And now for something completely frivolous..

This tweet by ER doc Seth Trueger, pointing to a blog post by ACA stats guru Charles Gaba, got me feeling singy, as Winnie-the-Pooh would put it:

how many types of health insurance are there in the US now? by @charles_gaba; @louisenorris @_kjkelly @xpostfactoid1 http://t.co/rjQpNHfp9P
— Seth Trueger (@MDaware) March 7, 2015

Resulting in this serial-tweet nonsense:

How many roads must man walk down
before you call him insured?
How many frivolous suits must fail
before health reform is secured?
How many deaths will it take till we know
our health system still isn't cured?
The answer, my friend,
is forecast by Sean Trende,
the answer is forecast by Sean Trende.

You don't think Trende belongs here? He wanted to come in, as Pooh would say.

How about a doctor's mandate in the health reform law?

The Times' Robert Pear today reports on a major roadblock to expanding health care access in the United States: in many states, few or no doctors in a wide array of specialties will see Medicaid patients.  And the Affordable Care Act aims to add about 15 million people to the Medicaid rolls, while cash-strapped states continue to cut Medicaid reimbursement rates.

I have a solution. It's simplistic, and perhaps someone will demonstrate to me that it's unworkable or unfair. It's surely politically impossible at this point, given the power of the doctors' lobby.  But here it is: require doctors to devote a minimum percentage of their practice to Medicaid patients.  At present, about 28% of doctors refuse to accept any Medicaid patients.  The percentages are doubtless much higher in some practice specialties and states.

Olympia Snowe, put up or shut up on healthcare reform's flaws

In George Packer's long dossier of Senate dysfunction, Olympia Snowe repeats for the umpteenth time that she voted against the healthcare reform bill because she was shut out of merging the Finance Committee bill, which she help forged and voted for, with the HELP Committee bill:

Snowe also voted for the Finance Committee’s health-care-reform bill last October, the only Republican to do so. But in December, at the pivotal moment, she voted against the version that went before the full Senate. “I wasn’t interested in expanding this program beyond the Finance Committee version—it grew by a thousand pages,” Snowe said. She wasn’t included in the negotiations with White House officials that took place in an elegant conference room across from Reid’s suite of offices, and said that the Democrats “did not accept any of my proposals. As I said to the President, it was all windup and no pitch.” 

Snowe here resorts to the Republican fallback position of ridiculing numbers of pages rather than specifying what she didn't like in substance.  The enacted health care reform law is similar in its essentials to the Finance Committee bill -- about which Snowe had this to say to Ezra Klein on October 16, 2009:

Something was missing in Obama's Oval Office speech...

Everything about Obama's oval office speech about the Gulf oil spill tonight was predictable and effective -- except his call for a new energy bill.

This time, for me, his familiar riff about the nation's history of rising to major challenges, mustered in support of action to change our energy consumption and production, rang a bit hollow:

The one answer I will not settle for is the idea that this challenge is too big and too difficult to meet. You see, the same thing was said about our ability to produce enough planes and tanks in World War II. The same thing was said about our ability to harness the science and technology to land a man safely on the surface of the moon. And yet, time and again, we have refused to settle for the paltry limits of conventional wisdom. Instead, what has defined us as a nation since our founding is our capacity to shape our destiny – our determination to fight for the America we want for our children. Even if we're unsure exactly what that looks like. Even if we don't yet know precisely how to get there. We know we'll get there.

It rang hollow because, while the echoes of his advocacy for health care reform were striking,  so was a core difference: he did not lay out the "core elements" of the bill he wanted.

New coverage rules for employer-provided health plans

Most overviews of the effects of the new health reform law have suggested that it won't have a large impact on employer-provided insurance. That ain't necessarily so.

Business Insurance reports that employers "will have to redesign their health care plans to extend coverage to employees' adult children up to age 26, eliminate lifetime dollar limits and remove pre-existing condition exclusions, if any, for children up to age 19."

Historically, insurance has been regulated by the states. While many states have strict coverage mandates (and others minimal ones), employers that offer self-funded health plans to their employees have been exempt from these mandates.  Since more than half of all Americans who get their health coverage from their employers are in self-funded plans -- approximately two thirds of large employers self-fund -- that's a large regulatory loophole.

According to Business Insurance, however, the new federal coverage rules do apply to self-funded plans:

For example, few employers extend coverage to employees' children to age 26 as the legislation will require starting next year; typical cutoffs are at age 23. Many states already require such extensions, but those state laws apply only to insured plans and not to the roughly two-thirds of larger employers that self-fund their plans.

A more perfect speech draft: Obama edits "our" national story

Editors of the world are agog at a close-up of Obama's mark-up of a draft of the speech on health care he delivered to both chambers of Congress on September 9. It's an extraordinary window into Obama's mind.

What did Obama do to the draft? Repeatedly, he added agency, attributing acts, feelings and thoughts to specific people or groups of people.  He added nouns and pronouns and active verbs, converting verbal nouns in the original draft to active verbs with human predicates(Teddy, our seniors, members of Congress, I, we, etc.).  He drew individuals, members of Congress generally, and the American people as active agents into a joint national project of compassion and positive action.  He reminded Republicans that they had been part of this national project (extending from social security to Medicare to the current health reform) in the past.

His additions of this sort are boldfaced below. Text in blue appears neither in the typescript nor in Obama's handwritten edits -- it was apparently added later

But those of us who knew Teddy and worked with him here -- people of both parties -- know that what drove him was something more.  His friend Orrin Hatch -- he knows that.  They worked together to provide children with health insurance.  His friend John McCain knows that.  They worked together on a Patient's Bill of Rights.  His friend Chuck Grassley knows that.  They worked together to provide health care to children with disabilities.

On issues like these, Ted Kennedy's passion was born not of some rigid ideology, but of his own experience.  It was the experience of having two children stricken with cancer.  He never forgot the sheer terror and helplessness that any parent feels when a child is badly sick.  And he was able [orig: or his ability]  to imagine what it must be like for those without insurance, what it would be like to have to say to a wife or a child or an aging parent, there is something that could make you better, but I just can't afford it.

That large-heartedness -- that concern and regard for the plight of others -- is not a partisan feeling.  It's not a Republican or a Democratic feeling.  It, too, is part of the American character -- our ability to stand in other people's shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand; a belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgment that sometimes government has to step in to help deliver on that promise [orig: "...security and fair play that only government can ensure"].

This has always been the history of our progress.  In 1935, when over half of our seniors could not support themselves and millions had seen their savings wiped away [further edited before delivery], there were those who argued that Social Security would lead to socialism, but the men and women of Congress stood fast, and we are all the better for it.  In 1965, when some argued that Medicare represented a government takeover of health care, members of Congress -- Democrats and Republicans -- did not back down. They joined together so that all of us could enter our golden years with some basic peace of mind.  

You see, our predecessors understood that government could not, and should not, solve every problem.  They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom.  But they also understood that the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, the vulnerable can be exploited.  And they knew that when any government measure, no matter how carefully crafted or beneficial, is subject to scorn; when any efforts to help people in need are attacked as un-American; when facts and reason are thrown overboard and only timidity passes for wisdom, and we can no longer even engage in a civil conversation with each other over the things that truly matter -- that at that point we don't merely lose our capacity to solve big challenges.  We lose something essential about ourselves.

That was true then.  It remains true today.  I understand how difficult this health care debate has been.  I know that many in this country are deeply skeptical that government is looking out for them.  I understand that the politically safe move would be to kick the can further down the road -- to defer reform one more year, or one more election, or one more term. 

But that is not what the moment calls for.  That's not what we came here to do.  We did not come to fear the future.  We came here to shape it.  I still believe we can act even when it's hard.  (Applause.)  I still believe -- I still believe that we can act when it's hard.  I still believe we can replace acrimony with civility, and gridlock with progress.  I still believe we can do great things, and that here and now we will meet history's test.

Because that's who we are.  That is our calling.  That is our character.  Thank you, God bless you, and may God bless the United States of America. 

One addition -- not the warmest, but one that opens a window onto how Obama conceives of government -- deserves an additional spotlight. At the end of  a complex sentence, he added a clause to change this:

It, too, is part of the American character -- our ability to stand in other people's shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand; a belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play that only government can ensure.

 To this:

It, too, is part of the American character -- our ability to stand in other people's shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand; a belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgment that sometimes government has to step in to help deliver on that promise. 

Talk about "active government" -- you have here a seven-word active verb phrase: "has to step in to help deliver."  Note how qualified government's role is: it steps in only when it has to, and it only helps deliver on the promise that is part of the American character.  That is liberalism chastened by Reaganism -- a conservative superego imposed on a liberal id.

UPDATE: In a look at Obama's rhetoric, Jonathan Bernstein suggests that Obama defines American greatness as the capacity for creative political action:

We, in the United States, do not accept history, or live through history -- we have the capacity, Obama (and Biden) say, to make history, through collective action, whether it is in the Revolution, the Constitution, the Civil War, the civil rights revolution, or now, in tackling the challenges that face us in the 21st century.  America, therefore, is self-created, and continues to be self-creating, by political action. 

The changes noted above reinforce this theme by naming and crediting the actor. See also 'We've been here before': How Obama frames our history.

Update, 10/4/12: In a similar vein, see the changes Bill Clinton ad-libbed in his speech at the 2012  Democratic National Convention.

The Obama Rhetoric Series

• The great myth about Obama's soaring rhetoric
• Obama denounces Holocaust denial, loses Arab students
• 2029: Look back in wonder
• The gospel according to Obama
• What Will.i.am had to work with
• Killing McCain with Kindness
• We've been here before: How Obama frames our history
• Obama does it with integrity
• Obamanomics: rebalancing the national portfolio
• Breaking the commander-in-chief chokehold: Obama maps a strategy
• What Obama owes to Reagan II
• Obama praises Bill Clinton, and buries him

You'd think Obama wrote the damned bill

Not to be subtle, here's the keynote of Obama's re-presentation of the Democrats' health care plan, boldfaced below.

Now, the proposal I put forward gives Americans more control over their health insurance and their health care by holding insurance companies more accountable...

 Essentially, my proposal would change three things about the current health care system... 

Second, my proposal would give uninsured individuals and small business owners the same kind of choice of private health insurance that members of Congress get for themselves...

Obama bends over backwards, and does not yield

Obama's post-summit bid for a comprehensive health care bill, unveiled in a letter to the Congressional leadership, extends his paradoxical  approach to Republican intransigence: bend over backwards/do not yield.  That is, keep suggesting -- and trying to showcase -- the meme that Repubicans can be right at the margins but are missing the big picture.

The White House blog stresses that the President is proposing to include "even more Republican ideas" (!) and the revised plan incorporates several proposals voiced by Republicans at the summit. Yet at the same time, Obama's letter insists "that piecemeal reform is not the best way to effectively reduce premiums, end the exclusion of people with pre-existing conditions or offer Americans the security of knowing that they will never lose coverage, even if they lose or change jobs." In other words, the damn bill -- a blend of the bills passed by House and Senate Democrats -- will pass. 

Pelosi calls for courage -- and demonstrates it

Prior to the Massachusetts election, I can't say I had a very distinct impression of Nancy Pelosi.  Since that bomb dropped, however, scattering Democrats' brains in all directions, I have admired her courage.  She has been the one voice who has consistently said from almost the moment of impact on: we will get it done. We will pass comprehensive health care reform. Most memorably there was this, on Jan. 28:

“You go through the gate. If the gate’s closed, you go over the fence. If the fence is too high, we’ll pole-vault in. If that doesn’t work, we’ll parachute in. But we’re going to get health care reform passed for the American people.”

Today on This Week, Pelosi addressed the hardest question of all for wavering Democrats:

VARGAS...What do you say to your members, when it does come to the House to vote on this, who are in real fear of losing their seats in November if they support you now?

PELOSI: Well first of all our members -- every one of them -- wants health care. I think everybody wants affordable health care for all Americans. They know that this will take courage. It took courage to pass Social Security. It took courage to pass Medicare. And many of the same forces that were at work decades ago are at work again against this bill.

But the American people need it, why are we here? We're not here just to self perpetuate our service in Congress. We're here to do the job for the American people. To get them results that gives them not only health security, but economic security, because the health issue is an economic issue for -- for America's families.

David Brooks "Dull as Expected" on health care reform

The headline to David Brooks' column proclaims cheerfully that the health care summit was "not as dull as expected!"  But David Brooks here is dim as expected -- as dim as ever on health care.

His signature charge, here and elsewhere, is that the Democrats are not serious about cost control because supporters of the excise tax on expensive policies have allowed that tax to be weakened:

Fifth, you got to see at least one area of bipartisan agreement. Neither side was willing to be specific about how to cut costs and raise revenue. The Republicans continued to demagogue efforts to restrain Medicare spending. The Democrats (and the Republicans) conveniently neglected to mention the fact that they had just gutted the long-term revenue source for their entire package, the excise tax on high-cost insurance plans. That tax was diluted and postponed until 2018. There is no way that members of a Congress eight years from now are going to accede to a $1 trillion tax increase to pay for a measure that the 2010 Congress wasn’t brave enough to pay for itself.

First, it is just plain slander to assert that the Democrats are unwilling to be specific about how to raise revenue.  The House bill has no excise tax, but it is deficit neutral -- it raises money from other taxes, such as a surtax on high earners, while the Obama plan published in advance of the summit adds a new Medicare surtax on capital gains for high earners.  Second, as Atul Gawande has documented in exhaustive detail and as a group of top health care economists led by Dr. Alan Garber has affirmed, the bill deploys just about every means of cost control that health care experts deem to have potential  -- coordinated care teams, incentives for results and penalties for not meeting standards on measures such as hospital readmissions, a MedPAC commission with real authority -- and yes, the excise tax, albeit delayed.

Third, it is always suspect to speak of "courage" when dealing with collective bodies.   The excise tax has not been weakened because of a lack of "courage." Indeed, Obama has gone to the mat for it as he never did for the public option -- as Ezra Klein predicted he would long ago. Unions and their closest allies in the House have had the 'courage' to risk the entire bill to weaken this tax.  Cost control hawks have had the "courage" not to let it go.  Any further "courage" on their part would doom the bill to failure.

Chait, is the gate "wide open"?

Jonathan Chait has argued since the darkest dog days of August that inexorable political logic will ultimately lead the Democrats to pass a comprehensive health care reform bill. Serial resurrections of the bill have seemed to confirm Chait's perspicuity.  I hope and pray that he's right.  But I fear that at this point he is underestimating the the tenuousness of the effort to get across the goal line. And I fear that the public option boomlet may cause a fumble.

Chait makes it all sound so easy...

Some of us realized all along that there was no rational reason that the Massachusetts election had to kill health care reform. Fundamentally, the main barrier -- getting sixty votes in the Senate -- had already been crossed. The remaining obstacles are puny. All the Democrats needed to do was have the House pass the Senate bill. If they insisted on changes, most of those could easily be made through reconciliation, which only requires a majority vote in the Senate...the legislative door to health care reform is wide open, and Democrats simply need to walk through it...it's fairly easy to just have the House pass the Senate bill, then use reconciliation to eliminate the Nebraska Medicaid subsidy and change the mix of taxes that pay for new coverage.

"Wide open" is quite a stretch. It's far from "fairly easy to just have the House pass the Senate bill."  The House passed its own bill 220-215 in November and has since lost 3 votes - Murtha through death, Wexler through resignation, and Cao through reversal.  That bill only squeezed through because the Stupak Amendment brought 28 blue dogs aboard. Passing the Senate bill means abjuring the Stupak Amendment.  Perhaps the more conservative nature of the Senate bill will add a few more blue dogs -- if the booming movement to include the public option in the reconciliation package doesn't hit critical mass. On the other side of the Hill, no one seems to know whether a negotiated reconciliation patch can capture 51 votes.

The door seems as about as wide open as the eye of a needle for a camel.

Related posts:
The earth beneath their feet: Obama recasts health care reform
Aghanistan redux: Obama's HCR surge
Obama picks "none of the above" again
A gallon of water at bedtime for bedwetters: Obama's HCR prescription
How Obama will -- and won't -- lead on health care

The earth beneath their feet: Obama recasts health care reform

Reading the Obama Administration's letter setting out the terms of the Feb. 25 health care summit, it struck me that the obvious has crept up on us by inches. It's this: moving in his own deliberate fashion, President Obama has doubled down on health care reform.  Rather than gather his Democratic flock in the immediate aftermath of the Massachusetts debacle, he has moved the political ground beneath them as well as the Republicans.  He has issued a put-up-or-shut-up to the whole Congress. Of course, he knows that only the Democrats have something to put up. But he is going to make them put it up -- even if they vote it down. 

Look at how the work order, so to speak, is framed (the letter is under the signature of Rahm Emanuel and Kathleen Sebelius):

We have seen again in recent days that when it comes to health care, the status quo is unsustainable and unacceptable. The proof is right in front of us: just last week, a major insurer, Anthem Blue Cross, announced plans to increase premiums for many of its policyholders in California by as much as 39 percent on March 1.

As the President noted this week, if we don’t act on comprehensive health insurance reform, this enormous rate hike will be "just a preview of coming attractions. Premiums will continue to rise for folks with insurance; millions more will lose their coverage altogether; our deficits will continue to grow larger."

Now is the time to act on behalf of the millions of Americans and small businesses who are counting on meaningful health insurance reform. In the last year, there has been an extraordinary effort to craft effective legislation. There have been hundreds of hours of committee hearings and mark-ups in both the House of Representatives and Senate, with nearly all of those sessions televised on C-SPAN. The Senate spent over 160 hours on the Senate floor considering health insurance reform legislation and, for the first time in history, both the House of Representatives and Senate have approved comprehensive health reform legislation. This is the closest our Nation has been to resolving this issue in the nearly 100 years that it has been debated...[snip]

How Obama will -- and won't -- lead on health care reform

Steve Benen has the very section of Obama's meeting with Senate Democrats (cut up and elided) that I was struggling to transcribe from the tape:

"All that's changed in the last few weeks is our party has gone from having the largest Senate majority in a generation to the second-largest Senate majority in a generation," Obama said. "If anybody is searching for a lesson from Massachusetts, I promise you the answer is not to do nothing."

He added, "I know these are tough times to hold public office. The need is great; the anger and anguish are intense." While "the natural political instinct is to tread lightly, keep your head down and play it safe," he said, Democrats should remember the promises they made in their election campaigns.

"So many of us campaigned on the idea that we're going to change this health-care system" Obama said. ..So many of us looked people in the eye who had been denied because of a pre-existing condition, or just didn't have health insurance at all ... and we said we were going to change it..*. "Well, here we are with a chance to change it....I hope we don't lose sight of why we're here. We've got to finish the job on health care."  We've got to finish the job on regulatory reform. We've got to finish the job, even though it's hard."

1995 Redux: Call the Republicans' shut-down-the-Senate bluff

It's a given by now that Republicans will do all they can to obstruct any deal between House and Senate Democrats entailing the House passing the Senate health care bill and amending it through the reconciliation process. Jeff Davis, Greg Sargent and Karen Tumulty have explained in numbing detail how Senate Republicans can stall reconciliation fixes. Sargent:

The GOP Senate leadership has privately settled on a strategy to derail health reform if Dems try to pass the Senate bill with a fix through reconciliation, aides say: Unleash an endless stream of amendments designed to stall for time and to force Dems to take untenable votes.

The aide described the planned GOP strategy as a “free for all of amendments,” vowing Dems would face “a mountain of amendments so politically toxic they'll make the first health debate look like a post office naming.”

Notwithstanding the difficulties, what remains striking is the difference in political will between the two parties. Republicans, as ever, will act as a body to do whatever it takes to get what they want -- the death of comprehensive health care reform, a Waterloo for Obama, an electoral debacle for the Democrats to dwarf 1994. 

Grade for the great test of leadership: Incomplete

In a 7,000-word speech, Obama devoted 500 words to health care, beginning at almost the exact mid-point. So it may seem perverse to assess the whole speech on the basis of the health care portion.  But it's not. Health care remains the fulcrum, the keystone, the hinge, the pivot point, the centerpiece of Obama's domestic agenda, for these reasons:

• He says the deficit keeps him up at night. Well, as he used to remind us frequently, say nine months ago, health care reform is entitlement reform. Bend the health care cost curve, and the Federal government's core commitments are affordable; fail to, and they're not. But those magic seeds of cost control packed into the Senate bill that Atul Gawande catalogued so lovingly will not become law unless the House passes that bill.
  
  
• Obama's core campaign promise, reiterated in an email to supporters following the speech, was "restoring economic security for struggling middle class families."   That cannot be done as long as losing a job means exposure to catastrophic medical cost, or as long as having the wrong job can make insurance an impossible dream, or as long as millions of "insurance" policies leave holders exposed to catastrophic costs. 
  
  
• He said that change is not easy, that he wanted to tackle the hard stuff, . In the health care reform process, Americans got full frontal exposure -- overexposure, according to conventional wisdom -- to the mammoth difficulties and not-always-destructive competitive tradeoffs of moving major legislation through the United States Congress. That leaves Obama with a double message: let's fix the process/let's make the process work. Both messages will spiral to massive fail if a comprehnsive bill does not pass.
  
  

Quell Pascrell, who'd kill the bill

On Monday, I was dismayed to learn that my own Congressman in New Jersey's 8th District, Rep. Bill Pascrell, is leading a posse of House Democrats who want to kill the effort to pass comprehensive healthcare reform.

On South Orange Patch, a local news website, I've asked my neighbors to send Pascrell a message -- fast.

Quote of the Day

It is simply astonishing that the GOP is now posing as a party of fiscal responsibility. It's like Bristol Palin campaigning against teen pregnancy.

 Andrew Sullivan

Meanwhile, the drumbeat of core progressive voices urging the House to pass the Senate HCR bill cotinues.    Andy Stern is threatening. Steve Benen is warning. The New York Times is importuning. And Paul Begala is begging.

Plouffe offers political clarity on health care reform

It's amazing how two-sided statements by Obama, Pelosi and Axelrod about the way forward on health care reform have been to date. Obama has managed to suggest simultaneously that piecemeal health care reforms can't work and that he's receptive to a scaled-back bill; Axelrod has done the same. Pelosi has been subtler, suggesting that she doesn't have the votes this moment to pass the Senate bill and work fixes by reconciliation, but that she wants them.

Into this haze comes a ray of clarity (in a Wash Post op-ed) from David Plouffe, newly brought aboard to lead White House political operations. Here's the first plank of the platform he sketches out for Democrats:

-- Pass a meaningful health insurance reform package without delay. Americans' health and our nation's long-term fiscal health depend on it. I know that the short-term politics are bad. It's a good plan that's become a demonized caricature. But politically speaking, if we do not pass it, the GOP will continue attacking the plan as if we did anyway, and voters will have no ability to measure its upside. If we do pass it, dozens of protections and benefits take effect this year. Parents won't have to worry their children will be denied coverage just because they have a preexisting condition. Workers won't have to worry that their coverage will be dropped because they get sick. Seniors will feel relief from prescription costs. Only if the plan becomes law will the American people see that all the scary things Sarah Palin and others have predicted -- such as the so-called death panels -- were baseless. We own the bill and the health-care votes. We need to get some of the upside. (P.S.: Health care is a jobs creator.)

Here's hoping that Plouffe is speaking with what will be Obama's voice.  The political logic is incontrovertible, and that's Plouffe's bailiwick. As for the long-term policy imperative, no one understands it better than Obama.

UPDATE (from the Dept. of taking credit for the sunrise): further down Plouffe's column, there's this fighting sentiment:

Instead of fearing what may happen, let's prove that we have more than just the brains to govern -- that we have the guts to govern.

That chimes with a bit of xpostfactoid-ese, highlighted in The Daily Dish on Jan. 19:

"We have one party that has not got the brains to govern. Will we now learn for certain that we have another party that hasn't got the guts?

 And of course, The Dish does have its readers:

As for what Obama reads online, his advisers said he looks for offbeat blogs and news stories, tracking down firsthand reporting and seeking out writers with opinions about his policies. Obama was particularly interested in Atlantic Online's Andrew Sullivan's tweeting of the Iranian elections last year, said an aide, who requested anonymity to discuss what influences the president. 

Who's thwarting 'the will of the people'?

Democrats need to start heading off this "argument" immediately:

And any Democratic move to slow-walk seating Brown in order to pass reform, [Republican strategist Phil] Blando said, is "just naked, pure power politics where, at that point, you're just thwarting the will of the people."

To state the obvious: a Senate in which sixty votes is required to pass any legislation does not reflect "the will of the people."  Republican lying, stonewalling, bad-faith negotiation and procedural manipulation of a Senate whose norms have grown dysfunctional have been thwarting "the will of the people" since the day Obama was inaugurated.  No legal Democratic maneuver to obtain a vote on the reconciled House and Senate bills should raise the slightest ethical or political qualms.

UPDATE: TPM reports that Democrats will have a minimum of 15 days after the election before Scott is seated:

Save the filibuster, guardian of health care reform

Andrew Sullivan trusts that health care reform will remake the country's political landscape:

I don't think this is about a short term five point bump. Here's what has happened: a liberal Democratic president has just passed universal health insurance. No Democratic president has done something like that since Johnson. It is designed to show that government can do something real and tangible for the working poor. And in that respect, its impact on the political culture will be deep and lasting, unless the opposition can stop it, demonize it, or jump up and down enough to make it seem as if Obama is out of step with the times rather than them.

My suspicion is that they will fail in the end to achieve this; and that this new landmark for liberalism will reorient American politics the way Reagan's first year did - profoundly.

I agree with this read in principle and in fervent hope. But it worries me that the health care exchanges won't power up until 2014 (if HCR passes) -- while cuts to Medicare Advantage start right away.  Couple this with Democrats' flirtation with weakening the filibuster, and that leaves me chewing a few cuticles about a worst-case scenario: Democrats lose lots of seats and maybe a chamber of Congress in 2010, and the Obama administration goes into a Clintonian holding pattern. The asset bubble bursts in China, or there's some other second wave economic tsunami, or a successful terrorist attack, and the Republicans win the presidency in 2012.  With the filibuster weakened -- and the precedent set for weakening it further -- Republicans repeal health care reform before the exchanges ever get started.

It's always easy to spin out worst-case scenarios.  But I still think that the Democrats, having (almost) squeezed health care reform through the eye of the needle, should regard the filibuster as the bulwark against rollback.

The best cure for the legislative sclerosis blamed on the filibuster is a change in political culture, effected once the Republicans reap the long-term whirlwind for their obstructionism.  Meanwhile, guarded by the filibuster, health care reform will probably have the long-term effect that Andrew envisions.