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Historic Senate Vote on Reform Dampens Democratic Revolt

The Democratic left's insurrection against the Senate's healthcare reform bill was mostly over the week after it began. Even before this morning's historic vote to end debate on the bill, former Democratic National Committee Chairman Howard Dean signaled a change in position on NBC's "Meet The Press." While he still was insisting on a public option, Dean said that the Senate bill, which doesn't include one, had been significantly improved and should be allowed to go to conference with the House bill, which does include the public plan.

Of course, by that time Dean knew that the Senate measure was probably going to pass. But still, he praised the addition of a ceiling on insurers' medical loss ratios (the amount they have to spend on patient care) and the strengthening of a Medicare advisory commission to control costs. This was a long way from his inflammatory statement last week that the whole bill should be scrapped.

Meanwhile, Sen. Bernie Sanders, the Vermont independent who is a strong advocate of a single payer system, went along with the Democrats after $10 billion for more community health centers-including two in Vermont-was added to the measure (a fig leaf if there ever was one).

Not that all of the left has been mollified. MoveOn.org, a center of liberal activism, urged Democrats to vote against the Senate's bill after its leadership ditched both the public option and a Medicare "buy-in" for people aged 55-64. Moveon.org has not reversed that position, even in the wake of the vote to cut off debate. And in an online roundtable discussion on Bill Moyers Journal, both Moyers and Rolling Stone insurgent journalist Matt Taibbi opposed the bill as a giveaway to the insurance industry. Robert Kuttner, a cofounder of The American Prospect, complained that the public option had gotten "whittled down" to nearly nothing as a result of White House dealings with the insurance industry. But still, because a failure of healthcare reform would embolden the Republicans, Kuttner said, "I would hold my nose and vote for it."

There will be further battles over the public option before this is all over. But if liberals thought long and hard about it, they would realize that a robust public option was never in the cards, because there's too much opposition to a government takeover of healthcare. Moreover, as Obama advisor David Axelrod has pointed out, the insurance companies--which, the left would have us believe, love the Senate bill--do not want it and are even more fiercely opposed to its House counterpart.

In a statement released on Dec. 19, Karen Ignani, CEO of America's Health Insurance Plans (AHIP), said, "While the [Senate] bill makes important improvements in access and takes steps towards cost-containment, it lacks accountability to ensure that costs are brought under control. Moreover, this bill includes provisions that will increase costs for families and small businesses and disrupt the quality coverage on which millions of Americans rely today."

So, while insurance company stock prices are at a 52-week high, and news of the Senate vote buoyed stocks across the board today, it is not reasonable to say that either the Senate or the House legislation is all about increasing insurance company profits at the expense of consumers. Instead, these bills are complex sets of provisions that, if combined and passed by both houses, will start moving the country toward a fairer and more sustainable healthcare system. Although the cost controls in the bills are far from sufficient, they contain the seeds of approaches that could eventually bend the cost curve. And, unless most people have insurance, it will be impossible to do that, because millions of folks will not receive the care they need until it is too late to treat them cost-effectively.

I think it is time for the left wing of the Democratic party to get off their high horse and recognize that those who support reform are contending with giant political and economic forces that have frustrated it for decades. In just the first nine months of this year, the healthcare industry spent about $400 million lobbying on this issue. Senate Majority Harry Reid, House Speaker Nancy Pelosi, and President Obama deserve enormous credit for getting this far. Let's not jinx them now.

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