Nelson finally gave in, and now Senate Democrats have their 60 votes:

Because the Democrats nominally control 60 seats in the Senate — the precise number needed to overcome Republican filibusters — every senator in the Democratic caucus effectively has veto power over the bill. No Republican is willing to support it.

The legislation, the most sweeping overhaul of the nation’s health care system in more than a generation, seeks to extend health benefits to more than 30 million uninsured Americans by expanding Medicaid and providing subsidies to help moderate-income people purchase private insurance.

The bill also imposes tight new regulations of the health insurance industry, barring insurers from denying coverage based on pre-existing medical conditions and limiting how much extra they can charge for people based on their age.

The majority leader, Harry Reid of Nevada, racing against the clock to complete the bill by his self-imposed holiday deadline, introduced a 338-page package of last-minute amendments, including the key provisions needed to win Mr. Nelson’s support.

[...]

Mr. Reid’s amendment includes tighter restrictions on insurance coverage for abortions sought by Mr. Nelson. Health insurance plans would not be required or forbidden to cover abortions, but states could prohibit the coverage of abortions by plans that are offered for sale through new government-regulated marketplaces.

The amendment also includes a special extension solely for Nebraska: increased federal contributions to the cost of an expansion of Medicaid, the state-federal insurance program for the poor.

Can the Democrats deliver on the desire to pass a greatly-watered-down-reform-bill-hijacked-by-”centrist”-Democrats-in-the-Senate-that-progressive-are-divided-in-support-of by Christmas? One can only hope, sort of.

I think I understand the rationale for cuts to Medicare spending as part of the overall health care reform package, but I have to admit I don’t understand the rationale behind this:

Home care shows, in microcosm, a conundrum at the heart of the health care debate. Lawmakers have decided that most of the money to cover the uninsured should come from the health care system itself. This raises the question: Can health care providers reduce costs without slashing services?

Under the legislation, home care would absorb a disproportionate share of the cuts. It currently accounts for 3.7 percent of the Medicare budget, but would absorb 10.2 percent of the savings squeezed from Medicare by the House bill and 9.4 percent of savings in the Senate bill, the Congressional Budget Office says.

The House bill would slice $55 billion over 10 years from projected Medicare spending on home health services, while the Senate bill would take $43 billion.

Democratic leaders in the House and Senate justify the proposed cuts in nearly identical terms. “These payment reductions will not adversely affect access to care,” but will bring payments in line with costs, the House Ways and Means Committee said. The Senate Finance Committee said the changes would encourage home care workers to be more productive.

The proposed cuts appear to be at odds with other provisions of the giant health care bills. A major goal of those bills is to reduce the readmission of Medicare patients to hospitals. Medicare patients say that is exactly what home care does.

“It helps me be independent,” said Mildred A. Carkin, 77, of Patten, Me., as a visiting nurse changed the dressing on a gaping wound in her right leg, a complication of knee replacement surgery. “It’s cheaper to care for us at home than to stick us in a nursing home or even a hospital.”

Delmer A. Wilcox, 89, of Caribou, lives alone, is losing his vision, uses a walker and has chronic diseases of the lungs, heart and kidneys. He said his condition would deteriorate quickly without the regular visits he received from Visiting Nurses of Aroostook, a unit of Eastern Maine Home Care.

I have always heard that the rationale for emphasizing home health care was twofold, to grant patients more independence and more time at home, and to cut the excessive costs of hospitalization or hospice care. Is that wrong? If not, then why are the cuts focused disproportionately on services that lower the cost of health care overall? Someone smarter than me will have to explain this, because frankly I don’t get it.

Paul Krugman, on what I believe is the single most powerful argument for health care reform:

… the proposed health care reform links the expansion of coverage to serious cost-control measures for Medicare. Think of it as a grand bargain: coverage for (almost) everyone, tied to an effort to ensure that health care dollars are well spent.

Are we talking about real savings, or just window dressing? Well, the health care economists I respect are seriously impressed by the cost-control measures in the Senate bill, which include efforts to improve incentives for cost-effective care, the use of medical research to guide doctors toward treatments that actually work, and more. This is “the best effort anyone has made,” says Jonathan Gruber of the Massachusetts Institute of Technology. A letter signed by 23 prominent health care experts — including Mark McClellan, who headed Medicare under the Bush administration — declares that the bill’s cost-control measures “will reduce long-term deficits.”

The fact that we’re seeing the first really serious attempt to control health care costs as part of a bill that tries to cover the uninsured seems to confirm what would-be reformers have been saying for years: The path to cost control runs through universality. We can only tackle out-of-control costs as part of a deal that also provides Americans with the security of guaranteed health care.

And the tactics of those renowned fiscal disciplinarians, the Republican party:

…in the closing rounds of the health care fight, the G.O.P. has focused more and more on an effort to demonize cost-control efforts. The Senate bill would impose “draconian cuts” on Medicare, says Senator John McCain, who proposed much deeper cuts just last year as part of his presidential campaign. “If you’re a senior and you’re on Medicare, you better be afraid of this bill,” says Senator Tom Coburn.

If these tactics work, and health reform fails, think of the message this would convey: It would signal that any effort to deal with the biggest budget problem we face will be successfully played by political opponents as an attack on older Americans. It would be a long time before anyone was willing to take on the challenge again; remember that after the failure of the Clinton effort, it was 16 years before the next try at health reform.

That’s why anyone who is truly concerned about fiscal policy should be anxious to see health reform succeed. If it fails, the demagogues will have won, and we probably won’t deal with our biggest fiscal problem until we’re forced into action by a nasty debt crisis.

This charge is being led by that maverick McCain, who was for Medicare cuts (last year!) before he was against them. So remember guys: the GOP is the party of fiscal discipline…unless a Republican president is office, Medicare spending will win some voters, or scaring old people about cuts to Medicare will derail health care reform.

1. Nicholas Kristof, on how Republican have been scare-mongering Americans into voting against their own interests for eighty years now. History has proven them wrong, every single time.

2. Perhaps you heard about the “Hand of Frog” that secured France a berth in the World Cup over poor Ireland. Ireland’s petition to FIFA for a replay has been denied, proving that FIFA is an organization mired in the past, both rejecting modern instant replay technology and favoring the world’s powerhouses (particularly the Western ones) over the rest of the world.

3. No one sitting on death row in Texas can expect any sort of clemency from Gov. Perry right now…the man has a primary to win!

4. Short-term lenders in Texas are getting what they pay for with their campaign contributions: zero regulation. As I have said before and will say again, our democracy will forever be corrupted by money until the Supreme Court wises up and decides that money is not the exact equivalent of speech, or political campaigns become publicly funded.

Republicans, doing their part for health care reform:

Late last night, the Congressional Budget Office released its initial analysis of the health-care reform plan that Republican Minority Leader John Boehner offered as a substitute to the Democratic legislation. CBO begins with the baseline estimate that 17 percent of legal, non-elderly residents won’t have health-care insurance in 2010. In 2019, after 10 years of the Republican plan, CBO estimates that …17 percent of legal, non-elderly residents won’t have health-care insurance. The Republican alternative will have helped 3 million people secure coverage, which is barely keeping up with population growth. Compare that to the Democratic bill, which covers 36 million more people and cuts the uninsured population to 4 percent.

But maybe, you say, the Republican bill does a really good job cutting costs. According to CBO, the GOP’s alternative will shave $68 billion off the deficit in the next 10 years. The Democrats, CBO says, will slice $104 billion off the deficit.

The Democratic bill, in other words, covers 12 times as many people and saves $36 billion more than the Republican plan.

Are Republicans secretly in favor of Democratic health care reform?

Kevin Drum’s take on this is the best thing I’ve read today:

There are still plenty of battles to be fought, including those over subsidy levels and the public option, but we basically have on the table a plan that’s budget neutral (or better), covers most of the population, saves a considerable amount of money, and ought to be roughly acceptable even to the most timorous of the centrists. That’s more than anyone’s ever managed to do before. And remember: it took most European countries decades before they had more than 94% of their population covered, but they all got there eventually once they had a starting place. There’s plenty left to do, but as a starting place this isn’t too bad.

Are we really this close to victory? God, but I hope so.

Last month I wrote this about critics of health care reform:

But thanks to lying liars like Krauthammer and McCaughey, progress on this front has probably been set back a good ten or twenty years, all because defeating health care reform justifies any lie, no matter how pernicious or no matter the effect it has on actual, real people. I’m not a Christian, and even if I was I doubt I’d believe in Hell. But if there is one, it is my most sincere and fondest wish that there is a special circle reserved for the likes of Krauthammer and McCaughey, and all those who lie without regard to the impact their lies have on the lives and deaths of real people.

But if this is at all true, one hack in particular is guilty of so much worset:

I have deliberately laid off the Betsy McCaughey theme for the past month-plus. I had my say; she continues to have hers; people can make up their minds.

But revelations late last week by Tim Dickinson, of Rolling Stone, are at face value so important that they deserve to be underscored. It’s worth reading Dickinson’s whole dispatch and studying the on-line scans of the documents he has found. But to me the real news is the evidence that tobacco lobbyists secretly worked with McCaughey to prepare her infamous 1994 New Republic article “No Exit.”

In case that’s blurry, here is what Dickinson says:

“What has not been reported until now is that McCaughey’s writing was influenced by Philip Morris, the world’s largest tobacco company, as part of a secret campaign to scuttle Clinton’s health care reform. (The measure would have been funded by a huge increase in tobacco taxes.) In an internal company memo from March 1994, the tobacco giant detailed its strategy to derail Hillarycare through an alliance with conservative think tanks, front groups and media outlets. Integral to the company’s strategy, the memo observed, was an effort to “work on the development of favorable pieces” with “friendly contacts in the media.” The memo, prepared by a Philip Morris executive, mentions only one author by name:

‘ “Worked off-the-record with Manhattan and writer Betsy McCaughey as part of the input to the three-part exposé in The New Republic on what the Clinton plan means to you. The first part detailed specifics of the plan.” ‘

“McCaughey did not respond to Rolling Stone’s request for an interview.”

Maybe there is another side to this story, but if unrebutted it is damning.

Oh, if only those words could become literally true. One would think that upon this revelation, Betsy McCaughey would be utterly disgraced, and too ashamed to show her face in the media. But that would imply that McCaughey has any decency or grace to be dispossessed of. Since it is not presently illegal to sell your soul to companies who profit off of the deaths of people, we shall have to merely wait and hope that divine justice is presented to her most directly upon her death.

Congress is actually passing stuff again! Though still not health care.

The House of Representatives voted for the biggest overhaul of federal student loan programs since their creation; the measure ends subsidies for private lenders, boosts Pell Grants for needy students and creates grant programs to improve community colleges and college graduation rates. The House also passed a resolution of disapproval for Rep. Joe Wilson’s “You lie!” outburst during President Obama’s speech to Congress.

The Senate passed a big boost in spending for housing and transportation projects, and to allow guns on Amtrak.

And, yeah, both houses voted to defund ACORN to appease paranoid conservatives.

I borrow the title of Al Franken’s book for this post because, as is usually the case when dealing with right-wing pundits, it is apt. This is inspired by Daily Show host Jon Stewart’s exchange with lying liar Betsy McCaughey, who would like to reprise her fifteen minutes of fame by playing a critical role in sinking not one, but two health care reform packages in her lifetime. First, watch some of the exchange, via James Fallows (it’s thirteen minutes total between the two segments so I forgive you for not watching the whole thing; you don’t need to for the purposes of this post anyway.) Now, observe this excerpt from Fallows’ post:

That is: when McCaughey admits that there is no literal “death panel” provision in the new health care provision, she goes on to say something similar to what other conservatives, most recently Charles Krauthammer in the Washington Post today, contend: that the very act of reimbursing doctors for a discussion about “living wills” and end-of-life care will have a subtle bias in favor of an euthanasia-like outcome.

On the merits of this claim, I vehemently disagree. Having had, along with my siblings, first-hand, extended, and very painful experience with this process during my own father’s decline and death last year, I would put reimbursement schemes for living-will discussions at the very bottom of the list of factors that make such decisions so wrenching for everyone involved.

This is the article by lying liar Krauthammer that Fallows is referring to, wherein Krauthammer concludes that it is “obvious” that it’s better to rely upon the wishes of family and friends then some “form” somebody checked off “some fine summer’s day years before being stricken.” Really? Terri Schiavo might beg to differ.

It is simply a lie to say that mere discussions about late stage health care and end-of-life decisions will influence people (subtly or otherwise) to die early against their will (or be “euthanized”, which isn’t even legal in any state in the nation.) I’m not even going to assume for the purposes of argument, like Fallows does, that there might be such an effect because there isn’t. And it is a pernicious and malicious lie at that, because this lie-whose primary goal is to scare idiots and the uninformed into being afraid of health care reform-will also have the incidental effect of encouraging people to avoid not only getting medical powers of attorney or advanced directives (also known as “living wills”) but to avoid even talking about how much treatment they want before they die. It would not surprise me in the least to find out that there are literally thousands of people who, thanks to the casual but malicious lying of people like Krauthammer and McCaughey, will now delay or avoid having discussions about end of life care with their doctors or their family members, for fear that they might be giving somebody permission to stick a needle in them and send them off to the great beyond earlier than they might like. So what will they get instead? They will get family members arguing over how “grandma” wants to die (and sometimes going to court about it, a la Schiavo) or if they are alone, they will have anonymous doctors or hospital administrators or courts make the decision for them. Some of them will die in agony, when had someone spent fifteen minutes talking to them about it, they might have decided to die another way. Perhaps even some will be disconnected from life support because their family “knows” it’s how they want to die (and anyway, best to get to probating grandma’s estate so they can get her china) when in fact that person would have preferred to hang on until even machines couldn’t keep them alive.

I guess a bunch of screaming nutballs at these “town hall” meetings are having the desired effect:

The White House, facing increasing skepticism over President Obama’s call for a public insurance plan to compete with the private sector, signaled Sunday that it was willing to compromise and would consider a proposal for a nonprofit health cooperative being developed in the Senate.

The “public option,” a new government insurance program akin to Medicare, has been a central component of Mr. Obama’s agenda for overhauling the health care system, but it has also emerged as a flashpoint for anger and opposition. Kathleen Sebelius, the health and human services secretary, said the public option was “not the essential element” for reform and raised the idea of the co-op during an interview on CNN.

[...]

Mr. Obama himself sought to play down the significance of the public option at a town-hall-style meeting on Saturday in Grand Junction, Colo., when a university student challenged him on how private insurers could compete with the government.

After strongly defending the public plan, the president suggested that he, too, viewed it as only a small piece of a broader initiative intended to control costs, expand coverage, protect consumers and make the delivery of health care more efficient.

“The public option, whether we have it or we don’t have it, is not the entirety of health care reform,” Mr. Obama said. “This is just one sliver of it, one aspect of it.”

Of course the administration would like to have its cake and eat it too:

An administration official said tonight that Health and Human Services Secretary Kathleen Sebelius “misspoke” when she told CNN this morning that a government run health insurance option “is not an essential part” of reform. This official asked not to be identified in exchange for providing clarity about the intentions of the President. The official said that the White House did not intend to change its messaging and that Sebelius simply meant to echo the president, who has acknowledged that the public option is a tough sell in the Senate and is, at the same time, a must-pass for House Democrats, and is not, in the president’s view, the most important element of the reform package.

A second official, Linda Douglass, director of health reform communications for the administration, said that President Obama believed that a public option was the best way to reduce costs and promote competition among insurance companies, that he had not backed away from that belief, and that he still wanted to see a public option in the final bill.

“Nothing has changed,” she said. “The President has always said that what is essential that health insurance reform lower costs, ensure that there are affordable options for all Americans and increase choice and competition in the health insurance market. He believes that the public option is the best way to achieve these goals.”

A third White House official, via e-mail, said that Sebelius didn’t misspeak. “The media misplayed it,” the third official said.

Always the media with these folks. I’m trying to understand how Sibelius’ “is not an essential part” is any different from “the public option is the best way”, but not the only way, to achieve the goals of reducing health care costs and expanding coverage of the uninsured. Doesn’t seem all that different from me.

Howard Dean at least isn’t having any of it:

Former Democratic Party Chairman Howard Dean, a leading figure in the liberal wing of his party, said Monday he doubts there can be meaningful health care reform without a direct government role.

Dean urged the Obama administration to stand by statements made early on in the debate in which it steadfastly insisted that such a public option was indispensable to genuine change, saying that Medicare and the Veterans Administration are “two very good programs that have been around for a long time.”

Dean, a physician, argued that a public option is fair and said there must be such a choice in any genuine shake up of the existing system.

“You can’t really do health reform without it,” he said. Dean maintained that the health insurance industry has “put enormous pressure on patients and doctors” in recent years.

He called a direct government role “the entirety of health care reform. It isn’t the entirety of insurance reform … We shouldn’t spend $60 billion a year subsidizing the insurance industry.”

Agreed. Health care reform without a public option is insufficient.