With 60 votes, as promised.

Even though there’s still one more hurdle (getting the House and Senate to agree), this really is a huge achievement.

Matt Yglesias:

As you know, my view is this: For all its flaws, if signed into law this bill would be the greatest progressive social policy achievement in over forty years. It’s fine not to be satisfied with this legislation, but it’s perverse not to be happy about it. The important thing is to try to make sure that we don’t need to wait another forty years before additional major improvements become possible.

Ezra Klein:

H.R. 3590, the Patient Protection and Affordable Care Act, passed with 60 votes, and though that sounds a razor-thin margin given the odd rules of the Senate, it is a landslide in the more normal context for major choices in American politics. The last time a president won with 60 percent of the vote, for instance, was when Lyndon Johnson trounced Barry Goldwater in 1964. Health-care reform passed the House with only 50.5 percent of the body voting for it. And the senators making up this morning’s 60 votes actually represent closer to 65 percent of the population. Harry Reid has much to be proud of today. [...]

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. The slow, grinding, ineluctable advance of legislation that is quite similar, albeit not identical, to what you began with. It’s not pretty, and it doesn’t necessarily feel like winning is supposed to feel. But this 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.

Today is a good day for America.

It isn’t super dramatic. This is not about insurance or any of that. It is about a critical area of medicine and how it is growing faster than most can handle. I’m talking about medical scans and their widespread use. The post is on our Darkwind Media blog since it is related to our ongoing work with CT scans: http://darkwindmedia.com/blog/2009/10/14/medical-data-overload

Let me know what you guys think. I see such a potential here for reliable non-invasive diagnostics and more accurate surgery planning. I’m staring on 3D renders of CT scans constantly and I’m amazed at the level of detail I can see inside a person’s body.

Ezra Klein has a great post up on the finally-ready bill out of Max Baucus’ Senate Finance Committee. Punchline?Good framework with some bad elements.

The key thing to learn about the Baucus bill, though, is that it’s an example of what happens when you try to negotiate with Mike Enzi and Chuck Grassley.

Ezra:

At this time, Baucus has no Republican votes for his legislation. Olympia Snowe is a maybe, and Enzi and Grassley are pretty certain to vote against it. Conceding so much in return for so little isn’t just bad politics — it’s bad precedent. Why should Republicans sign onto Baucus’s proposals in the future if they can simply adjust the bill to their liking and then withhold their support at the end?

If Baucus’s Republican colleagues want to support this bill and give him some cover, their presence should be welcomed. But if not, Baucus should loudly and publicly allow the Democrats on his committee to strengthen the bill, as it will be a Democratic majority that passes the bill. A bipartisan group should shape a bipartisan bill. But a bipartisan group should not get to shape a partisan bill, particularly if that bill becomes partisan because they have abandoned it.

In 2001, Baucus helped shape the president’s tax cuts, and he voted for them. In 2003, he helped shape the Medicare Modernization Act, and he voted for it. He has upheld his end of the bargain of bipartisanship. Now is his moment to demand the same of his Republican colleagues.

Republicans have no interest in voting for any serious healthcare reform bill. It’s time to stop pretending otherwise, and pass the bill that Democrats can pass themselves.

[via Palmetto Scoop]

With “death panel” rumors abound, it far past due to have a simple explanation of what the health care reform proposal on the Hill is all about.  Enter Nick Beaudrot:

When put into this context, we can see that the nefarious public option is relatively minor in scope.  The real big reforms are the added consumer protections, coupled with employer mandates and health care exchanges.  Not to say that the public option should be dropped, because I think it would be a significant upgrade to the system, but I wouldn’t want a bill to get killed simply because it didn’t contain one.

Having said that, it becomes even more clear that all those grannies out there have nothing to fear, because there will be no change to Medicare.  That is, there’s no change anymore, now that expanding Medicare benefits to cover end-of-life counseling has been stricken from the bill, because that was obviously unacceptable.

On a much larger note, it blows my mind that a political party can be continued to be taken seriously after knowingly and maliciously lying to the American people.  In this particular case, lying to little old ladies.

These people cannot be allowed to shape policy in this country.  It’s time to boycott the GOP and completely shut them out of the legislative process.  I have no interest whatsoever in bipartisanship unless both sides are acting in good faith, and it’s clear that the GOP has no intention of that.

Republican Party, you’re dead to me.

Sullivan repeats the usual conservative refrain when it comes to healthcare reform:

On healthcare, I’m not so sure. It’s hard to oppose the upgrade in information technology as a cost-saver. I can see the merits of getting more people insured. As long as any reform is careful to prevent the private sector being squeezed out of business, I’m open to persuasion. But I’m more cautious on this than most, I guess. I value the private healthcare system in the US, that, for all its faults, has innovated medicines that have saved my life.

This is one thing that I’ve never really understood or had explained to me.  I don’t understand how removing primary healthcare from the private sector stifles medical innovation.  The way I think about it, most medical innovation comes from new drugs, new equipment, and/or new procedures.  Which of these are performed/funded by insurance companies?  Am I wrong to say none?  I’m not a healthcare expert, but I don’t see where this comes into play.  It seems to me that Pfizer will still develop prescription drugs whether or not a private insurance company or the government is buying its pills, and the same goes for GE in developing a new MRI machine.  Switching to a public health care system would not stifle innovations in these fields any more than innovation in military weapons technology is stifled by the monopoly of the US Military.

As for new procedures, again I’m no health care expert, but isn’t the research for this mostly done at universities, funded by a mix of private foundations/corporations and government money?  So I still don’t see where insurance companies come in for any of this.  The only real argument you could make, in my opinion, for innovation by private insurance companies would be innovations for cost savings, but we know that this is definitely not happening.

The fact of the matter is that the only real innovations that private insurance companies make is finding new ways to screw people out of their coverage, which is why we need reform.

[Update]

It appears Yglesias is on the same page:

The point that I think receives too little attention in the debate is the one about innovation rather than risk segmentation. At the moment, insurance companies primarily compete by getting better at risk segmentation—at avoiding the riskiest cases, and doing various kinds of price discrimination. We can and should regulate much of this away. But if that’s all we do, we’ll still have a situation in which the companies are trying to find new and more creative ways of doing risk segmentation. We’ll end up “overly dependent on government enforcement to achieve the goals of health reform,” playing an endless game of cat-and-mouse to see whether or not we’re actually achieving our policy objective of promoting health in a reasonably fair and cost-effective manner. Inserting a publicly managed enterprise into the framework lets us rely more on competition and less on regulatory mandates.

The way this works is that if the private plans can’t or won’t compete by offering innovation, value, and quality then the bureaucrats at the public plan should be able to beat them. That, in turn, creates incentives for the private sector to unleash its own imaginative powers on beating the bureaucrats. Otherwise, it’s just bureaucrats drawing up rules and then the private sector dully complying with the rules while working creatively to find loopholes.

Doug Holtz-Eakin, explains away concerns that John McCain’s health care plan would cause young and healthy individuals to drop out of group plans:

Younger, healthier workers likely wouldn’t abandon their company-sponsored plans, said Douglas Holtz-Eakin, McCain’s senior economic policy adviser.

“Why would they leave?” said Holtz-Eakin. “What they are getting from their employer is way better than what they could get with the credit.”

Haha.  Gee, maybe we shouldn’t tax those “way better” benefits, thus creating an incentive to participate in them.  Nah, let’s go with the way worse plan instead.  That oughtta do it.

Barack Obama, quick to pounce: