while I appreciate my Senator's leadership on this, and assume this is in part intended to provide some comfort to progressives, I think we'd be better if he kept quiet until the bill passes. i could just see an anti-PO Dem - Liberman, Nelson, Bayh, Landreiu, Lincoln - saying if that it really the intent, to do in two steps what they already promised they would not support doing in one step, then they need to re-evaluate their support of step one.

i like the noises tom harkin is making... i hope it gives lieberman a case of diarrhea and he gets cornyned from voting...

As long as we have a spineless president and a corrupt Senate, the Lieberman's and Nelson's of this world will prevail. What has just happened is an abomination. No matter how hard the bought-and-paid-for corporate crowd tries to make a silk purse out of a sow's ear, the American people, those who need decent healthcare the most, just got screwed. And the insurance companies are already handing out bonuses.

Harkin may be thinking ahead, but like almost all Senate Democrates so far, not thinking very far ahead or not to really reform the system. His plan is gradualism applied to the filibuster. Why not go right to killing the filiuster with the nuclear option or some similar parliamentary maneuver that takes 50 Semocratic Senators + Biden? Unless the Senate ends the filibuster quickly, there will be no passing of riders or other bills to strengthen health reform and make benefits quickly and obviously available by November 2010, pass meaningful finance/bank reform, and be in a much better position to lose fewer seats (or even gain seats) in 2010 and/or 2012. Voters least like wimps, wusses, chumps … pick your term that describes this meme that Obama and the Senate have been reinforcing for the past 9 months.

conservadems don't read the blogs so no danger of giving our plans away. I think that a robust public option tied to medicare rates should come up as soon as the congress comes back to DC. Make it a reconciliation item as it clearly affects the budget and it isn't burdened with all of the insurance regs (such as they are) are in the current bill. Let 2010 be a referendum on the public option. It is still insanely popular with the public. I want to see who will vote against something as popular as this. They will pay at the ballot box.

Could I puh-leeze ask the fine Senator from the great state of Iowa to STFU until this bill is passed? The last thing we need is Lieberepbulican starting to think "if this bill is going to be revisited to include the public option, then I'm filibustering the mofo."

Yeah right. A Public Option is on the way. Why is that carrot tied to that stick?

Actually the Public Option was the ONLY thing Health Care Reform needed. With a fair option the insurance companies could all go and connive themselves out of business. The market would work. Adam Smith's invisible handjob would arrive.

The most likely explanation is simply that Harkin is trying to recover some of his liberal bona fides after doing absolutely nothing to stop the Senate from blowing up the public option and selling out womens' abortion rights in the process.

When Congress doesn't revisit this issue, will anyone blame Harkin? Of course not. This is a no-lose statement by Harkin.

If we don't pass reform with a public option this time around, nobody in Congress will want to touch it for at least a decade, even if reform passes without it. It is supremely unrealistic to think it will be revisited in two or three years. The motivation will be gone, killed by the strident opposition we dealt with all year. This is our only chance for a long, long time.

"Very few big ideas are passed on the first try, and the public option was embraced so enthusiastically so many this year, it stands to reason that it will be part of the policy landscape, forevermore, until it becomes law."

The problem with this analysis is that the PO was NOT embraced by the people that actually matter- the president, the senate leadership, or pretty much any dem leader outside of Dean. The only ones who embraced it, the progressives, are the same ones who were just given a giant "&^% you by the party.

Those praying for some kind of incrementalism to save them from this monstrosity are deluding themselves. After the bill passes the insurance companies will have more money and more legitimacy with which to prevent any real reform.

Something I keep thinking, although the reconciliation procedure could not possibly have been used to pass the health care bill as a whole, it seems extremely likely reconciliation could be successful in passing a public option or medicare buy-in. Both the public option and the medicare buy-in are simple, singular programs which are self-financing and can be justified as budget procedures. They seem tailor made for the rules of reconciliation as it has been described to me.

I don't recall Harkin doing much to save the public option. Promising to revive it after the current debacle passes is bad kabuki theater--after all, if it couldn't get the votes up to now in the Senate, with the insurance industry dead set against it, it's not going to get those votes later. And Harkin must really love you for thinking this mess somehow encouraging.

Steve, I know you really want the health care thing to pass, but do you really feel you need to carry water for someone like this?

Very few big ideas are passed on the first try

And even fewer are passed after the government rewards the powerful interests that defeated them the first time with subsidies that increase those interests power to fight the big ideas.

How many different parts that were removed can be attached as amendments to a budget bill?

I've had issues with Harkin in the past, but I find it interesting that VoteView's 3rd most liberal Senator of the current Senate, through July 09, is now just another game-playing kabuki theater actor who doesn't live up to Progressive standards. When we question the motives and the veracity of the few allies, in an objectively measured proof-is-in-the-votes sense, that we have, how can anyone here be surprised progressives lack power in DC? And if the 3rd most liberal Senator is not sufficiently liberal for us, how far out there does that put us?

The comments I read on here the past few weeks have the same basic content and structure as on Tea Party blogs, with the issue positions flipped. The problem with such dogmatic idealism is particularly bad, however, when recent polls suggest that self-identified Tea Partiers outnumber self-identified liberals. A battle of our hardcore versus theirs isn't going to get us anywhere, and pissing on the parade of people like Harkin will only weaken our voice, not strengthen it, as the few actual liberals in office see progressives as impossible to please ingrates and turn a deaf ear toward them (someone like Harkin, in particular, is already well to the left of his constituency which as recently as 2004 voted Bush, and looks likely to put an R back in as Governor in 2010).

Soon there will only be one blog commenter in all the world pure enough to be an unquestioned progressive - and after additional navel gazing, s/he may not even vote for him or herself.

Harkin's idea just gets me wondering, why not more about various possible and actual add-on/segmented bills that could fix some problems. Yes, "if they wouldn't vote for X in one bill why in another", but it reduces the combination of "objectionable" features. That is, the simple theory is you offer feature X which only 40 Senators refuse, then feature Y which 39 refuse, then feature Z which 41 refuse. So you get X and Y and not Z, but with X+Y+Z the whole bill fails. I'd like to think that notion has at least some truth, to be worth trying.

BTW Tlaloc and similar:
I think many in the leadership wanted or would accept the PO etc. They just didn't have enough votes to get all that. Please, don't put down the whole Democratic party and crew. They are flawed, but exaggerating it because of sexagesimal scrounging is unfair.

"Sen. Tom Harkin (D-Iowa) told reporters that the public option is not dead. 'It will be revisited,' he said."

With whose votes ?

This is gibberish.

"I think many in the leadership wanted or would accept the PO etc. They just didn't have enough votes to get all that."

if a 60% majority in both houses and the presidency isn't enough then nothing ever will be. They had plenty of muscle to get this through if they'd fought for it, but they didn't. They could have attached riders to every funding bill. They could have forced actual fillibusters by the right. They could have done a thousand things that range from standard politics to dirty pool to get it passed.

That's what you do when you passionately believe in the cause.

They just don't care. That doesn't get fixed by re-electing them. And if they insist on completely &^%$ing up then we're better off having enough republicans in congress to put on the brakes.

Obstructionism FTW!

[...] it seems hard to imagine Pelosi or Reid initiating another debate on health care policy so quickly [...]

Certainly not Pelosi. Pelosi has announced (over the weekend?) that she's had it with the Senate shenanigans. She pushes her sheep, hard, into taking positions which might be unpopular with more conservative voters and then Senate pokes holes in the fabric, till it's lace. She ends up with irate representatives who feel they stuck out their necks for nothing. Happened with healthcare, is likely to happen with cap-and-trade, which the House has just passed but the Senate isn't likely to even pick up for ages. She now says that any risky business will have to *start* at the Senate level. Can't say I blame her; in her position, I'd be pissed off too.

I've been a big fan of Harkin for years. Is he drinking the kool-aid or propping up the regime? JFC, the people in this country are stupid.

the public option was embraced so enthusiastically by so many this year, it stands to reason that it will be part of the policy landscape, forevermore, until it becomes law.

WOW! where can I get some of that?

Re what Richard Wang said, what's to stop 51 Senate Democrats from steamrolling a robust and universally available public option (or even public option plus Medicare buyin) through reconciliation the week after the regulatory bill passes?

Can you imagine the look on Holy Joe's face?

It may be that we will have to give the insurance companies an opportunity to demonstrate to everyone their treachery, mendacity, and untrustworthiness first.
Since many of the reforms do not go into effect until 2014, that means 2016 for the Public Option, probably one of the Democratic campaign planks.

Steve Benen wrote: "Democrats spent years improving Social Security and Medicare after they were passed, and this will be similar. The public option will remain a top progressive priority indefinitely."

When a public option is passed, only then will you have something that can be legitimately compared with Social Security and Medicare: a nonprofit, government-run health insurance system under open, accountable, efficient public administration.

And no doubt, once a public option is passed, we will need to "spend years improving it".

That is, assuming that a public option doesn't, in fact, "remain a top progressive priority indefinitely", being proposed year after year as a sop to "progressives" by "liberal" Democrats who have no intention of ever actually enacting it into law.

But unless and until a public option is passed, comparisons of this bill with Social Security and Medicare are fundamentally dishonest. This bill entrenches and empowers the for-profit insurance corporations and compels the American people to guarantee their profits under penalty of law, and subsidizes insurance corporation profits by taking resources out of Medicare.

This bill is the antithesis of Social Security and Medicare.

The fact that "sensible liberals" keep pouring on the absurd hype, pretending that this bill is comparable to Social Security, Medicare, Medicaid and the whole danged Great Society rolled into one piece of legislation, just tells me that they are unwilling or unable to make a case for it on its actual "merits", such as they are.

SecularAnimist, one of the most important parts of this bill is the exchanges, and they can indeed be built on and expanded. Ezra Klein argued that robust and universally available exchanges would be more important than a public option in offering real competition to the insurance industry.

And I would add that the main reason the exchanges are so important is that they mimic a free market in insurance under government auspices, bypassing the anti-competitive regulations in a heavily cartelized industry.

One of the best things we could do to lower the cost of insurance coverage would be to eliminate the regulations, passed largely at the behest of the big insurance companies, that impose capitalization requirments and specific forms of coverage (elective cosmetic surgery, etc.), and otherwise raise entry barriers to low-cost cooperative insurance.

A good example is that doctor in NY whose plan offers coverage for everything that can be done on an outpatient basis for $79/month (essentially a revived form of lodge practice). The insurance industry jumped on him with both feet to suppress the competition, claiming he was an unregulated insurance company.

To lower costs of health care itself, we need to eliminate artificial scarcity in the form of drug patents, regulatory barriers to direct delivery of service by nurse practitioners, etc.

A lot of other costs also probably reflect various forms of artificial scarcity and cartelization, as well. For example, I wonder how much of the price of an MRI machine results from embedded rents on "intellectual property." I'll bet a team of open-source hardware hackers could reverse engineer a commercial, proprietary MRI machine and produce a homebrew version at a Factor Ten price reduction.

Our whole system is drowning in scarcity rents from artificial property rights, mandated artificial overhead and fixed costs, etc., and the effect is the same as that of shit on a human body bloated by constipation. It's what Paul Goodman called "the great realm of cost-plus"--a 300% or 400% markup to do anything.