some honest politician stand up and say to people "This reform is so important to us and you that it is worth it to spend 1700 pages bribing people and giving goodies to our big-money supporters to get it." It'd run the risk of pissing the voters off but at least someone would be completely honest.

[Guardsman Bass]

This bill is what 1,300 pages?

Dear rocket powered jesus on a rubber crutch, that's bigger than the U.S. Statutes for an entire year back in the 1940s.

Senate version: 2079 pages. House version: 1990 pages. I wonder what's in the 1700+ pages that WEREN'T needed to create this reform...
Seriously... this reform isn't particularly complicated. Canada did it in what, 14 pages (as Duckie points out)? No matter how much other countries expand it, the underlying structure is pretty damn simple. Yet according to the Democrats, we need over 100x the number of pages of blathering before they can create utopia. Why can't some honest politician stand up and say to people "This reform is so important to us and you that it is worth it to spend 1700 pages bribing people and giving goodies to our big-money supporters to get it." It'd run the risk of pissing the voters off but at least someone would be completely honest.

How big are the provincial law-sets on universal health care in Canada, though? Most of the administrative work happens at that level, so presumably that's where the bulk of the paperwork is at.

[MKSheppard]

Bit of an issue here MKSheppard is that the longer our congress goes on the bigger the bills will get.

Bullshit. As Serafina pointed out, the other version is 2000+ pages; which is longer than all the bills put together from 1941-1942; you know, during a time of GLOBAL WAR, MASSIVE EXPANSION OF GOVERNMENT SPENDING -- what the fuck is so goddamned complicated about health care reform that we need something bigger than all bills put forth in the years 1941-1942?

[CmdrWilkens]

Bit of an issue here MKSheppard is that the longer our congress goes on the bigger the bills will get.

Bullshit. As Serafina pointed out, the other version is 2000+ pages; which is longer than all the bills put together from 1941-1942; you know, during a time of GLOBAL WAR, MASSIVE EXPANSION OF GOVERNMENT SPENDING -- what the fuck is so goddamned complicated about health care reform that we need something bigger than all bills put forth in the years 1941-1942?

The problem lies with amending a dozen different existing sections of law rather than simply creating a new title of the US Code. When you do that you have to go through and list all the deletions, all the changes, and all the new definitions ("For the purpose of this section Healthcare Provider shall mean ...") then you have to rinse and repeat for each and every code section that you change. I wouldn't be surprised if there are about 1000 or so pages of "definitions" which repeat endlessly.

There is also the fact that this bill doesn't just say "here is how we will pay for healtchare." A lot of the bill is taken up with things like revenue measures, malpractice reform, nursing care reform, medical research grants and governing law, community health center funding, access to new healthcare centers, promoting more general practice doctors, upgrading the CDC and USAMRIID, changing Medicare Part D, changing SCHIP, changing Medicaid funding and operations, and expanding the number of healthcare providers just from a quick search of the top level topics. this isn't just creating a national healthcare plan (which this won't do) but editing just about every bit of federal code as it relates to healthcare.

[KrauserKrauser]

You can also use it on the campaign trail to squash detractors....literally, that thing must weigh enough to do some serious damage.

[Garibaldi]

Criticism of the bill based on the number of pages of text is so asinine as to be almost unbelievable. It instantly belies a complete ignorance of not only the nature of the reform but of the unavoidable process of government in a bitterly divided legislature that I am frankly astonished that anyone would bring it up as a legitimate point, let alone compare it to a completely different spending bill from 65 years ago. It's the epitome of the style-over-substance showboating that passes for legitimate political debate in this country.

Yet according to the Democrats, we need over 100x the number of pages of blathering before they can create utopia.

You must be joking. There are many baffling stupidities compressed into this short sentence, but the two main ones are that this quote implies that you think A) the Democrats are a unified bloc, B) they regard this as an ideal bill. Both of these are self-evidently wrong to anyone with eyes, ears, and a passing interest in politics.

[MKSheppard]

The problem lies with amending a dozen different existing sections of law rather than simply creating a new title of the US Code.

Or you could just write

"Title x, Section y is struck down by this bill." and simply write a new title instead of wallpapering things over.

[Duckie]

That'd just make it longer, since they'd have to rewrite the entire title in the new section rather than just writing amendments to the text change- thus why amendments exist in the first place: they're more brief and highlight the differences better than reposts of text.

[MKSheppard]

Criticism of the bill based on the number of pages of text is so asinine as to be almost unbelievable

Have you ever gone through the past editions of the U.S. Statutes at Large at Federal Depository Libraries?

If not, shut the fuck up.

This *single*, chtulthu-damned bill is bigger than *all* the bills passed in 1941-1942 COMBINED.

After all, it's not like we were doing anything important in those two years, no sir.

[Mr Bean]

Criticism of the bill based on the number of pages of text is so asinine as to be almost unbelievable

Have you ever gone through the past editions of the U.S. Statutes at Large at Federal Depository Libraries?

If not, shut the fuck up.

This *single*, chtulthu-damned bill is bigger than *all* the bills passed in 1941-1942 COMBINED.

After all, it's not like we were doing anything important in those two years, no sir.

Have you gone and read the latest versions Sheppard of the U.S. Statues and not what we did in 1945? You must understand if we don't give a shit about how many laws we had six decades ago.

Also to note here's a copy of the old Slate article about bill lengths. Keep reading to the end, I've highlighted the important bit that might help you understand.

With the debate over health care reform heating up, one peculiar criticism keeps surfacing: That the bill—or, at least, the House version—is too long. "I have a fundamental problem with any 1,000-page bills," said Sen. David Vitter, R-La., at a town hall meeting on Wednesday. Back in June, Newt Gingrich complained on Fox News that "[t]his bill is already 1,000 pages long." It's now 1,018 pages, to be exact—is that especially long for a bill?
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Not really. Sure, most legislation is much shorter: The average statute passed by the 109th Congress—the latest session for which figures are available—clocked in at around 15 pages, according to the Senate Library. And the recent law authorizing President Obama to give gold medals to the Apollo 11 astronauts on the 40th anniversary of the moon landing filled just two pages. But major spending bills frequently run more than 1,000. This year's stimulus bill was 1,100 pages. The climate bill that the House passed in June was 1,200 pages. Bill Clinton's 1993 health care plan was famously 1,342 pages long. Budget bills can run even longer: In 2007, President Bush's ran to 1,482 pages.

Over the last several decades, the number of bills passed by Congress has declined: In 1948, Congress passed 906 bills. In 2006, it passed only 482. At the same time, the total number of pages of legislation has gone up from slightly more than 2,000 pages in 1948 to more than 7,000 pages in 2006. (The average bill length increased over the same period from 2.5 pages to 15.2 pages.)

Bills are getting longer because they're getting harder to pass. Increased partisanship over the years has meant that the minority party is willing to do anything it can to block legislation—adding amendments, filibustering, or otherwise stalling the lawmaking process. As a result, the majority party feels the need to pack as much meat into a bill as it can—otherwise, the provisions might never get through. Another factor is that the federal government keeps expanding. Federal spending was about $2.7 trillion in 2007. That's up from $92 billion 50 years ago. And as new legislation is introduced, past laws need to be updated. The result: more pages.

Again we spent more last year than the entire second world war cost us, even with inflation adjusted numbers. Most budgets run over a thousand pages during the Bush administration and are just as long under Obama.

I assume your making such a case out of ignorance not out of genuine dismay. We will pass a bill just as long at the end of next year and every yea rtheir after when the Defense authorization bills get passed.

Sheppard why can you not grasp the fact that the amount of legalese in bills has gone up a massive amount since 1945? If you know anything about contract law you can take two pages just to say hello and Congressional bills can be even worse than this.

[Molyneux]

Would anyone care to explain exactly why the fuck individual mandates are a part of this bill? I certainly can't figure it out.