AARP: 8 Myths About Health Care Reform

And why we can't afford to believe them anymore [AARP Magazine]

Americans spend more on health care every year than we do educating our children, building roads, even feeding ourselves—an estimated $2.6 trillion in 2009, or around $8,300 per person. Forty-five million Americans have no health insurance whatsoever. These staggering figures are at the heart of the current debate over health care reform: the need to control costs while providing coverage for all. As John Lumpkin, M.D., M.P.H., director of the Health Care Group for the Robert Wood Johnson Foundation, says, "There is enough evidence that it is now time to do something and to do the right thing." The key is to focus on the facts—and to dispel, once and for all, the myths that block our progress.

The 8 Myths:

Myth 1: "Health reform won't benefit people like me, who have insurance." Just because you have health insurance today doesn't mean you'll have it tomorrow.

Myth 2: "The boomers will bankrupt Medicare." If you're looking to blame the rise in health care costs on an aging population, you'll have to look elsewhere. Our fee-for-service payment system, in which doctors are paid by how many treatments they prescribe, rather than by the quality of care they provide. Some experts say this fee-for-service payment system encourages unnecessary and wasteful over treatment.

Myth 3: "Reforming our health care system will cost us more." Think of health care reform as if it's an Energy Star appliance. Yes, it costs money to replace your old energy-guzzling refrigerator with a new one, but over time the cost savings can be substantial.

Myth 4: "My access to quality health care will decline." Just because you have access to lots of doctors who prescribe lots of treatments doesn't mean you're getting good care. In fact, researchers at Dartmouth College have found that patients who receive more care actually fare worse than those who receive less care.

Myth 5: "I won't be able to visit my favorite doctor." Mention health reform and immediately people worry that they will have fewer options—in doctors, treatments, and diagnostic testing. The concern comes largely during discussions of comparative effectiveness research (CER): research on which treatments work and which don't. But 18 organizations in a broad coalition, including AARP, NFIB, Consumers Union, and Families USA, support CER—and believe that far from limiting choices, it will instead prevent errors and give physicians the information they need to practice better medicine.

Myth 6: "The uninsured actually do have access to good care—in the emergency room." It's true that the United States has an open-door policy for those who seek emergency care, but emergency room care doesn't help you get the right information to prevent a condition or give you help managing it. Plus, hospitals have no way to recoup the costs of treating the uninsured, so they naturally pass on some of those costs to their insured patients.

Myth 7: "We can't afford to tackle this problem now." We may be in the middle of a recession, but as Robert Zirkelbach, spokesperson for America's Health Insurance Plans, says, "the most expensive thing we can do is nothing at all." If we do nothing, the Congressional Budget Office projects that our annual health costs will soar to about $13,000 per person in 2017, while the number of uninsured will climb.

Myth 8: "We'll end up with socialized medicine." Some experts favor a single-payer system similar to Medicare or the health program offered to federal-government employees. Yet all the proposals being discussed today would build on our current system, Feder says—which means that private insurers and the government are both likely to play roles. Says Lumpkin: "There are many ways to solve our health care problem, but we will come up with a uniquely American solution, and that solution will be a mixed public and private solution."

Related Links:

• AARP: Health Care Reform: The Assault on Truth

Republican Party Chairman Michael Steele: Protect Medicare By Privatizing It

Updated Friday, August 28, 2009 @ 10:43AM

NPR [7 min 42 sec]

Republican Party Chairman Michael Steele opposes government-run health care insurance programs, as do most members of his party. In an exchange with National Public Radio's Steve Inskeep, Steele grew upset (4:45 into the audio clip) when Inskeep questioned the apparent contradiction in his arguments -- Steele argues both that the government shouldn't run public health insurance programs and that the Medicare public health insurance program must be protected. (That is, the part of Medicare already privatized by Republican controlled congresses over the past decade.)

Steele is attempting to argue that there is nothing contradictory about protecting Medicare by stopping the president from making Medicare operate more efficiently while also insisting that the government-run Medicare program is a failure and calling for it to be privatized.

At the beginning of this week RNC Chairman Michael Steele wrote an op-ed for the Washington Post, declaring the Republican Party to be the new protectors of the government run Medicare public health insurance program. He also this week appeared on Fox News and said:

... that Medicare is "a very good example of what we should not have happen with all of our health care." Asked to respond to Rep. Anthony Weiner’s (D-NY) argument that "if you like Medicare and you don’t want to make any cuts to it, then you’re basically defending a single payer system," Steele attacked Medicare implying that the government run Medicare public health insurance program should be privatized into the private health insurance industry:

I mean the reality of it is that, you know, this single payer program known as Medicare is a very good example of what we should not have happen with all of our health care.

... Government cannot run a health care system. They’ve already shown that. Trust the private markets to do it the right way. If there are reforms to be put in place, let’s deal specifically with those reforms.

The partial privatization of Medicare, that a Republican controlled Congress and the Bush Administration pushed on seniors as part of the 2003 Medicare Modernization Act, is costing U.S. taxpayers billions. It is the Privatized Medicare program (known as “Medicare Advantage” or “MA” plans) that Steele seeks to not only protect from reform, but also pushes to expand.

Under the "privatized" Medicare Advantage (MA) program, created by a Republican-led Congress in 2003 with the support of President Bush, the government buys private insurance coverage for Medicare patients in lieu of paying for health services directly. Republicans argue that by buying private insurance policies for seniors the government both saves money and delivers additional care to Medicare patients, including dental and eye services not covered under the traditional program. Those additional benefits, combined with a heavy dose of marketing, have made the program enormously popular. This year, a record-high 10.5 million seniors — or 23 percent of all Medicare beneficiaries — are enrolled in MA plans, according to a June report from the Medicare Payment Advisory Commission, or MedPAC, an independent panel that recommends Medicare reforms to Washington policymakers.

Despite Republican arguments that private Medicare plans operating under MA could eventually save money, the cost to treat the average patient in the MA program is 14 percent higher than the cost to treat the average senior under traditional Medicare.

A part of that additional cost, consists of funds used for MA plan administration overhead costs, marketing and profits and not direct health care services for beneficiaries. RNC Chair Steele, in his "protect Medicare argument," is actually arguing to protect this "privatized Medicare" program that subsidizes private health insurance industry profits, management bonuses, overhead and marketing.

The argument that private Medicare plans, subsidized by the government, are necessary to keep Medicare sustainable is belied by the fact that private plans cost taxpayers more than if the same coverage is provided under the standard public Medicare program where public money is not siphoned off into private profits, management bonuses, overhead and marketing.

Republican defenders of the privatized Medicare Advantage program on Capitol Hill have successfully thwarted most Democratic attempts in recent years reduce Medicare costs by reigning in the costs and abuses in the privatized Medicare Advantage program.

New York Times - Medicare Audits Show Problems in Private Plans : Tens of thousands of Medicare recipients have been victims of deceptive sales tactics, found they lack of coverage they thought their insurance policy provided and have had claims improperly denied by private insurers that run the huge new Medicare drug benefit program and offer other privatized Medicare Advantage program options, a review of scores of federal audits has found.

The Under the House health reform bill, which has already passed through the Energy and Commerce, Ways and Means, and Education and Labor committees — the three panels with jurisdiction over the issue — the privatized Medicare Advantage payments would be pulled back under public administration over several years in an attempt to eliminate the 14 percent cost overhead where public money is not siphoned off into private profits, management bonuses, overhead and marketing. The Congressional Budget Office estimates that the cuts will save taxpayers $156 billion over 10 years.

The White House has taken a different tack. As part of its 2010 budget proposal released in February, the Obama administration aimed to control MA costs by creating system that would require plans to bid competitively for regional contracts under MA. Those plans bidding higher than the regional average would nonetheless get paid only the regional average.

At an AARP-sponsored health reform forum last month, President Obama promoted his proposal saying, “We’ll eliminate billions in unwarranted subsidies to insurance companies in the Medicare Advantage program — giveaways that boost insurance company profits but don’t make you any healthier.”

President Obama's also commented at that AARP-hosted town hall that, "I got a letter the other day from a woman. She said, 'I don't want government-run health care. I don't want socialized medicine. And don't touch my Medicare.' I wanted to say, you know, that's what Medicare is: a government-run health care plan that people are very happy with."

The lady that wrote, "don't touch my Medicare" was likely referring to her Medicare Advantage paid private health insurance policy. Those opposed to health insurance reform have been telling seniors that Democrats will eliminate or drastically cut health care coverage for those seniors that have a Medicare Advantage paid private health insurance policy. This is the fear that GOP Chair Michael Steele is attempting to stoke in his rhetoric about "protecting Medicare."

If the Democrats are successful in their efforts to reform the privatized Medicare Advantage program, it could mark a set-back to the decades-old Republican push to fullly privatize Medicare. In October 1995, for example, then-House Speaker Newt Gingrich (R-Ga.) took the podium at a Blue Cross/Blue Shield conference in Washington and promoted a health reform strategy he knew would be music to his audience. Labeling Medicare “a centralized command bureaucracy,” Gingrich proposed to shift the popular program from “a government monopoly plan” to a fully privatized “free-market plan.” [Washington Independent]

RNC Chair Michael Steele has been advocating this week in his media blitz to protect the “free-market" privatized Medicare beachhead established in 2003 when the Republican congress and Bush White House worked together to enact the Medicare Modernization Act.

Related Links:

• The Medicare-Isn't-Government Meme, Part 3 GOP Chairman Michael Steele loves Medicare but hates government
  
• Bush's Parting Shots to the Old and Sick, Part 1: A Gift to Privatized Medicare
• Bush's Parting Shots to the Old and Sick, Part 2: A Wing and a Prayer for the Dying
• Why Bush's Medicare Drug Plan is Just Plain Wrong
  
• The Public Cost of Privatized Medicare: How Medicare Advantage is hurting Medicare beneficiaries
• As Medicare goes private, the press just stands by
• Bush's privatization agenda for Medicare
• McCAIN WANTS TO PRIVATIZE SOCIAL SECURITY
• Advocates hope Obama shifts from private Medicare plans
• Bush Medicare plan robs seniors
• Narrowed the scope of services that can be provided to poor people under Medicaid’s outpatient hospital benefit
• Bush Plan to Privatize Medicare: Limiting Patient Choice of Doctors in Iowa

Nancy Reagan: Ted Kennedy Was A Close Family Friend

Nancy Reagan to Son Ron Reagan on AirAmerica radio: I’ll Miss Ted Kennedy. . . Senator Edward Kennedy had many friends on both sides of the political aisle, but what many people don’t realize is that he was closes friends was former President Reagan and First Lady Nancy Reagan. Mrs. Reagan spoke with her son Ron about the man behind the politician, her thoughts about the importance of bipartisan friendships and the melancholy fact that she will miss her good friend immensely.

AirAmerica radio [10 min 55 sec]

The full audio of the AirAmerica radio interview.

Sen. Kay Bailey Hutchison "Motivated Seller" Of Her DC Home!

Back on July 30 we posted a story headlined, "Sen. Hutchison Says Will Resign Senate Seat In Oct. Or Nov." A few hours after she clearly said she would resign on a local radio program [Radio Interview Transcript at Houston Chronicle ] she kind of retracted the statement.

Could be KBH's resignation really is as close at hand. Sen. Kay Bailey Hutchison (R-TX) is selling her 4,300-square-foot house in McLean, VA, at a bargan basement price for a quick sale, according to a Dallas Morning News story last week. The listing describes a "motivated seller" seeking "all offers."

Said a spokeswoman: "She's no longer going to be in the United States Senate. She's coming home to Texas. That's why it's for sale."

Senator Ted Kennedy Dies Of Brain Cancer At 77

Senator Ted Kennedy has died, losing his battle to brain cancer.

Sen. Ted Kennedy died shortly before midnight Tuesday at his home in Hyannis Port, Mass., at age 77.

The man known as the "liberal lion of the Senate" had fought a more than year-long battle with brain cancer, and according to his son had lived longer with the disease than his doctors expected him to.

Sen. Edward Moore Kennedy, the youngest Kennedy brother who was left to head the family's political dynasty after his brothers President John F. Kennedy and Sen. Robert F. Kennedy were assassinated.

Kennedy championed health care reform, working wages and equal rights in his storied career. In August, he was awarded the Presidential Medal of Freedom -- the nation's highest civilian honor -- by President Obama. His daughter, Kara Kennedy, accepted the award on his behalf.

Senator Kennedy finishing his powerful speech at the
2008 Democratic National Convention in Denver.


Senator Kennedy speaking at the
2004 Democratic National Convention.

Insurance Industry Pushing For "Private, For Profit" Mandate In Reform

Insurance Industry Is Pushing For Health Reform that requires people to purchase private health insurance, but without a "true" public health insurance option and insurance industry regulation.

Updated August 24, 2009 - The Los Angeles Times reports again today, just as it did in early June that the heath insurance industry so successfully lobbied the congressional committees responsible for crafting heath insurance legislation in the early stages of the drafts of that legislation that it is poised to reap a financial windfall.

The half-dozen leading overhaul proposals circulating in Congress would require all citizens to have health insurance, but the bills vary in the degree to which they would empower government to be an actual competitor and to regulate coverage type and costs.

Health insurance reform may turn turn out to be nothing more than a federal mandate for people to buy private health insurance, as auto drivers are now required to buy auto insurance, and the government will pay the private health premiums for the very poor - as the public option.

"It's a bonanza," said Robert Laszewski, a health insurance executive for 20 years who now tracks reform legislation as president of the consulting firm Health Policy and Strategy Associates Inc.

Some insurance company leaders continue to profess concern about the unpredictable course of President Obama's massive healthcare initiative, and they vigorously oppose elements of his agenda. But Laszewski said the industry's reaction to early negotiations boiled down to a single word: "Hallelujah!" . . .Read the full story in the LATimes.

Updated August 18, 2009 - from NYtimes OpEd Columnist Bob Herbert -

The hope of a government-run insurance option is all but gone. So there will be no effective alternative for consumers in the market for health coverage, which means no competitive pressure for private insurers to rein in premiums and other charges. (Forget about the nonprofit cooperatives. That’s like sending peewee footballers up against the Super Bowl champs.)

Insurance companies are delighted with the way “reform” is unfolding. Think of it: The government is planning to require most uninsured Americans to buy health coverage. Millions of young and healthy individuals will be herded into the industry’s welcoming arms. This is the population the insurers drool over.

This additional business — a gold mine — will more than offset the cost of important new regulations that, among other things, will prevent insurers from denying coverage to applicants with pre-existing conditions or imposing lifetime limits on benefits. Poor people will either be funneled into Medicaid, which will have its eligibility ceiling raised, or will receive a government [tax credit] subsidy to help with the purchase of private insurance. --For full OpEd click here--

Original June 8, 2009 post continues:
The Los Angeles Times reports that private health insurance companies faces a bleak future if the proposal they champion most vigorously -- A federal mandate that everyone buy medical insurance coverage from private health insurance companies -- is not adopted. They are fighting hard for this federal mandate legislation which would be sweetened with taxpayer-funded subsidies for customers who can't afford it, and enforced with fines.

This so-called "individual mandate health care" program amounts to a huge booster shot for private "for profit" health insurers, which would serve up millions of new customers almost overnight. "I think that's why we've seen the industry basically trying to play the administration's game," said Jane DuBose, an analyst with industry tracking firm HealthLeaders-InterStudy. "They really could be licking their chops over the potential here."[LATimes]

Private insurers lost an estimated 9 million customers between 2000 and 2007. In many cases, people lost coverage because they or their employers could no longer afford it as premium increases outpaced wage growth and inflation.

According to the National Coalition on Healthcare, nearly 266,000 companies dropped their employees' health care coverage from 2000 to 2005 and for those employees that have not yet lost coverage the average employee health insurance premium is rising nearly eight times faster than income.

Yet, while the private insurance industry is hemorrhaging customers, profits at 10 of the country’s largest publicly traded health insurance companies rose 428 percent from 2000 to 2007. Clearly, there is a vicious cycle where an ever shrinking number of people are paying ever increasing monthly insurance premiums for less coverage. (more statistics)

By DAVID ORTEZ

The private insurance industry successfully scuttled the "single payer" approach to health care reform.

The private insurance industry is spending tens of millions dollars to lobby congress to also scuttle medicare-like government option plan complaining that such competition would cut into their near-monopolistic lock on the health care marketplace and significantly impact industry profits.

According to the Physicians for a National Health Program Organization - The U.S. spends twice as much as other industrialized nations on health care, $7,129 per capita. Yet our system performs poorly in comparison and still leaves 45.7 million without health coverage and millions more inadequately covered.

This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.

Public Option Health Care A "Core Ethical" Issue

Speaking in front of a group of religious leaders last Wednesday, President Barack Obama said the health care debate is a "core ethical" issue and should be treated as such. On "The Ron Reagan Show," Senator Bernie Sanders (I-VT) echoed Pres. Obama's words and went on to say that having a public option is a "necessity."

Ron Reagan and Senator Bernie Sanders on AirAmerica Radio:

Private Vs Public Health Insurance 'Myth'

By Stuart Carlson posted at carlsontoons.com

• Why We Need a Public Health-Care Plan
• NYT: "Any Nation As Rich As Ours Ought To Guarantee Health Coverage For All Of Its Residents"
• Health insurance rates to double by 2020
• Obama slams 'outrageous' health insurance reform 'myths'
• Myth of private health competition

The Republicans and their right-wing money men are trying hard to make it look like the opposition to President Obama's health care reform is a spontaneous grassroots movement by ordinary Americans. The truth is that the "grassroots" movement is funded by a series of right-wing organizations, created and funded by rich conservatives. McClatchy News reports on just who these groups are:

CONSERVATIVES FOR PATIENTS' RIGHTS -- created and funded by health care entrepreneur Rick Scott, the co-founder of Solantic urgent care walk-in centers. These centers advertise themselves as the option for those without insurance (so he specializes in ripping off poor and working class folks). This is also the guy who had to resign as CEO of the Columbia/HCA hospitals when they were investigated by the federal government for fraud.

FREEDOMWORKS -- This is formerRep. Dick Armey, who used to be the majority leader for Republicans in the House of Representatives. No one is farther to the right than this guy. He's also the person who said there's nothing wrong with our economy except Americans being cowards. This group also contains Steve Forbes, billionaire and former presidential candidate, and Richard J. Stephenson, who founded Cancer Treatment Centers of America.

PATIENTS FIRST and PATIENTS UNITED -- Were both created and funded by the ultra right-wing group Americans for Prosperity (AFP). AFP was started by billionaire David Koch of Koch Industries. It's president is Tim Phillips, who used to be in business with Christian Coalition director Ralph Reed. AFP and FreedomWorks both funded and organized the "tea parties". They hope to organize 600 anti-health care rallies by Labor Day.

CLUB FOR GROWTH -- A right-wing anti-tax organization headed by former Indiana Republican congressman Chris Chocola. This group has just announced a $1.2 million anti-health care ad campaign in in North Dakota, Colorado, Arkansas and Nevada.

60 PLUS ASSOCIATION -- This group was originally started to abolish the estate tax. Its current spokesman is Pat Boone, former singer and current right-wing fundamentalist. Its current goal seems to be to scare the elderly. In just the last week, the group has spent $1.5 million in anti-health care ads.

These are the real opponents of health care reform in America.

John Darkow The Columbia Daily Tribune

ActBlue Fundraiser To Support Health Care Reform

A fundraiser launched Tuesday by progressive bloggers as part of an effort to support progressive members of Congress with the guts to stand up to Big Insurance, Big Pharma and to the pressure from their own party bosses has topped $100,000 from more than 1,500 donors in just 24 hours and counting.

By Friday morning the ActBlue fundraiser has taken in over $300,000 -- with over 5,200 contributors.

The effort is being driven by FireDogLake.com and backed by blogs across the country.

How Can Only 40 Senate Republicans Stall Health Care Reform?

And How Senate Democrats Can Out Maneuver The Republicans

Updated Thursday August 20, 2009 10:10 AM
So far the new era of bipartisanship in Washington is more uni-lateral that bi-lateral. Last winter Pres. Obama kindly offered Republicans a bipartisan olive branch and extended them a place at the table of ideas to craft an economic stimulus package.

The response to that bipartisan olive branch was that Republicans trash talked Democrats and voted in mass against the stimulus bill anyway. Pres. Obama's stimulus package passed the in the U.S. House with zero Republican votes and only three Republicans broke ranks in the Senate to vote yes on cloture, which narrowly avoided a 'cloture filibuster' of the stimulus bill.

Pres. Obama, who had hoped for a widely supported bipartisan economic stimulus bill, got stonewalled despite conceding away large parts of the stimulus package to Republican objections that many economists said were essential.

Sound Familiar? The same thing is happening on health care reform legislation! How can only 40 Senate Republicans, with maybe the help of half-a-dozen conservative blue dog Democrats, kill, or at least stall, health care reform legislation?

In the Senate a mere threat of a no vote by 41 Senators on a cloture motion to limit debate on a bill amounts to a filibuster.

Cloture - The only procedure by which the Senate can vote to place a time limit on debate of a bill or other matter, and thereby guarantee that an up or down vote will be called on the bill. This is the only way to overcome a Senate filibuster. Under the cloture rule (Rule XXII), the Senate may limit consideration of a pending matter to 30 additional hours, but only by vote of three-fifths of the full Senate, normally 60 votes. The cloture rule, adopted in 1917, allowed the Senate to end a debate with a two-thirds majority vote. The new 'two-thirds' rule still made breaking up a filibuster difficult; therefore, the Cloture rule was amended by the senate body in 1975 to reduced the number of votes required to end the filibuster from two-thirds (67 votes) to three-fifths (60 votes).

Photo of Senator Hubert H. Humphrey (D-MN) June 10, 1964 Civil Rights Filibuster Ended At 9:51 on the morning of June 10, 1964, Senator Robert C. Byrd completed a [filibuster] address that he had begun 14 hours and 13 minutes earlier. The subject [of Sen. Byrd's filibuster] was the pending Civil Rights Act of 1964, a measure that occupied the Senate for 57 working days, including six Saturdays. Democratic Whip Hubert Humphrey, the bill's manager, concluded he had the 67 votes required at that time to end the debate. The Civil Rights Act provided protection of voting rights; banned discrimination in public facilities—including private businesses offering public services—such as lunch counters, hotels, and theaters; and established equal employment opportunity as the law of the land. From senate.gov/artandhistory

Democrats in the Senate today do not seem ready to make Republicans actually stand on the Senate floor and publicly filibuster health care reform in front of the Senate cameras for hours and days and weeks. (As in Mr. Smith Goes To Washington - youtube clip) Neither do Democrats seem ready to threaten the "nuclear option," to eliminate or amend filibustering in the senate rule book, as Republicans did against Democrats when the G.O.P controlled the Senate.

It certainly did not routinely takes sixty votes to do almost everything in the Senate during the years Republicans were in the majority and controlled Senate business. When Republicans controlled the U.S. Senate during the Bush presidency they accused Democrats of being obstructionists any time they said they might call for and vote down cloture in response to Republicans pushing very partisan conservative legislation and judicial nominees through congress. Ranking Republicans in the G.O.P who then controlled the U.S. Senate, threatened the "nuclear option," against Democrats, which would have effectively eliminated filibustering from the senate rule book.

(The term "nuclear option" was coined by Lott, one of the leading advocates of a proposal to change the Senate rule that requires a three-fifths supermajority to invoke cloture and end a filibuster. After Republican strategists deemed the term a political liability, Republican senators began to attribute it to Democrats. As Media Matters for America noted, at the time, many in the news media followed suit, repeating the Republicans' false attribution of the term to the Democrats.)

The nuclear threat worked - Senate Democrats were consistently cowed into allowing Republicans to pass very partisan conservative legislation and confirm very conservative judges, effectively unopposed. Ultimately, this left Democrats with no voice in the Republican controlled Senate! - None!

Republicans were singing a different tune after they they lost control of the senate in the November 2006 election and became the minority party in the 110th Congress. The number of cloture votes (stealth filibusters) forced by Senate minority Republicans skyrocketed in the 110th Congress.

So, before Republicans were for using the filibuster as the minority party, they were against it when they were the majority party - A clear flip flop!

The Senate was forced by Republicans to voted on 112 cloture motions (filibuster attempts) in the 110th congress controlled by Democrats, exactly double the number (56) of cloture votes in the 109th Congress, when Democrats were in the minority and Republicans were in control. The 110th congress cloture motions were two-and-a-half times as many as the average number of cloture votes (44) over the previous nine Congresses.

Of these cloture motions, 51 were rejected, meaning that Republicans succeeded in "procedurally filibustering" an up-or-down vote because at least 41 Republican Senators merely said they would vote against limiting debate to allow a floor vote. They effectively accomplished a "procedural filibuster" without actually holding the senate floor to continue debate for hours and days and weeks in a "Mr. Smith Goes To Washington" type of filibuster. On the 61 cloture votes to limit debate that did succeed, thus defeating the procedural filibuster, Republicans at the very least successfully stalled for time.

With the Republican minority numbers slipping to just 40 Senators for the 111th Congress (now that Al Franken D-MN has been seated) Republicans have formed a united front in threatening to use the power of the cloture vote to stall legislative business at every opportunity. Republicans forced the legislative pendulum to the far right during the Bush years and now with the help of up to six or so conservative blue dog Democrats they are determined to do everything possible to keep it stuck in the far right position using the 60 vote cloture rule.

With the Republican minority in the senate, along with a handful of blue dogs, exerting every effort to kill any health care reform legislation, Senate Democrats have two options to skirt Republican cloture vote filibusters against health care reform legislation:

1. The Nuclear Option of changing senate rules on the cloture vote threshold, or
2. Use Senate Budget Reconciliation rules, which disallows a motion for a cloture vote, to vote on health care legislation

Under the Congressional Budget Act of 1974, so called "Budget Reconciliation" legislation was given special Senate protection so that budget related bills may be passed by simple a majority of 51 votes, after limited debate. Budget Reconciliation rules give senators the ability to make the kinds of tough decisions on slim support margins required to cut the deficit.

Legislation passed under the Budget Reconciliation rule is allowed to contain only provisions for policy changes in mandatory spending (entitlements) or revenue programs (tax laws) to achieve government spending and revenue goals. Therefore, Republicans would undoubtedly contest "Budget Reconciliation" legislation that includes health reform items, such as regulations on rescission and pre-existing conditions practices employed by private insurance companies. Republicans would argue such items do not conform to Budget Reconciliation rules. [NYTimes]

The question of whether or not the public health insurance option legislation conforms to Budget Reconciliation rules is a gray area and would likely also be challenged by Republicans. [Dailykos] Even so,
White House and Senate Democratic leaders are reportedly considering a strategy shift that would present health reform legislation in two separate bills. One bill would include health reforms that do conform to Budget Reconciliation rules and would reportedly include a public insurance option to compete with private insurers. This bill could be passed with just 51 votes through the Budget Reconciliation parliamentary maneuver. [WSJ Online]

Republicans repeatedly used reconciliation to pass President Bush's agenda when they controlled congress to circumvent any possibility of a filibuster by Senate Democrats. Republicans used the budget reconciliation process to pass President Bush's 2001 and 2003 tax cuts as well as the 2005 "Tax Increase Prevention and Reconciliation Act." The Senate also used the reconciliation procedure to pass a bill containing a provision that would permit oil drilling in the Arctic National Wildlife Refuge. (Although, the final version of that bill signed by President Bush did not contain the provision on drilling.)

The second health care reform bill would include non-budgetary items such as the stricter insurance regulations central to Pres. Obama's health-care message. This bill would be advanced as normal legislation. The second bill would likely set new rules for private insurers, including stopping the practice of rescission and requiring they accept anyone, regardless of pre-existing medical conditions. This portion of the health-care overhaul has already drawn some Republican support and wouldn't involve new spending, leading Democratic leaders to believe they could clear the 60-vote hurdle.

The Nuclear Option From Talking Points Memo: Should the Democrats Change the Filibuster Rule? December 10, 2008, 9:00PM With the Democrats holding the presidency and solid majorities in both houses in Congress, Republican filibusters are now the only thing preventing truly progressive legislation. Should the Democrats therefore try to change or get rid of filibusters? We should keep in mind that the Democrats could do this if they wished, possibly turning the Senate into a majority-rule chamber like every other legislative body. How could this be done? There are two possible ways to change the rules. Rule changes in the Senate currently require a two-thirds majority of Senators present and voting. So theoretically this is possible, but the Republicans of course would never allow it. The other way is to use what is called the nuclear option (by its opponents), or the constitutional option (by its advocates). This is a complicated use of parliamentary procedure that ultimately results in a simple majority vote that ends a filibuster. Essentially a Senator wishing to end the filibuster makes a point of order calling for an immediate vote and the presiding officer of the Senate upholds this, citing the Constitution rather than Senate precedent as a guide (hence the name Constitutional option). When this happens the only recourse in parliamentary procedure is to appeal the decision of the chair. If one of the filibustering Senators does this, then an anti-filibuster Senator immediately moves to table that appeal. Since motions to table are non-debatable in parliamentary procedure, a vote to table the appeal is held immediately, and if it is passed by a simple majority then the chair's ruling that a vote must take place is upheld, and so a vote is taken. The filibuster is broken by a simple majority. The Republicans threatened to use this option when the Democrats were filibustering some of George Bush's judicial nominees, but a compromise was eventually reached and it was not employed. It has been used in the past, however, and it definitely does work. If the Democrats wanted to use it they could, and once this option is employed it becomes precedent-setting, so the Senate would then become a majority-rule body. There is no question, really, about whether this would work. It does work if a majority votes for it. The only real question is political: does the majority want to do it? A bit of history is in order here. The Senate had unlimited debate, and no cloture rule, until 1917, when a rule was adopted requiring a supermajority of two-thirds of Senators present and voting in order to cut off debate and end a filibuster. This rule remained in force until 1975, and filibustering was used most importantly by Democratic Senators from the south in order to block civil rights legislation. The longevity of this rule despite the fact that it can be overridden demonstrates the political considerations, as does the next step in the evolution of the rule. In 1975 a version of the nuclear option was used to change the filibuster rule by a simple majority vote of 51-42. However, the filibuster was not eliminated, rather the supermajority that was required to end a filibuster was changed from two-thirds of Senators present and voting to three-fifths of the Senate's full membership. This shows the political caution that Senators feel they must exercise regarding the filibuster rule. Polls have shown support for the filibuster rule, so Senators have two reasons not to use the nuclear option. First, they might want to use filibusters themselves at some point, second, they might not get re-elected if voters disapprove. The result is that Senators are very reluctant to get rid of the rule completely. The 1975 change was supposed to reduce the use of filibusters by lowering the cloture requirement from two-thirds to three-fifths, but it hasn't worked out that way. In the past, the requirement of two-thirds of those present and voting meant that the filibustering minority had to keep its Senators constantly present in order to maintain a one-third blocking minority anytime a vote to cut off debate might be held. This required a lot of personal commitment and discomfort f the majority decided to keep the Senate in session around the clock. This also produced high drama at times, as was depicted in the classic Jimmy Stewart movie Mr. Smith Goes to Washington. The 1975 change made the required supermajority to cut off debate three-fifths of the Senate's full membership, or sixty Senators if there are no vacancies. This means that the filibustering minority really only needs to mobilize one Senator at a time to conduct a filibuster, just the one doing the talking. If they rotate people speaking, then even if a cloture vote winds up 59-1 in favor of cutting off debate, it still fails and the filibuster continues. The result has been that the minority now just tells the majority that they intend to filibuster, and if the majority can't find sixty votes, it gives up. This is called a procedural filibuster, because an actual one is no longer necessary. Due to this, filibusters have proliferated tremendously. In the old days, filibusters were only employed when the minority felt very strongly about something, because filibusters were really uncomfortable and took a lot of effort and sacrifice. Now, any time a minority has 41 votes, they just announce a procedural filibuster, and they win. Given all this, I think we can expect that in the very near future we will see a huge number of filibusters. There is a lot of pent-up demand for progressive legislation, and the Democrats control the presidency and both houses of Congress, but the 41 or 42 Republican Senators can still effectively kill all the new legislation that the country needs. We also should keep in mind that several Democratic Senators are from Republican states, and we are as likely to lose votes at the margin as to gain them. So, the question soon will be: should the Democrats use the nuclear (oops, I mean Constitutional) option? I think they should, but in the same cautious way it was used in 1975. The Democrats will not be willing to just go completely to majority rule, because voters are not in favor of it. I feel that the Democrats should use the constitutional option to amend the filibuster rule, changing it from three-fifths of the full membership of the Senate to three-fifths of those present and voting. That would make it like the old days, but with the magic number being three-fifths instead of two-thirds. Then the chronic absenteeism of Senators becomes a very big factor. If only 90 Senators are present for example, then you would only need 54 votes to end a filibuster. This would require the Republicans to work for it if they really wanted to oppose something. They would have to do the Jimmy Stewart thing, which would also have the added benefit of making the Senate a lot less boring. I think we should expect this issue to be prominent in the coming months and prepare for it. The slogan should be "the filibuster - amend it, don't end it", and I have some talking points. The first is "when a vote is 59-1, one shouldn't win, and the second is "90% of life is showing up, except in the US Senate". Be prepared.

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