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September 29, 2009

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Nelson was nay on the Rockefeller amendment (public option paying at Medicare rates) and yea on the Schumer amendment (public option with HHS negotiating with providers).

So, a mixed bag.

Carper (Delaware) split his vote the same as Nelson.

Baucus, Conrad, and Lincoln were agin'em both.

And of course, every Republican on finance was against both.

h/t Washington Monthly.

Net/net, your theory seems consistent with his votes.

Pay attention to the Senate Finance Committee's vote today. Note that neither Rockefeller's robust public option nor Schumer's PO Lite passed. They failed because Democrats voted against it. And despite how the vote in Congress goes, the public option is not a partisan issue in the public at large. Large majorities of the public support it; even in some states, like Montana, some of whose Senators are more interested in representing their donors than their constituents. Many polls still show a majority of independents supporting it. Even a healthy minority of Republicans support it (though not a single Republican in either House will back it).

None of this, of course, is news.

It's fine to hope for the best. But it's important--especially for those of us who believe a public option is not just a fine idea, but necessary for the reform to be worth the paper its printed on (and I know publius isn't in this category)--to assume the worst and push like crazy to make sure no bill without a public option can pass the House.

The only way we end up with a public option is if marginal Dems in the Senate have the future of their majority threatened by the prospect of no reform passing at all. Given a choice between total failure and a public option, I think we just might be able to cobble together 50 Senate votes (plus the VP) to pass a public option under reconciliation.

It seems equally as likely to me that this "it needs 65 votes" line is designed to justify voting against cloture when the time comes, seeing a danger that "it needs 60 votes" might put him in a tricky spot if he was the 60th.

That said I too have a hard time seeing any Democratic Senator literally filibustering a bill implementing the Democratic President's most important campaign promise, even with a public option. But then I have a hard time understanding why any self-described Democrat would be opposing a public option at all, which makes it hard to understand anything else they do.

Oh, and a note on today's votes for people like me who were confused: the how-can-you-claim-to-be-trying-to-save-money-if-you-vote-against-the-cheaper-option Nelson who voted against the Rockefeller amendment (PO paying Medicare rates) but for the Schumer amendment (PO paying unregulated rates) is Bill Nelson (D-FL); the outright-crazy Nelson declaring that the already doubly-anti-majoritarian Senate should be even less democratic is Ben Nelson (D-NE).

Just to clarify.

Nelson and other Blue Dogs need a figleaf to allow them to switch. The public option can be regional non-profit plans for huge populations organized by groups of states with Federal start-up loans. Lots of clout, with fundamental purpose of making low-cost plans available in the exchanges. Five of them would have average population bases of 60 million each -- each the equivalent of France. Blue Dogs can say they prevented a Federal Government plan.

Jacob Davies says: "But then I have a hard time understanding why any self-described Democrat would be opposing a public option at all, which makes it hard to understand anything else they do."

Because of the Medicare 'shift.' Democrat Kent Conrad of North Dakota explained it clearly today at the Baucus hearing. The 'shift' is the difference in cost between what Medicare pays doctors and hospitals for patient services (the caps), and what it actually costs for those medical services provided: anywhere between 10% and 20% difference; money that's 'shifted' to private insurance customers, and walk-in patients without insurance. Because the public option payments would be the same as Medicare caps, insuring millions of new people at those rates would have caused mass shutdowns of hospitals in his state.

The 'shift' is the fatal flaw in any health care proposal linked to Medicare caps: to survive most medical providers will have to raise costs to private insurers: but if there's not enough private policy holders to make up the difference, hospitals will close and doctors will quit, and the only solution will be government assistance to keep them in business.

And indeed, that's what happened after the Balanced Budget Act of 1997 went into effect -- the same kind of 'slowing the growth rate' plan Obama and some Democrats are counting on to finance universal health care now. And yes, at first they realized significant savings, but then the benefit payment reductions caused havoc in the system, leading to facility closings and limits on beneficiary access to care, and Congress had to pass funding increases to stop more from closing.

So, no problem. If funding is the problem *pass more funding*. The hospitals won't close, and the doctors won't go out of business. Its not a fatal flaw that every system needs some adjusting--at least with what the public option we are introducing new ways to keep the money in the actual health care system instead of bleeding it out into the for profit sector and high salaries.

aimai

AIMAI sez: "So, no problem. If funding is the problem *pass more funding*."

Ah, so the plan isn't'budget neutral' as claimed.
More spending means higher taxes, or rationing of health services. And for those in private plans, higher premiums.

That's a lose-lose-lose proposition for the middle class.

Nebraska is a very conservative and Republican state. Even so, Obama actually won an electoral there! Like Maine, Nebraska awards its electoral votes by congressional district, with just two (reflecting the number of US Senators per state) going to the statewide winner.

I'm guessing this EV came from urban Omaha and/or Lincoln. Without these folks, a strong Republican might take Nelson out someday.

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