Obama Plans Bipartisan Summit on Health Care - New York Times

President Obama said Sunday that he would convene a half-day bipartisan health care session at the White House to be televised live this month, a high-profile gambit that will allow Americans to watch as Democrats and Republicans try to break their political impasse.

Democrats chafe as White House wavers on health care bill - Politico

President Barack Obama has left Democrats as confused as ever about how the White House plans to deliver a health care reform bill this year, after two weeks of inconsistent statements, negligible hands-on involvement and a sudden shift to a jobs-first message.

Pelosi: ‘We Will Pass Health Insurance Reform’ - New York Times

The House speaker, Nancy Pelosi, predicted on Friday that Democrats would succeed in winning passage of major health care legislation this year, and she described the bill as a core component of her party’s effort to improve the economy.

Clinton-era health aides push to save Obama's plan - Associated Press

Shock and awe. That's what survivors of the Clinton-era health care collapse are feeling as President Barack Obama's overhaul legislation wobbles in Congress.

OPINION

On health care: 'Finish the kitchen' - Washington Post

If President Obama gets to sign a health-reform bill, as I believe he will, one reason may be Rep. Jay Inslee's difficult experience renovating his kitchen.

Pelosi Promises To Repeal Insurers’ Anti-Trust Exemption Next Week - Think Progress

House Speaker Nancy Pelosi’s (D-CA) announcement that the House will pass legislation repealing health insurers’ exemption from federal anti-trust legislation, elicited a standing ovation this morning at the Democratic National Committee’s Winter Meeting. Language removing the exemption was originally part of the House health care bill and Pelosi hopes that passing the provision separately would recommit the party to health care and narrow the differences with the Senate bill, which did not include the repeal.

Obama to GOP: Fine, Let's Talk (Updated) - Jon Cohn

President Obama is making good on his pledge, first put forth in the State of the Union, to reach out to Republicans on health care reform.

The Antitrust Exemption For Health Insurers: Meaningful Or Not? - Kaiser Health News

With comprehensive health care legislation foundering in Congress, the House is turning to a narrower piece of legislation that lawmakers hope has widespread, populist appeal: repealing the antitrust exemption for health and medical liability insurers. House Speaker Nancy Pelosi, D-Calif., said the bill is likely to be on the floor next week.

Time for the White House to Stand and Deliver - Mike Lux

The way Barack Obama ended his State of the Union -"We don't quit. I don't quit". - has already become a rallying cry for Democrats. I have seen that quote now in Democratic Party fundraising emails and call to action emails, have seen numerous Democrats make reference to it in different ways. Like his "fired up, ready to go" line from the campaign, it is fast becoming the mantra of Obama supporters around the country.

There are millions of underinsured people in America. That underinsurance presents similar problems to uninsurance - delayed and denied care, bankruptcy due to medical costs, poorer health, and ultimately higher costs when these people have to seek emergency care or treatment for preventable illnesses. And many of the people with lousy insurance are those with individual insurance policies which they buy on their own instead of getting through work.

Unlike large businesses, who can bargain with insurance companies for good rates and good coverage because they have leverage in their numbers, the self-employed, unemployed, or people who don't get insurance through work have to buy coverage on their own. It's just them against their insurance company. So, people on the individual market tend to get hit with the highest rates, the most denials of care, and see the least of their premium dollars spent on their health care. Many small businesses face the same issues.

News today only underscores the problems in the individual market:

California's largest for-profit health insurer is moving to dramatically raise rates for customers with individual policies, setting off a furor among policyholders and prompting state insurance regulators to investigate.

Anthem Blue Cross is telling many of its approximately 800,000 customers who buy individual coverage — people not covered by group rates — that its prices will go up March 1 and may be adjusted "more frequently" than its typical yearly increases.

The insurer declined to say how high it is increasing rates. But brokers who sell these policies say they are fielding numerous calls from customers incensed over premium increases of 30% to 39%, saying they come on the heels of similar jumps last year.

Many policyholders say the rate hikes are the largest they can remember, and they fear that subsequent premium growth will narrow their options — leaving them to buy policies with higher deductibles and less coverage or putting health insurance out of reach altogether.

"I've never seen anything like this," said Mark Weiss, 63, a Century City podiatrist whose Anthem policy for himself and his wife will rise 35%. The couple's annual insurance bill will jump to $27,336 from $20,184.

"I think it's just unconscionable," said Weiss, a member of Blue Cross for 30 years.

Insurers already spend dramatically less of each premium dollar from individual policies on actual care. Where the average "medical loss ratio" of private insurance companies is around 86% - which means only 86 cents out of every dollar is spent on actual medical care and not CEO salaries, overhead and profit - medical loss ratios for individual policies can routinely be as low as 70%, or even lower. Now on top of that, Anthem, owned by WellPoint, is increasing rates in California by almost 40%.

This exact problem - individuals having to fight with insurance companies on their own for decent, affordable coverage - is what health reform is designed to solve. Individuals and small businesses would be able to purchase coverage in a new, regulated insurance marketplace, called an "exchange. " Insurers would be required to sell good policies, without caps on annual or lifetime benefits and would not be allowed to turn people away because of a pre-existing condition or charge more because someone has a health condition. Medical loss ratios would be regulated. The Congressional Budget Office says this will lower premiums dramatically.

And the strongest version of the exchange will be run by the federal government and include the choice of a public insurance plan to compete with private insurance.

Today's news of near 40% rate hikes simply underscore why Congress must finish health reform now and finish it right. We can't wait any longer.

Anthem Blue Cross dramatically raising rates for Californians with individual health policies - LA Times

Policyholders are incensed over rate hikes of as much as 39%, which they say come on top of similar increases last year. State insurance regulators say they'll investigate.

Obama's "next step": Go back to Republicans - Politico

Months after Congress abandoned any hopes of a broad bipartisan deal on health care reform, President Barack Obama said Thursday the "next step" on health care reform involves going back to the negotiating table with Republicans.

Progressives Look For Ways To Get Public Option Revived - Congress Daily

Progressives plan next week to reach across the Capitol and plot a strategy to revive the public option, the single provision in the healthcare overhaul that dominated the debate for weeks only to die in the Senate at the hands of …

OPINION

The Dems Need a Shove. Will Obama Give It? - Jon Cohn

In the last week and a half, Obama has rediscovered his voice on health care–telling audiences he is determined to achieve comprehensive reform, not some piecemeal version, and that he is willing to fight for it. And, administration officials say, the sentiments are genuine. Obama has instructed his staff not to abandon the pursuit of a full reform package, even though, it seems, that's what some advisers would prefer–and even though the Democrats no longer have the sixty votes necessary to break Republican filibusters in the Senate.

Obama Sends Congress Mixed Message On How To Move Forward With Health Reform - Think Progress

President Obama sent Democrats mixed signals about how to move forward on ahead health care reform during a question and answer session organized by Democracy for America. While he argued that the “key [is] to not let the moment slip away,” Obama did not pressure the House to accept the Senate health care bill or echo House Speaker Nancy Pelosi’s (D-CA) call for the Senate to pass a package of ‘fixes’ through reconciliation.

It's just you, Democrats - Ezra Klein

There's been a lot about procedural impediments to moving forward on health-care reform: Can the Senate can pass a reconciliation bill before the House passes the Senate bill? Can Republicans delay reconciliation with amendments? Who should go first, House or Senate?

What's 19 cents worth to you in 2019? The rise and rise of health care costs - Health Populi

Here's a health economics riddle: what do one dime, one nickel, and four pennies get you in the year 2019? Health care costs' value carved out of every single dollar.

Why Is Aetna Forcing 650,000 Clients To Drop Their Coverage? - Think Progress

Sam Stein reports that “[h]ealth insurance giant Aetna is planning to force up to 650,000 clients to drop their coverage next year as it seeks to raise additional revenue to meet profit expectations.” One industry analyst told Stein, “[t]hey were surprised by an acceleration in medical costs in 2009 which pressured their earnings.” “In an effort to get back to a more profitable level, they are raising their prices to match cost trends. When you raise rates, you run the risk of losing your membership. Health insurance is a very competitive marketplace“:

Overall spending on health care increased to 17 cents for every dollar spent in America last year, the largest one year increase since the government started keeping this record. For every dollar you make, almost one fifth of it goes to health care costs. And it's not stopping there, if health reform is not finished:

By 2019, health care spending will represent 19.3% of the nation's total economic output, according to a report released today by the Centers for Medicare and Medicaid Services.

…

The rapid increase in health care spending as a percentage of the economy — up from 16.2% in 2008 to 17.3% last year — can be partly explained by the recession. Although the nation's gross domestic product declined in 2009, health care spending rose to an estimated $2.5 trillion in 2009, or $8,047 per person, according to the report. That number will grow to $4.5 trillion in 2019, or 19.3% of the GDP, which is the entire economic output of the USA.

The skyrocketing trajectory of health care spending is hardly new, but it still spells doom for individuals, employers, and government alike. Health care costs will take more and more out of our pockets, out of small businesses, and out of government to finance Medicare and Medicaid unless costs are brought under control.

The report on these increases, done by CMS, didn't take into account what would happen if health reform passes. The CBO has previously estimated that under health reform, premiums would go down for individuals and businesses, and the federal deficit would be reduced as well. An earlier report by CMS estimated that overall health care spending increases would slow under reform, adding further weight to the analysis.

The key to getting cost under control is getting everyone in the system and making health care affordable, so people can get the care they need. A recent study in the New England Journal of Medicine affirmed the cost-cutting potential of increased coverage:

When Medicare plans raise co-payments for outpatient care, older people cut back on doctors’ visits, then wind up needing more expensive hospital care, a new study reports.

The study examined changes in the use of inpatient and outpatient care among people in Medicare plans that almost doubled co-payments, and compared the trends with similar plans that kept co-payments steady.

Though outpatient visits increased over time in all plans, health plans that raised their co-pays had slower increases: 19.8 fewer outpatient visits per 100 enrollees compared with plans that kept prices steady.

But they also had 2.2 additional hospital admissions per year, 13.4 more annual inpatient days and a 0.7 percent increase in the number of enrollees who had been hospitalized, when compared with plans that did not raise prices.

The Senate bill needs to be fixed before health reform can be finished right. Things like dealing with the excise tax on middle class health benefits, asking employers to pitch in their fair share, increasing subsidies to low-income people, creating a national exchange, and a public option will make health care more affordable to individuals and expand coverage. Those people will get the care they need early, preventing more expensive emergency care later. Health care costs will go down as a result.

If our country is to avoid financial ruin, health reform needs to be finished and finished right. Spending 17 cents of every dollar on health care is crazy and clearly not sustainable.

Medical expenses have 'very steep rate of growth' - USA Today

Spending on health care consumed an estimated 17 cents of every dollar spent last year in the United States, representing the largest one-year increase since the federal government started tracking the number in 1960.

Health-care sector grew as economy contracted in 2009 - Washington Post

Health-care spending in the United States grew last year despite a contracting economy, amounting to 17.3 percent of the gross domestic product, according to estimates released Wednesday.

Soaring cost of healthcare sets a record - LA Times

Spending was 17.3% of the economy last year. The share paid by the U.S. will soon exceed 50%, a study says.

Therapy benefit cap looms over patients and providers as healthcare bill stalled - The Hill

Medicare beneficiaries face a steep cliff in their coverage for physical therapy and similar treatments due to Congress’s failure to enact a healthcare reform bill.

Rep. Tsongas joins Congress push on health-care reform - Lowell Sun

In the wake of the election of Sen.-elect Scott Brown, U.S. Rep. Niki Tsongas has not given up on passing health-care reform and continues to advocate for a "public-option" insurance plan that has been deemed all but dead following Brown's upset victory.

Ed Schultz Pleads For Health Care Reform, Calls Lieberman A 'Coward' (VIDEO) - Huffington Post

Ed Schultz made an impassioned plea for health care reform Wednesday during an on-location shoot at a temporary free clinic in Hartford, Connecticut.

OPINION

Obama: If Democrats don't pass health-care reform, 'I don't know what differentiates us from the other guys' - Ezra Klein

Today's televised session between Barack Obama and the Senate Democrats wasn't encouraging to those of us hoping the Democrats are spending their time worrying about how to pass the health care bill. There were questions on the deficit, on jobs, on partisanship, on energy and on judicial nominees. No one bothered to ask about health-care reform. The closest was New York's Kirsten Gillibrand, who asked about health care for 9/11 responders. It felt, for a moment, like we were back in the Bush years. Want to talk health care? Add 9/11 to the sentence.

Health Care Industry Front Group Cheers Death Of The Public Option With Large Washington Post Ad - Think Progress

One of the most aggressive industry front groups fighting to defeat health care reform has been the Conservatives for Patients’ Rights (CPR), run by disgraced hospital executive Rick Scott and represented by the same public relations (CRC Public Relations) firm that brought us the Swift Boat Veterans For Truth.

What Happens If Nothing Happens to Health Care? - Wall Street Journal

Barring a political miracle, we're going to learn the cost of doing nothing—nothing significant to restrain health-care cost increases, nothing to prod the health-care system to produce more benefit for each dollar it takes, nothing to expand health-insurance coverage.

Under this theory, wider coverage is a good thing. More people paying into the pool means the risk is more spread out. But Wall Street run insurance companies have perverted this system. Instead of striving for the largest risk pool, insurance companies can make more money by selectively insuring only the least risky people and cutting out the rest. In other words, they make money by cutting membership.

Insurance companies are just now disclosing their earnings and membership numbers from 2009. The changes from where they were in 2008 give a clear look into how these companies do business, and the human cost to their business practices.

For example, WellPoint is one of the nation's largest insurers. They have 14 state Blue Cross brands in their portfolio. In 2009, they made $4,746,000,000 dollars, up 91% from their 2008 earnings of $2,491,000,000. How did they achieve those profits? In a large part in two ways. First, they lowered their medical loss ratio - the amount of money they spend on actual health care as opposed to CEO profits and overhead - by 1%. This can cause big changes in the bottom line:

In 2008, [WellPoint] spent 83.6% of the premiums it took in on care - paying for doctors, drugs, and the like. In 2009, they spent only 82.6% of your money on your care. That seemingly small difference actually belies bigger discrepancies. An analysis by the Senate Commerce Committee [pdf] found that while WellPoint spends about 85% of every premium dollar on care in the large group market that big businesses can tap into, they spend as low as 73% of every dollar collected through individual plans, and 79% on small group plans purchased by small businesses.

A small change in this "medical loss ratio" means billions of more dollars that can be spent on CEO pay or reported as profit. Indeed, Martin L. Miller, a Senior Vice President at WellPoint, said that lowering the amount of money WellPoint spends on health care "really is the driver of profitability" and that the lowering of this percentage "is really what's driving our improved financial results this year."

WellPoint also aggressively cut membership. By pricing their services out of the reach of sick people, by cutting off policies of those who get sick (rescissions), by denying care due to pre-existing conditions, or by simply continuing to jack up premiums, 1,379,000 people were cut in 2009 from WellPoint's rolls. These people were undoubtedly sicker or less wealthy, and therefor less profitable for WellPoint. By cutting them as customers, perversely, WellPoint was actually able to make more money.

That's the twisted logic of Wall Street-run health care. Healthy people get coverage, but as soon as you get sick, you're pushed out. And for those still in the system, less of your premiums get spent on your care. By reducing medical spending and coverage, profits skyrocket.

This is a system that has nothing to do with insuring good health, and everything to do with making money. As Congress finishes reform right, they need to hold the insurance companies accountable and make sure they're in the business of keeping America healthy, not keeping shareholders fat with profits.

Rangel: Lawmakers writing compromise health bill - Associated Press

Leading lawmakers hoping to revive President Barack Obama's stalled health care overhaul have started writing a compromise bill, but it's unclear when the legislation will be ready for votes, a top House Democrat said Tuesday.

Pelosi: Piecemeal Reform No Better Than A "Get Well Card" - Huffington Post

Amid the wreckage of the health care debate, some rescue workers have been searching for small pieces that could be salvaged. On Tuesday, House Speaker Nancy Pelosi (D-Calif.) suggested that the search was in vain. What good is a door, after all, without a building?

Stumping for Jobs Plan, Obama Pushes Health Bill - New York Times

President Obama hit the road again Tuesday to promote the new job-creation program he described as his No. 1 priority, but he refused to abandon his embattled health care legislation, vowing to “punch it through” resistance in Congress.

Nancy Pelosi's new health care plan - Politico

With the broader health care bill still perilously close to collapse, House Speaker Nancy Pelosi plans to take a shot at the health insurance industry next week by scheduling a vote on a smaller bill to revoke its half-century-old exemption from antitrust laws.

Poll Finds Dropping Health Care Plan Doesn’t Help Dems. So Pass The Bill! - Greg Sargent

The  latest poll from Public Policy Polling finds that Dems are in a tough spot heading into 2010 whether or not they pass health care reform.

THE INFLUENCE GAME: Health lobbying gears down - Washington Post

Notice you're not bombarded anymore by TV ads about President Barack Obama's health care overhaul plan?

Obama's Budget Increases Funding for Medical Research That Compares Treatment Options - Kaiser Health News

The Obama administration, in an effort to forge ahead with its sometimes-contentious effort to compare various medical treatments, is proposing a big boost in funding for the agency that oversees the research.

OPINION

Cost control essential if health care reform is to succeed - Senator Collins

A recent column challenged me to put forth my ideas on controlling health care costs and said that the "debate (on cost) should start after the establishment of universal health care."

What Susan Collins's explanations don't explain - Ezra Klein

It's telling, I think, that in an op-ed explaining why she doesn't support the Senate health bill, Susan Collins cherrypicks numbers from CMS, which make the bill seem like it costs a lot of money, rather than using the more traditional numbers from the CBO, which imply that the bill saves money. It's also a hard rationale to believe, given that Collins supported the Medicare Prescription Drug Benefit, which not only increased spending by more than $400 billion, but paid for it by adding to the deficit.

Pelosi On Health Reform: ‘We Will Not Be Deterred From Getting Something Done, One Way Or Another’ - Think Progress

House Speaker Nancy Pelosi (D-CA) reiterated her commitment to passing comprehensive health care reform during a conference call this afternoon, describing the measure as a “first among equals” in Congress’ broader jobs agenda. Pelosi insisted that she would have the votes to pass the Senate health care bill in the House if the upper chamber fist passed a reconciliation package of fixes.

Republican Health Care Stall Means Higher Health Costs - AFL-CIO

The longer that congressional Republicans roadblock health care reform, the more it is going cost the American people–and the bigger the bite health care costs will take out of a reeling economy.

Senator Specter (D-PA) came out strong:

I believe we ought to pass comprehensive health care reform and we ought to do it now and there is a way to do it. I provided the 60th vote. We passed it in the Senate. Let the House accept it, simultaneously with a bill to make certain changes through reconciliation and 50 votes. There will be no disagreement about taking away the giveaway to Nebraska and Louisiana and the other inappropriate measures but let's move ahead and let's move ahead now.

Senator Franken (D-MN) was also pushing for the move:

The best way for that to happen, and as far as I can see – the only way for that to happen – is what I’m calling 'pledge and pass. If we in the Senate pledge to fix those elements through reconciliation – a budget process that requires only 51 votes, the House of Representatives should pass the Senate Bill.

Senator Ben Nelson (D-NE) walked back his earlier critisisms of the process and is open to reconciliation:

I’ve been asked about whether I’d support using the process known as reconciliation now. So, I want to make it clear: If I support a bill, then I will vote for it regardless of whether it takes 50 votes to pass or 60 votes to pass. My position doesn't change just because the House or Senate decides to change the process.

Senator Baucus (D-MT), who chairs the crucial Senate Finance Committee, says it's the only way:

Approving the Senate bill through the procedure, known as reconciliation, “is the only solution,” Baucus said, adding the Senate “was close” in getting enough votes to pass it.

Senator Conrad (D-ND), who chairs the other crucial commmittee in the process, the Budget Committee, says he would be open to fixes:

If the House passed the Senate bill, could reconciliation, that process, be used to fix things that might be improved upon? Yes. Would I support it? I can’t know that without knowing what would be included in the package.

Senator Bingaman (D-NM) said in a recorded call with reporters that reconciliation is an option (click for audio):

10:01 – Bingaman says that using the reconciliation process is an option for getting portions of the health care reform bill passed in the Senate.

Senator Carper (D-DE) has been reaching out to moderates in the House to convince them that the reconciliation "sidecar" option is the way to go:

Sen. Tom Carper, a centrist Democrat from Delaware who played an active role in Senate healthcare talks, said he would reach out to House Democratic centrists to persuade them to vote for the Senate-passed bill along with a sidecar.

“We’ve had some conversations with some of them already,” he said.

Senator Durbin (D-IL), the Senate Majority Whip, said reconciliation is an option:

We could go to something called 'reconciliation', which is in the weeds procedurally, but would allow us to modify that health care bill by a different process that doesn't require 60 votes, only a majority. So that is one possibility there.

Senator Pryor (D-AR) said he's open to it:

According to the Arkansas News, Pryor said reconciliation was not his first choice but "he was not necessarily opposed to the idea."

Someone familiar with Senator Feingold (D-WI) has said the Senator is open to the idea:

I spoke to someone from Feingold's campaign about his position on reconciliation in light of the Massachusetts special election. She informed me that while Sen. Feingold is no fan of reconciliation, now that it's reconciliation or nothing (apparently), he would be willing to support reconciliation if that's what it took to get a good bill passed. It wasn't the slightest bit equivocal or hedgy; it was a straight "yes". So that's a bit of good news. Hopefully the House can get their act together.

Senator Kerry (D-MA) says reconciliation is his preferred route to passing health reform:

Senator John Kerry said today his preferred route to completing health care reform is for the House to pass the Senate bill, and for the Senate to make it more digestible to the House by approving fixes through the reconciliation process, which allows legislation to pass the Senate by a simple majority instead of 60 votes.

Senator Klobachar (D-MN) is also open to the move:

Whether it's going to be [reconciliation] or whether it's going to be taking some of the main initiatives for the self-employed and small business to allow them to get better rates of insurance, and insurance reforms and prevention, and the Medicare cost reforms — which, some of us can't even imagine voting for health care without having some Medicare cost reform — the bill will move forward, and I think something will get done….

Senator Sanders (I-VT) definitely supports it:

Sen. Bernie Sanders, I-Vt., said he favors using a parliamentary maneuver known as reconciliation to get health care reform passed. Such a move would require only support of a simple majority of the Senate, not the 60 needed to prevent a filibuster threatened by Republicans.

"I support the reconciliation process or any other way we can get the votes we need to go forward," Sanders said in a statement.

Senator Menendez (D-NJ) supports it as well:

I’m not sure how we get where we want to be if reconciliation is not the process.

More statements will no doubt come in as the process moves forward, but for now there is building support for finishing health care reform using the reconciliation process. Of course, we need to encourage them not just to finish reform, but to finish it right by making health care affordable to all and holding the insurance companies accountable.

Update

@ProgressOhio points me to Senator Sherrod Brown (D-OH) and his support of reconciliation:

Brown said didn’t yet know for sure whether Reid would commit to the reconciliation fix approach, but added that there’s a widespread sense in the caucus that this is probably the only workable route forward.

“I can’t imagine another scenario,” Brown said. “We can’t start anew, and we can’t do piecemeal.”

Specter: Democrats Must Use Reconciliation To Pass Health Care Fixes 'Simultaneously' - Huffington Post

Sen. Arlen Specter (D-Penn.) urged his Democratic colleagues over the weekend to unite around a plan that would allow them to move forward with health care legislation using a process that requires only 51 votes.

Obama Calls Health Overhaul ‘My Greatest Hope’ - New York Times

President Obama, in a question-and-answer session to be posted on YouTube, the online video-sharing site, said that “it is my greatest hope” that health care legislation be adopted “not just a year from now, but soon.” Yet he also referred to the effort in the past tense: “We came extremely close,” he said — a sign that the fate of the health care measure is now highly uncertain.

Obama Says He’s Counting on GOP Support on Health Care - Wall Street Journal

President Barack Obama doesn’t seem to think much about the prospects of Democrats moving health care legislation on their own at this point. He said today that he is counting on Republican support.

State health plans in jeopardy - USA Today

Sherie Brace fears the coming of summer. That's when a special health insurance program for low-income adults in Washington state is set to close, ending coverage for her and about 65,000 others.

OPINION

Racing Against Time - Jon Cohn

For most of the last year, time has been health care reform's enemy. Could it now be reform's friend? That's the gamble reform's proponents in the administration and Congress are making now.

Health cost increases will hit double-digits in 2010 - another reason for real health reform - Health Populi

So much for America's ability to manage health care costs without health reform: health costs will increase in the double-digits this year, according to Buck Consultants' 21st National Health Care Trend Survey.

Are DNC donors funding ads praising Ben Nelson for diluting real health care reform? - Americablog

To the tune of nearly $500,000.

Is this "roadblock" for reconciliation really a roadblock? - Congress Matters

If it's just a straight-up question of whether it creates some kind of legal paradox to pass a reconciliation bill full of amendments to HR 3590 (widely referred to as "the Senate bill") before passing HR 3590 itself, then I think the answer is pretty clearly no, it does not.

It's not 1994 all over again right now, but it could be if things go in a certain direction. What Ezra Klein said last week is true:

It is very, very, very important to be clear on what the death of health-care reform looks like. It is not a vote that goes against the Democrats. It is not an admission that the White House has moved on from the subject. It is continued statements of commitment from the key players paired with a continued stretching of the timetable. Like everything else in life, policy initiatives grow old and die, even if people still love them.

The danger is there, and the parallels of 1994 are an important warning. Things are different right now then they were. We don't have to go down that road again.

There are two main differences between today and 1994.

First, unlike 1994 where barely any health bill made it out of committee, both Houses of Congress have already passed comprehensive health care reform bills. Every Democratic Senator and almost every Democratic House member has already voted YES.

Democrats will have to run for re-election in November on health care whether they want to or not, because they've already taken the votes. If Democrats fail to complete the job, all that voters will remember are the lies and scare tactics. If Democrats finish the job, then voters will see start seeing real benefits and Democrats will have proven they can stand up to the powerful and delivered. It should be obvious which is the stronger electoral position.

Second, unlike 1994 where the various committees, not to mention Houses of Congress, couldn't agree on anything, the large contours of the House and Senate bills are similar. And the final bill that will pass will include needed improvements in Senate bill, within the common reform framework. If you look back at the proposals circulating among the various committees in 1994, you'll see the divergence of opinion was much greater than it is now.

One other key difference between 1994 and now: Democrats saw what happened when they failed to pass health care reform in the '90s. There is no doubt that the same thing could happen again if they fail to pass reform this time.

The path forward on reform is clear and straightforward: Fixes to the Senate bill should be passed using budget reconciliation. The Senate will use the budget reconciliation process to improve their bill with a majority vote. The House will pass the reconciliation bill with the improvements along with the bill that the Senate passed in December.

The only thing that could turn the current situation into 1994 is a lack of political will. It's up to leaders in Congress to build that political will, finish health reform right, and finish it now.