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Health Reform Looks Uncertain as Prominent Dems Shift Positions

It is no exaggeration to say that healthcare reform hangs in the balance as the Senate Democratic leadership tries to deal simultaneously with an attack on the bill's latest version by former Democratic National Committee Chairman Howard Dean, the obdurate refusal of Nebraska Sen. Ben Nelson to support the bill without a draconian anti-abortion provision, and parliamentary maneuvering by the Republicans to slow the bill's progress. Connecticut Sen. Joe Lieberman, who was the main obstacle to the bill's passage as late as yesterday, appears to be moving into the supporter column after the leadership agreed to drop the Medicare "buy-in" option for people aged 55-64. But that angered liberals who had seen the Medicare buy-in as a tradeoff for losing the public option. It was apparently the last straw for Dean, who said, "This is essentially the collapse of healthcare reform in the United States Senate."

Facing the need for 60 votes to close off debate and bring the reform measure to a vote, Senate Majority Leader Harry Reid appears to have no good options, but still expresses confidence that the bill will pass. Meanwhile, President Obama is taking the glass-half-full position, saying that the Senate is on "the precipice" of an historic decision. In a Huffington Post article, Linda Bergtholdt, who calls herself a "health policy consultant," praises the Senators and Congressmen who have worked hard on this legislation and have continued to back it despite declining public support and fierce attacks from Republicans and special interests. At the same time, she criticizes the Democratic politicians, including Nelson, Lieberman, and Dean, who are "preaching to their base" and, in her view, augmenting their own visibility by opposing the legislation.

"I am pleading with my fellow progressives to first read the whole bill before you go over the cliff with Dr. Dean. If you read the whole bill, I think you cannot help but see the good that it will do," she writes, citing the Medicaid expansion, the removal of discriminatory insurance company practices such as the pre-existing condition conclusion, and the provisions that would start paying providers for outcomes rather than volume. To that list I would add the 33 million additional people who would be insured if this bill passes.

One interesting point of division among Democrats is the potential effect of the Senate reform bill on the insurance industry. Dean views the current measure as a giveaway to health plans, and Lieberman, who comes from the state that is home to several leading insurance companies, has been called the "Senator from Aetna." The insurers do not want the Medicare buy-in because it could increase cost shifting to them and might be a step toward a single payer system-which is what the liberals want. So now that that's gone, Lieberman is going to support the bill and Dean is against it-just the opposite of where they stood a few days ago.

The one thing that is clear in this mess is that the demise of the public option has improved the financial prospects of the insurance companies. Shares of WellPoint, Cigna and UnitedHealth are all at 52-week highs.

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