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Today, Ezra Klein made the logical and concise case for why Paul Ryan’s Medicare privatization plan wasn’t about health care cost control but just saving the government money by shifting more of the health care cost burden onto regular people.
Ryan’s plan works differently. Let’s say health-care costs grow at 8 percent a year — a fairly common rate. And let’s say inflation sticks near the Federal Reserve’s target of 2 percent a year. Ryan gives seniors a voucher that starts at $15,000 — for our purposes, assume that’s the exact cost of a health-care plan this year — which grows at the rate of inflation. Let’s say these vouchers prove more successful than any previous experiment with constructing insurance markets and, with no other policies, bring the growth in health-care costs down to 6 percent. In 20 years, that plan costs $48,107. But Ryan’s voucher is only worth $22,289.
Ryan’s plan has cut the growth in health-care costs a bit. But the real way it’s saved money isn’t through competition. It’s by pushing the difference between the size of the vouchers and the real cost of health-care insurance off of the federal books and onto beneficiary budgets. That’s not the market at work, and it’s not cost control. It’s cost shifting. Putting aside that it’s not sustainable, it’s also not particularly helpful. Saving the federal government from bankruptcy by bankrupting millions and millions of families does not solve our fiscal problems.
My only problem with this excellent argument is that I wish Klein and many others on the left had bothered to apply this reasoned analytical thinking to the Affordable Care Act.
After all, “Obamacare” uses a near identical cost-shifting accounting trick to produce most of the CBO’s projected long term savings. It caps the employer providde health insurance deduction and also has the cap increase at the same, far-too-low, rate of inflation (PDF). Given that the bill uses a very poorly designed large excise tax to do this, it assures employers won’t offer insurance worth more than the cap.
Eventually, it will cause the same cost-shifting problem Ryan’s vouchers would for seniors. Because of the very low indexing, American tax exempt health insurance will get much worse with higher co-pays, less benefits and larger deductibles.
This doesn’t really save the government money by controlling cost–it mostly increases tax revenue for the government by forcing people to pay for more of their care out of pocket from their taxable income.
If critics want to rightly point out that, because of low indexing, the projected savings from Ryan’s plan are “unsustainable” and come mostly from cost-shifting the burden onto regular people, then they need to admit Obama’s long-term savings uses the same low indexing that is also not credible and shifts cost unto regular people.
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But ACA was a “starter home” /s Thanks Ezra for supporting these cost shifts onto us.
I guess Obama would say it’s one thing to raise cost-sharing on a working family who can just get second jobs to pay for health care, but another thing entirely to raise cost-sharing on seniors who earn a fixed income.
Yes we can.
Anyone who has ever tried to help a beloved senior navigate — or has tried to navigate for themselves — the maze of Medicare Parts A, B, and D along with the shark-infested Advantage waters knows this one thing: the idea of savvy seniors shopping among insurance companies for the best care is ludicrous. The current system is baffling enough for our oldsters. We don’t need to set the insurance companies lose on them, to feed on the halt and the weak.
These companies are predatory and profit-maximizing, by definition. They have no interest in helping people ‘make better choices.’
You’re comment is beyond true, if that’s possible.
I have one on VA care, the other on Medicare. With the supplemental insurance on Medicare, that’s a $500 premium per month. Yep, $6k per year.
Pus even VA benefits are means tested now, depending on one’s rating. My non-combat Korean vet is responsible for $2k per year now.
Together my 80 year olds, since Charlie’s pensions went bust, subsist on $18k per year, with the first $6k going to said supplemental policy, then there’s the out-of-pockets which amounted to about $5k last year.
Yes, that left them with $7k for everything else.
What we have right now is barely good enough. Any cuts are merciless and draconian. Ryan’s plan = certain death.
And to further the argument, the ACA assumes that once people with high end policies are forced to pay more out of pocket, they will put pressure on insurers to offer more cost effective insurance. That’s the same assumption Ryan makes. This assumes that the problem is people get too much care, not that providers charge too much. Ultimately, if there is nothing to squeeze providers to accept less, such as what they are paid in other countries, none of this works.
Not only that but they have no interest in insuring seniors at all. Most won’t even take over 75s.
The msnbc write up of the vote was ludicrous in itself. Nowhere does it mention the terrible CBO score or the fact that the Ryan plan also includes enormous tax cuts for the rich and corporations. Want to know how bad it is without reading it? Try the lede:
It gets worse from there.
“What we have right now is barely good enough. Any cuts are merciless and draconian. Ryan’s plan = certain death.”
Maybe that IS the point.
Exactly right!
Both parties are trying to pick our pockets clean while benefiting from kickbacks and campaign donations from Big Insurance and Big Pharma.
Obama is in the same bed with Big Insurance and Big Pharma, just on a different side of the bed. And citizens get screwed either way.
We need to go to another model entirely, perhaps a European model where they have universal access to good care at half the cost we have.
Just a Flash: I heard Hannity quote Trump who said O is worst Pres since Carter. Sorry I found that so amusing, while disgusting. Does Trump, or Han, really think we want the Trump opinion…..as if it matters….Now back to regularly scheduled….;)
“This assumes that the problem is people get too much care, not that providers charge too much.”
Yes, during the HCR debate, that was something that advocates really didn’t want to get into. ACA was about reducing quality of care, not improving it, yet it was sold as improving quality of care. The ability to improve quality of care went out the window in some WH backroom.
Any plan that shifts from a federal program (Medicare) that operates at 2% administrative expense to a private plan (Ryan) that operates with 20% expenses obviously costs everyone more money, and that money goes to private investors and execs at insurance companies.
It’s called weath redistribution. Republicans just steal from the poor and give to the rich – Robbing Hoods.
The irony is that Ezra himself has referenced the graph below, which demonstrates that “benefit design” (a.k.a. cost-shifting) is the least promising approach to controlling health costs.
http://healthpolicyandreform.nejm.org/?attachment_id=2321
Yes Obama never said it direct but he believes the problem with America’s health care is that enough of us don’t actively worry about how expensive it is.
the whole focus on “saving the government money” was and is nuts.
first, it’s nuts because it is based on gold standard thinking where the fed govt can actually “save” money. that’s not the modern monetary system we have. “saving the govt” money is not the, or even a, real issue. it’s a distraction to keep people from thinking about the real issues.
second, it’s nuts because what actually matters is universal healthcare and the total national heathcare expenditure to get to universal healthcare. those are the real issues.
bat-shit-crazy all around.
@Jon Walker–I don’t get it, you seem to be using rhetoric to be a little deceptive about the differences between Obama’s and Ryan’s plans. I’d expect that from the WSJ editorial page, but not here.
Specifically, Obama has mechanisms for cost control in his healthcare plan, and Ryan doesn’t. Reading your post, if I didn’t already know about this topic, I wouldn’t even realize it. That’s a big difference between the two plans, and you don’t mention it. I can tell you we physicians are quite aware of it and some are concerned it will harm their bottom lines, so it’s there. Also, Ryan would get rid of Medicare itself, and thus actually *increase* costs for the same level of service, as private insurance companies are known to charge more for equivalent service, so that’s another difference.
Second, you state that “most” of the cost savings in the CBO come from cost shifting. I’m not sure if you are aware of this, but the CBO doesn’t give ACA credit from many of its cost-cutting components, because the CBO is conservative in its estimates, so doesn’t give credit for potential savings. Things like ‘bundling’ payments would decrease costs, but aren’t scored as such.
As an aside, I’m trying to understand the FDL angle. Do people actually want a Bachman to win and be president, and that’s why they slam Obama here? Is this the Hillary fight raised from the dead? What gives?
It’s no surprise that Obama’s plan resembles a Republican plan…because Obama’s plan WAS a Republican plan:
“Obama: We thought that if we shaped a bill that wasn’t that different from bills that had previously been introduced by Republicans, including a Republican governor in Massachusetts who’s now running for president. That we would be able to find some common ground there.”
http://fdlaction.firedoglake.com/2010/11/08/obama-again-admits-his-health-care-law-is-republican-not-progressive/
“Do people actually want a Bachman to win and be president”
Oh it would be a shame if she became president, then we’d have escalated wars, eroded civil liberties, Wall Street tools in every position of fiscal authority, increased oil-drilling, economic disaster, a bloated Pentagon budget while WIC gets cuts, government secrecy…
Isn’t the AHA supposed to bring the rate of medical cost inflation closer to the general inflation rate?
Don’t you think the Ryan plan is a smoke screen for a “Democratic” approach, The lesser of two evils?
So we should give Obamacare credit for theoretical cost controls, despite evidence that they don’t do much? (See my chart above.) You as a physician are probably relieved that the government doesn’t just tell you how much they’re going to pay you and that’s the end of it–like they do in sensible countries.
As time goes on the money to pay for the subsidies comes increasingly from the excise tax. That’s a fact.
What I and teabaggers like Bachmann agree on is that HCR takes money from the middle class and gives it to low earners, in a very inefficient way that rewards corporations and other high earners. That’s not progressive.
So the Republican plan is agressive and the Democrat plan is incidious… Sounds like a pretty clear message from the PTB:
“Old folks are a costly and unwanted burden.”
How feudal of them.
Nice write up Mr. Walker, thanks for your work. A stellar cast here at FDL Front Pagers n I appreciate them all.
LeSigh.
The more things change the more they stay the same.
Meet the new bosses same as the old bosses.
Same as it ever was, same as it ever was.
Puttin out fire w/ gasoline.
Turn n face the strange, ch ch ch changes . . .
Yeah, I take it back. Bachman would meet progressive desires better than Obama. She would have even passed ACA, finance reform, repealed DADT, and federalized student loans while she was at it. Right? Of course. And when she could actually pass the Ryan plan, you’d say, sure they just repealed ACA, and medicare doesn’t exist, but cutting my nose to spite my face just feels so good I don’t regret it.
That’s the real “shift” that I am worried about!
“Specifically, Obama has mechanisms for cost control in his healthcare plan”
Yes, Obama made sure that the costs were high by killing the Dorgan amendment, no PO, no drug price negotiation, etc.
“As an aside, I’m trying to understand the FDL angle. Do people actually want a Bachman to win and be president, and that’s why they slam Obama here? Is this the Hillary fight raised from the dead? What gives?”
Many here are sick of the lesser evilism that you youself are using in an attempt to silience criticism.
@bmull– You don’t think ACA helps the middle class? I’m supposing that some middle class people have kids between 21 and 26 years old, in which case they can include their kids on insurance. Is that not helpful? I’m sure some middle class people have pre-existing conditions and now will be able to get coverage. Is that not helpful? I’m sure some middle class people are at risk for losing their jobs and suddenly being stuck with expensive health insurance. Are the subsidies to cover them not helpful? And would you throw 30 to 40 million people off insurance coverage because you don’t like helping ‘poor people’. If that’s the case, sure, vote republican.
ACA is several steps in the right direction. It’s not all the way there yet, but it’s a heck of a lot closer. Getting the public option is just one more step in the same direction, whereas the republicans want to go in the opposite direction and pretty much kill (or fatally wound) Medicare. Sometimes we hold the most anger towards the people who are similar to us, like between religious sects, rather than against those who are truly against your beliefs.
And @spanishinquisition — What if the choice wasn’t between passing ACA with the Dorgan amendment vs. passing ACA without the amendment, but rather between getting ACA without Dorgan and not getting the ACA, period? Clinton got zilch. Obama could have gotten zilch, too, and that wouldn’t have helped anyone. If Obama was dictator, I’m sure he may have passed something you totally approve of, but seeing as the republicans were going to fillibuster everything in senate, it meant that compromise was required and you got a bill that was much much better than status quo, but only part way there.
“What I and teabaggers like Bachmann agree on is that HCR takes money from the middle class and gives it to low earners, in a very inefficient way that rewards corporations and other high earners. That’s not progressive.”
Yes, it should have been done with real cost controls instead of just having there be a wealth transfers from the middle class to Obama’s rich buddies in healthcare.
“You don’t think ACA helps the middle class?”
ACA does more harm then good by further empowering a corrupt system and the middle class isn’t helped by being ordered to buy a product from a private company.
“Sometimes we hold the most anger towards the people who are similar to us, like between religious sects, rather than against those who are truly against your beliefs.”
So you are saying that you are close to Mitt Romney in your beliefs?
Jon–You’re making a critical error. No where do you take into account Medicare cost reductions caused by people dying through lack of adequate health care. This factor should cause a significant drop in the cost of Medicare vouchers over time.
AND that’s not even counting the improved solvency of the Social Security System. /s
“What if the choice wasn’t between passing ACA with the Dorgan amendment vs. passing ACA without the amendment, but rather between getting ACA without Dorgan and not getting the ACA, period?”
It shouldn’t have been passed.
“Clinton got zilch. Obama could have gotten zilch, too, and that wouldn’t have helped anyone.”
You are making this into some sort of contest because one or more groups got benefited, but that doesn’t mean that the legislation as a whole was worthwhile, like did you support Bush’s Medicare Advantage?
“If Obama was dictator, I’m sure he may have passed something you totally approve of, but seeing as the republicans were going to fillibuster everything in senate, it meant that compromise was required and you got a bill that was much much better than status quo, but only part way there.”
Yes, ACA was quite revealing on how corporatist Democrats are seeing how they totally own the bill with all it’s corporatism. The corporatism of ACA is one thing that actually can’t be blamed on the Republicans because the Democrats did it all by themselves.
Not only have they shifted the costs, but they’ve given the insurance companies a carte blanche captive market in an industry with inelastic demand. This is a no brainer recipe for rising costs.
You can’t blame the Republicans for any part of ACA. It passed the Senate requiring only a majority. And it passed without a single Republican voting for it in either House.
You’re entitled to your opinion, but not to your facts. The fact the ACA is what it is was 100% the responsibility of Democrats. No public option because the DEMOCRATS chose not to have one, not the REpublicans. No single payer because the DEMOCRATS chose not to have one, not the Republicans.
And the FACT is that the Democrats NEVER had to have 60 votes in the Senate to pass ANYTHING. If you’re repeating that meme, then that proves you’re merely in on the deal of making excuses. The Democrats could’ve ended the filibuster ANY TIME THEY WANTED, and since they didn’t, that means they CHOSE not to.
How can you possibly blame Republicans for CHOICES the Democrats made?
AND in an industry with an anti-trust exemption, thus free to set prices however they feel they want to.
Clinton ultimately chose zilch over less than nothing. The Dole/Obama plan helps some needy people at the expense of the middle class. Did you like the Dole/Obama plan when it was just the Dole plan? That’s what Clinton rejected.
The Bush Medicare drug program provides benefits for people on Medicare. It does it very inefficiently with the largest benefits going to pharmaceutical companies. The Dole/Obama plan does the same for the health insurance industry while also benefiting some people.
The increased number of insured Americans, thus far, is working as well as Obama’s aid to people with mortgage problems.
Finally, the plan may cost the government less. The total cost of health care is expected to rise from 17% of GDP to 19%. The difference will be higher premiums and increased out of pocket expenses.
I’m very tired of conservative solutions failing while being labelled progressive. If we stick to truth in labeling at least the Republicans will be accountable for their messes.
@Oldfatguy – We both agree you aren’t entitled to your own facts. Hence you may reconsider your statement that democrats “never” have to have 60 votes to pass anything. Heard of the filibuster? And, yes, only democrats voted for this, so it’s a democratic bill. So, tell me, is it Obama’s fault that there are blue dog democrats? Is that a reason to criticize him? Senator Nelson wasn’t going to accept a public option. Does that make Obama a sellout? If you have $100 of political capital, you can get a $100 gift, and not a $1000 gift. The democrats didn’t have a strong enough caucus to pass the legislation you wanted, so it’s unreasonable to expect the president to give you the bill you precisely wanted. And what’s wrong with incremental change in the right direction? That’s what the bill is. Several important steps in the right direction. Support it, and then point out the next steps, rather than decrying the fact that it passed.
Extra Klein is a ‘star fucking pipsqueak’. I don’t doubt he always will be.
http://exiledonline.com/the-koch-whore-archipelago-how-the-billionaire-kochs-screwed-my-scoop-while-screwing-america/
Since the health care bill passed with less than 60 votes you might want to rethink your position.
It was Obama who killed efforts to have a vote on the public option during the reconciliation process. We won’t know whether it would have received the majority (50 + 1, not 60) it needed.
salemander:
No bill is better than Obama’s piece of shit effort. He sold out the country to the insurance companies. Those are not just my facts, but yours too. Gonna enjoy the little punk’s concession speech in 2012.
See ya.
: )
Jacob Hacker himself has said that the public option could have passed through reconciliation, so any mention of 60 votes is bullshit.
But Jon is being very misleading when he says both plans are the same. If premiums on the exchange went up 10,000% – after hitting X% of your income, the buyer pays zero extra, and the feds pay the rest. This may not do much for cost control, but that is very different from a fixed voucher.
Jon knows this and continues to play the false equivalence game.
First I appreciate your taking the time to list Obama talking points – it makes it easier to explain Obama is a con-man and will remain a con-job until he supports Vermont’s option 3 – single payer with prospective budget – that Vermont is considering this year.
As to “@bmull– You don’t think ACA helps the middle class? I’m supposing that some middle class people have kids between 21 and 26 years old, in which case they can include their kids on insurance.” – At the University of Illinois – as at every other group plan – the kids are on the plan as long as you pay the $8,000 per year – there is no subsidy – and better plans charge more. There is a small benefit – but hardly worth signing onto a $600 billion welfare check for the ins industry via premium subsidies from forced sales – or forgoing a 50% drop in drug prices because we can’t re-import from Canada. You ask “Are the subsidies to cover them not helpful?” = well there are no subsidies for the kids. You then go to “throw 30 to 40 million people off insurance coverage” – well half of that is Medicaid expansion where the states must pick up the bill after an initial Federal subsidy – the other half is money wasted as the ins co’s just raise there premiums and say thank you very much for the welfare check.
ACA WAS NOT several steps in the right direction. It’s simply a pile of money – available in 2014 – that could be used to start up Vermont single payer with prospective budget (a variation on the Taiwan health care that the actuary doing Vermont had previously installed).
As to “@spanishinquisition — What if the choice wasn’t between passing ACA with the Dorgan amendment vs. passing ACA without the amendment, but rather between getting ACA without Dorgan and not getting the ACA, period? Clinton got zilch.” I was plugged into the otherside in 93 and the game was to stop Hillary and her desire for single payer – Obama bought in the Hillary voters with the promise of a public option – and Obama lied to us – selling out to the medical industry a no single payer pledge well before he stopped telling us that he supported a public option – and when it only needed 50 votes and was a lock to pass, Obama told Reid to kill it because he had made a promise to the health industry folks.
Obama would not have gotten zilch because unlike Clinton he had a super majority and then more than 50 votes for the budget reconcilliation.
So your “fillibuster everything in senate” excuse is bull Sh_t – he had it and ordered the Dems to toss the chance. Obama does great compromise – yes to the Corporate types with a question as to what else they want – hope you enjoy the GOP/Dole plan we now have.
You try and try – fillibuster?
– yet the GOP with 51 votes gave us the Bush tax cuts –
budget reconcilliation – the way the ACA finally passed – required 50 votes – just like the Bush tax cuts.
The Obama folk are good at excuses aren’t they?
Hey, with Obama’s plan, if costs get shifted to you and your family, you can always ask for a waiver. (Or is that only if you’re a state, or something like that?)
The filibuster is an option. The Democrats could’ve ended it any time they wanted if they wanted to pass a more progressive health care bill, or more progressive bill of any kind.
Again, those are the facts. The Democrats could’ve ended the filibuster ANY TIME THEY WANTED and CHOSE not to. Then Joe Lieberman, Bill Nelson, Blanche Lincoln, and a few others wouldn’t matter because then they only needed 50 votes (Biden could’ve been tiebreaker).
And BTW, explain how the Republicans forced Obama to claim he can assassinate American citizens with no due process. And explain how the Republicans forced him to keep GITMO open that first year plus before Congress passed limiting legislation. And please explain how the Republicans forced him to argue before the courts that he, like a King, could sign a piece of paper declaring a person a “non-person” and not entitled to any rights whatsoever (and the courts agreed).
And after you’re done trying to make excuses for Obama, explain why the PO didn’t pass when they passed the ACA in reconciliation only requiring 51 votes. Because you can have all of those D’s you and I named above and there were still more than enough.
Please, please just look at the evidence, the mountains and mountains of evidence out there. The Democrats, had they chosen, could’ve done almost everything differently. That they CHOSE not to is evidence of where their hearts actually lie.
@frmripirsn- Last I checked, ACA passed with 60 votes in senate. Then Scott Brown was elected. House held its nose and passed the bill.
Either way, I think ACA is in the right direction. If you truly, honestly think the US would be better off without ACA, with people with pre existing conditions being denied, with kids not kept on parents’ insurance, with tens of millions more people with the security of coverage who before couldn’t afford it, then, sure, vote republican, or vote for Nader.
Again, you’re not entitled to your facts.
The final passage of ACA was passed in reconciliation, only requiring 51 votes. Look it up.
The answer is NO, it would not have gotten 51 votes (actually only needed 50 with Biden as tiebreaker).
And that’s because the Democrats, not just Obama, didn’t want it.
I was just watching Cent on MSNBC and he had Jon Alter on…well Jonny just let the cat out of bag and confirmed we all know…Obama is going to make cuts to SS and Medicare…Alter was trying to say the American people would support these cuts (what damn planet is he on?) but will wait until after the election to announce the plans…also Alter pull out the don;t let the mean repubs get back in the WH BS…Alter is shrill for Obama
The same media bozos who went after Bush for cuts to SS and now kissing Obama;s ass for the same policy,,guess the money from Peterson talks!
“So, tell me, is it Obama’s fault that there are blue dog democrats? Is that a reason to criticize him?”
Obama is a Blue Dog quicker than you can say PhRMA.
“Does that make Obama a sellout?”
There are many things that make Obama a sell-out.
“The democrats didn’t have a strong enough caucus to pass the legislation you wanted, so it’s unreasonable to expect the president to give you the bill you precisely wanted. And what’s wrong with incremental change in the right direction? That’s what the bill is. Several important steps in the right direction. Support it, and then point out the next steps, rather than decrying the fact that it passed.”
It’s a step, but not in the right direction – it’s like Bush’s Medicare Part D, which was a corporatist giveaway. It’s not a question of whether or not something is “the bill you precisely wanted,” but whether a bill is effective or ineffective. Further entreching and enriching the healthcare industry in Washington while having healthcare costs spiral even more out of control makes matters worse, not better.
Yeah, step in the RIGHT WING direction is more like it.
Now they’re trying to give Obamacare to seniors instead of Medicare.
The evidence is clear on which way the steps are headed.
Ezra Klein is a sleazeball.
So much of what I’m hearing with Obama and his supporters is just warmed over Bush. Like Iraq was supposed to be quick, just like how Libya was supposed to be “days not weeks” and now how Iraq has become years, Libya is now “long term” per Obama. Like with Medicare Part D, we’re supposed to support corporatists giveaways in Obamacare because some segment of the population benefits. So much of this is like a bad replay of the Bush years, just this time it’s Democrats who are cheering it on and this time around they aren’t fighting things like indefinite detention.
And people are supposed to pay the $25,819 out of their SS?
This is not cost sharing, it is cutting off medical care for the old.
Either get rich before you retire, or we will put you on an iceberg and let you drift out to sea.
Dems, Reps, Libs, Teas, aren’t they all united around this supposition, that they apply to everything? What “works” for Health care works for public education, namely the idea that costs have to be shifted onto working people.
Dems fight for Dem values when a GOPer is President – but when a Dem is president that fellow can advance GOP ideas with no Dem opposition.
So the question is which will result in a better situation after 4 years.
Passing the Bob Dole Health Pan/welfare for ins co’s as if it was real reform is a case in point. But as a doctor you know that the ACA commission – the Obama “savings that are not cost shifting” that you refer to – is opposed by doctors as the dropping of a procedure from the Medicare eligible for reib list means folks will not buy the service and less money for the doctors – or it means costs are shifted to the aged.
But you claim there are savings beyond this farce – savings that are not cost shifting – please state where they are. The exchanges are just a visit to a ins co rep’s office – like the magic of the market that does not work now will start to lower prices because of a comparison of plans blurb someone in the state writes as it lists the various premiums. Obama chose to ignore the actuaries – and run with an econ Pref at MIT with a spreadsheet and no idea of how the business works. At least Vermont (which used the MIT spreadsheet for show) had an actuary in charge of its proposal and he has the prospective budget that is in effect in many countries in one form or another – the only real cost control posible.
Sorry doctor – I do not believe you are reading the doctors who have been in this “reform” game – http://www.pnhp.org
And yes – Hillary would have been a better choice – but we deal with the cards as they have been dealt – looking forward.
Check again – those 60 votes got a right wing version passed that could not pass the house – but Pelosi saw it coming and inserted budget reconcilliation sections into the House bill. The ACA passed and was signed
– But the final ACA was passed via budget reconcilliation – a condition of the House before it allowed the crappier version to pass. So in the end it was a 50 vote situation – not a 60 vote problem.
I disagree only because we were told 52 Senators would vote for the public option – we will never know because Obama had Reid kill that vote before it occurred.