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Senate Passes Health Care Reform

Ezra Klein:

Health Care Refom: Passing legislation, it turns out, is a long and ugly process. God, is it ugly. The compromises, both with powerful special interests and decisive senators. The trimming of ambitions and the budget gimmicks and the worship of Congressional Budget Office scores. By the end, you're passing a compromise of a deal of a negotiation of a concession. But bad a system as it might be, it's the only one we've got. At least for now. This is what victory looks like.... [T]his bill will do most of the things supporters hoped it would do: cover about 95 percent of all legal residents, regulate insurers, set up competitive exchanges, pretty much end risk selection, institute a universal structure that we can improve and enhance as the years go on, and vastly reduce both medical and financial risk for families. It's been a long time since the legislative system did anything this big, and people have forgotten how awful the victories are. But these are the victories, and if they feel bad to many, they will do good for more. As that comes clearer and clearer, this bill will come to feel more and more like the historic advance it actually is.

Jonathan Cohn:

BREAKING: Senate Passes Reform: The party-line outcome was not surprising. But it was clarifying. McConnell used his time to restate some of his party's now-familiar complaints about the measure--and to vow more opposition. "This fight is long from over," McConnell vowed. "My colleagues will work to stop this bill from becoming law."... [I]t is not the left that has stood (and still stands) in the way of creating a decent, protective health care system for nearly a hundred years. It’s the right.... For nearly a hundred years, the political system has been debating whether access to basic medical care should be a right all citizens enjoy. When reform passes, the political system will finally render its verdict: "yes."

Jonathan Chait:

And The Rest Is Just Noise | The New Republic: The sum total effect of this legislation is fairly simple. It would redirect a large chunk of the money sloshing around the health care system away from ineffective treatments and toward providing care for the uninsured. On top of that, it would prod the system, in dozens of ways large and small, to adopt cutting edge methods. It is not the kind of plan liberals would create if they could design it from scratch. Rather, it is a centrist compromise of the best variety, combining the ideas of the now nearly-extinct moderate wing of the Republican Party with the smartest bipartisan technocratic reforms. 

What, then, is not to like? Conservatives have attacked reform with a potent combination of populist attacks against cost controls, aimed particularly at terrified elderly voters, along with more intellectually-respectable attacks protesting the lack of cost control, aimed at winning elite opinion.... The Republican charge of fiscal profligacy rests upon a handful of endlessly repeated data points. The first, and most commonly cited, is that health reform does not truly pay for itself because it is predicated on an unrealistic promise to slash physician pay by 20 percent. The accusation stems from a simple misunderstanding. In 1997, Congress enacted a series of cuts in Medicare, including a reduction in payments to doctors. The cut was poorly designed, and wound up slashing pay by far more than Congress intended. So, though the cut remains on the books, every year Congress provides for a one-year reprieve, in a ritual known to Hill insiders as the “doc fix.”... Inexplicably, this fact has become exhibit A in the case against health care reform. (“There is nothing in the bill that will take care of the doctor fixes, $247 billion over the next 10 years,” charges Senator Lindsey Graham, citing this fact as evidence of the bill’s “Enron-accounting.”) This would be a persuasive argument if the health bill were introducing the physician payment cut as a way to offset the cost of health care reform. But it isn’t. The physician payment blunder is a hole in the budget that will be there regardless of whether or not health care reform passes....

The persistence of these thoroughly debunked pseudo-factoids reveals a couple things about the state of the GOP. The first is that the party desperately lacks for genuine health care expertise. Being a member of a party long committed to defending American health care naturally makes one disinclined to study the horrifying reality of the system; likewise, a thorough understanding of the health care system makes one disinclined to support the party that has spent decades blocking its reform. Second, conservative belief in the failure of health care reform is undergirded by deeper ideological values that are not amenable to data. Consider this typical salvo against reform in National Review, by Jeffrey Anderson, a Bush-era HHS speechwriter: “The motivation is simple and can be reduced to one word: power. And it doubtless has the American Founders, who dedicated their lives to securing liberty, spinning in their graves.” If we want to understand why a bill that embodies the best of moderate Republican ideas has attracted zero support from the Republican Party, it is because moderation has disappeared from the party. The takeover of ideological conservatives, implacably opposed to the expansion of government, has rendered impossible any bipartisan solution....

Insurers may be getting a lot of new customers, but that comes with the trade-off of a lot of unwanted regulation. There is more at work in the progressive revolt than an irrational attachment to the public plan or an executive distrust of private industry. The bizarre convergence of left-wing and right-wing paranoia echoes the forces that brought down the moderate consensus of the postwar era. The GOP retreat into Palinism represents one half of this collapse. The left’s revolt against health care reform represents the other. What has re-emerged in recent weeks is the spirit of the New Left--distrustful of evolutionary change, compromise between business and labor, and the practical tools of progressive reform. It is the spirit that rejected Hubert Humphrey in 1968 and Al Gore in 2000. The New Left rejection of “corporate liberalism” came at what we now regard as the historical apex of American liberalism. At the moment of another historical triumph, liberals are retreating from politics into languor, rage, and other incarnations of anti-politics. One day they may look back upon this time with longing.