After a long debate (and I’m not just talking about today’s crazy floor proceedings given how long this has gone on!), the House of Representatives has passed both the Senate’s health care reform bill, which goes immediately to President Obama to be signed into law, and a reconciliation bill full of fixes that the House wanted. You can read a good summary of the details here. The reconciliation bill would also drastically reform student loan programs by completely removing private lender middlemen from the process. Special kudos go to Speaker Pelosi for getting her caucus together, though the White House also had to promise an executive order to get pro-life Dems in line.

The Senate will take up the reconciliation bill on Tuesday and hopefully pass it this week. If that happens, it will be a historic victory for President Obama and Democrats, and, well, all Americans who desperately needed a change from the status quo of our current health care system.

The House of Representatives approved an aid bill to Chili and impeached a Lousiana judge. They also approved a bill to establish a federal research strategy for addressing harmful algal blooms. In perhaps the most interesting news, the House Budget Committee will finally consider a health care reconciliation bill Monday.

After Sen. Jim Bunning dropped his one-man hold, the Senate passed an extension of unemployment benefits.

The House of Representatives voted overwhelmingly to remove health insurers anti-trust exemption, extended the PATRIOT Act for another year, and approved an intelligence authorization bill but without a provision that would have placed penalties for intelligene personnel who used “cruel, inhuman, and degrading” techniques.

The Senate approved a $15 billion job-creation bill that would give businesses tax breaks for hiring the unemployed and states more money for infrastructure projects. The House may vote on it next week. The Senate also followed the House in voting for a bill to boost U.S. tourism.

In 2003 the Texas legislature passed tort reform that, among other things, limited non-economic damages for plaintiffs in medical malpractice suits. The effect of this was to make it highly impractical for many plaintiffs to pursue their cases, however meritorious they were, because the (relatively) small amount typically awarded for economic damages such as lost wages, combined with the completely arbitrary cap on damages for things like pain and suffering, made it too expensive for most plaintiffs with even the most justifiable of cases to sue. A lot of completely dishonest arguments were made at the time by tort reform proponents, who argued that there is a shortage of doctors in Texas because they were driven off by malpractice premiums, medical expenses were being driven up by the need to practice defensive medicine, and so on (left unsaid naturally, was the damage the caps would do to trial attorneys who typically contribute to Democrats.) So, six years into tort reform are we seeing the benefits promised by it’s proponents? Public Citizen says no (via John Coby):

In spite of rhetoric to the contrary, the data show that the health care system in Texas has grown worse since 2003 by nearly every measure. For example:

• The percentage of uninsured people in Texas has increased, remaining the highest in the country with a quarter of Texans now uninsured;
• The cost of health insurance in the state has more than doubled;
• The cost of health care in Texas (measured by per patient Medicare reimbursements) has increased at nearly double the national average; and
• Spending increases for diagnostic testing (measured by per patient Medicare reimbursements) have far exceeded the national average.

“Members of Congress have conjured the supposed benefits of the Texas law out of thin air,” said David Arkush, director of Public Citizen’s Congress Watch division. “The only winners have been the insurance companies and, to a lesser extent, doctors.”

And:

Defenders of the Texas law claim it has prompted a massive influx of new doctors into the state, especially in underserved rural areas. But this, too, is false, according to state data. The growth in the number of doctors per capita in Texas has slowed since the liability law took effect. Meanwhile, the number of doctors per capita in underserved rural areas has decreased since 2003.

The only improvement shown by the data is a decline in doctors’ liability insurance premiums. But the reported 27 percent decrease in those premiums is dwarfed by the 67 percent reduction in malpractice payments, suggesting that liability insurance companies have pocketed most of the gains. The Texas data provide no evidence that patients or taxpayers have shared in the windfall at all.

As as vividly demonstrated in this New Yorker article by Atul Gawande, tort reform completely failed to reduce health care expenses in the state because the increase is due to the incentives doctors have to order more tests and treatments, not because the increase was due to malpractice insurance premiums. So who’s benefited the most from tort reform? Doctors whose premiums have fallen (slightly) and who avoid being sued over even the most egregious of malpractice, and insurance companies. Do you think that’s what most Texans in favor of tort reform in 2003 had in mind?

Other than the number of uninsured, and the cost of health care in general, do you know what else has gone up? The number of doctors disciplined in Texas. I don’t want to say that this is because a number of incompetent doctors who are attracted to lower malpractice caps have been drawn to Texas, but it would be irresponsible for me not to speculate, right?

Of course, proponents of tort reform are still cherry-picking and misrepresenting facts to make arguments for further reform, even as health care expenses in Texas have shot up, the number of uninsured has increased, and a shortage of doctors in underserved areas still exists.  But I think these results and the larger debate over health care reform make it clear: tort reform is an idea whose time should have never come, and is mostly certainly now gone.

After a long day of fighting over an abortion amendment and a Republican alternative, the House just passed their version of health care reform by a vote of 220-215. 219 Democrats and 1 Republican (Rep. Joseph Cao, whom replaced Bill Jefferson in his New Orleans district) voted in favor.  While a victory for President Obama and House Dems, a bill must now be passed in the Senate and then reconciled between the two chambers. A summary of of what the House version includes can be found here.

Congress has passed a good law allowing college students to take up to a year off of school for medical reasons and still remain on their family’s health insurance plan.

The House passed a defense appropriations bill that the Senate will likely pass next week. Both bills include a hate crimes provision covering homosexuals. The House also cleared its agricultural appropriations bill, along with the Senate.

Lastly, the Senate Finance Committee is scheduled to vote on its version of the health care bill on Tuesday.

Instead of passing health care, the U.S. House of Representatives voted to block money for the Obama administration to transfer Gitmo detainees to the U.S. The chamber also voted to spend more money on water-energy projects, sanction companies that sell gas to Iran, give more aid to Pakistan, create a registry for convicted arsonists, and, uh, keep the government from shutting down.

The Senate Finance Committee shot down the public option twice in their health care bill.

Great week, guys.

We discussed only yesterday David Leonhardt’s article for the NY Times, in which it becomes clear that taxes will have to rise if government is to continue providing social services that Americans have become accustomed to. In that vein, the Obama administration will propose reducing the value of itemized deductions for taxpayers in top brackets, raising revenue for the government for things like major health care reform:

The president will also propose, in the 10-year budget he is to release Thursday, to use revenues from the centerpiece of his environmental policy — a plan under which companies must buy permits to exceed pollution emission caps — to pay for an extension of a two-year tax credit that benefits low-wage and middle-income people.

The combined effect of the two revenue-raising proposals, on top of Mr. Obama’s existing plan to roll back the Bush-era income tax reductions on households with income exceeding $250,000 a year, would be a pronounced move to redistribute wealth by reimposing a larger share of the tax burden on corporations and the most affluent taxpayers.

Administration officials said Mr. Obama would propose to reduce the value of itemized tax deductions for everyone in the top income tax bracket, 35 percent, and many of those in the 33 percent bracket — roughly speaking, starting at $250,000 in annual income for a married couple.

Under existing law, the tax benefit of itemizing deductions rises with a taxpayer’s marginal tax bracket (the bracket that applies to the last dollar of income). For example, $10,000 in itemized deductions reduces tax liability by $3,500 for someone in the 35 percent bracket.

This is sort of a backhanded way of raising taxes, but whatever. Of course, Republicans will oppose it:

“Everyone agrees that all Americans deserve access to affordable health care,” Mr. Boehner said in a statement, “but is increasing taxes during an economic recession, especially on small businesses, the right way to accomplish that goal?”

So Republicans will continue to adhere to the “if the economy is good, cut taxes; if the economy is bad, cut taxes” philosophy. That’s fine. Increasing taxes is a hard sell, but I think it’ll get done. That is, if people can be persuaded that such is the cost of the things they want government to provide.

UPDATE: This Bloomberg article breaks down the costs of health care reform and the revenue produced by tax increases in greater detail. It also makes it clear that these tax increases won’t be enough, and that more are certainly on the way if we have any hope of successfully completing a reform program and cutting what is projected to be a $1.75 trillion deficit.

UPDATE II: About that cap-and-trade program, Rep. Chris Van Hollen, a Democrat from Maryland, has a different idea; take the revenue from permit and give it back to Americans in the form of a dividend. I seriously doubt this proposal will go anywhere, but interesting nonetheless. Generally though I favor the government using the money in aggregate on social programs, rather than me using a monthly check to go out to dinner somewhere.

After he banned gimmicks used by the Bush administration to make the federal deficit look smaller than it actually was, President Obama plans to outline steps in his budget proposal this coming week to halve that deficit it in four years, primarily through tax increases on the rich and corporations (whereas 95% of Americans are about to get their taxes cut) and cutting spending on the wars in Iraq and Afghanistan:

Even before Congress approved the stimulus package earlier this month, this year’s deficit was projected by Congressional budget analysts to approach $1.2 trillion, or 8.3 percent of the overall economy, the highest since World War II. With the stimulus and other expenses, some analysts say the annual gap between federal spending and income could approach $2 trillion when the fiscal year ends in September.

Obama proposes to dramatically reduce those numbers by the end of his first term, cutting the deficit he inherited in half, said administration officials, speaking on condition of anonymity because the budget has yet to be released. His budget plan would keep the deficit hovering near $1 trillion in 2010 and 2011, but shows it dropping to $533 billion in 2013 — still high in dollar terms, but a more manageable 3 percent of the overall economy.

To get there, Obama proposes to cut spending and raise taxes. The savings would come primarily from “winding down the war” in Iraq, a senior administration official said. The budget assumes that the nation will continue to spend money on “overseas military contingency operations” throughout Obama’s presidency, the official said, but that number is significantly lower than the nearly $190 billion the nation budgeted for Iraq and Afghanistan last year.

Obama also seeks to increase tax collections, primarily by making good on his promise to eliminate the temporary tax cuts enacted in 2001 and 2003 for wealthy taxpayers, whom Obama defined during the campaign as those earning more than $250,000 a year. Those tax breaks would be permitted to expire on schedule for the 2011 tax year, when the top tax rate would rise from 35 percent to more than 39 percent.

Obama also proposes to maintain the tax on estates worth more than $3.5 million, instead of letting it expire next year. And he proposes “a fairly aggressive effort on tax enforcement” that would target tax havens and corporate loopholes, among other provisions, the official said.

Overall, tax collections under the plan would rise from about 16 percent of the economy this year to 19 percent in 2013, while federal spending would drop from about 26 percent of the economy, another post-war high, to 22 percent.

That’ll deliver on three campaign promises right there… but wait, let’s not forget about health care:

The budget also puts in place the building blocks of what administration officials say will be a broad restructuring of the U.S. health system, an effort aimed at covering some of the 46 million Americans who lack insurance while controlling costs and improving quality. Many lawmakers said they had expected a health care overhaul to be pushed off while Obama deals with the economic crisis, but administration officials stressed they intend to forge ahead with comprehensive reform…

Administration officials and outside experts say the most likely path to revamping the health system is to begin with Medicare, the federal program for retirees and people with disabilities, and Medicaid, which serves the poor. Together, the two programs cover about 100 million people at a cost of $561 billion in 2007. Making policy changes in those programs — such as rewarding physicians who computerize their medical records or paying doctors for results rather than procedures–could improve care while generating long-term savings, expert say. It also could prod private insurers to follow suit.

Obama’s budget request would create “running room for health reform,” the official said, by reducing spending on some health programs so the administration would have money to devote to initiatives to expand coverage. The biggest target is bonus payments to insurance companies that run managed-care programs under Medicare, known as Medicare Advantage.

The Bush-era program has attracted nearly a quarter of Medicare beneficiaries to private health insurance plans that generally cover a package of services such as doctor visits, prescription drugs and eyeglasses. But the government pays the plans between 13 and 17 percent more than it pays for traditional fee-for-service coverage, according to the Medicare Payment Advisory Commission, which advises Congress on Medicare financing issues. Democrats have long complained about the cost, and eliminating the extra payments would save about $35 billion over the next five years.

Administration officials also are debating whether to permit people as young as 55 to purchase coverage through Medicare. That age group is particularly vulnerable in today’s weakened economy, as many have lost jobs or seen insurance premiums rise rapidly. The cost would depend on whether recipients were offered a discount or required to pay the full price of coverage.

As with the stimulus package, this show this is no small-thinking administration.

Matt Yglesias, on the strange American phenomenon of trailing other advanced nations in all sorts of infrastructure, technology and quality of life indicators, yet lead the world mostly in multi-millionaires getting bailed out by the federal government. There comes a point at which we cannot look ourselves in the mirror and honestly say we are one of the world’s most advanced nations. Maybe we already there, and we just won’t admit it.