December 17, 2009

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Can we please have new Senate leadership now? The White House and Harry Reid have made one bad decision after another. We can't do anything about Obama, but why do we have to put up with an incompetent Senate Majority Leader?

Four days before the Senate jettisoned the idea of expanding Medicare to younger Americans, a dozen Senate Democrats, including some of the chamber's most liberal members, dispatched a stern letter warning that the proposal would make it harder for elderly patients in parts of the country to find care.

The letter, sent to Senate Majority Leader Harry M. Reid (D-Nev.), attests to the effectiveness of a ferocious campaign by influential hospital and physician lobbyists to defeat the idea. And it underscores the difficulty of forging policy and political deals in the warp-speed, supercharged environment in which Congress is trying to reshape the nation's health-care system.

The proposal to allow people ages 55 to 64 to buy insurance through Medicare -- one of the most significant ideas to emerge from the Senate's side of the debate -- appeared and vanished in a mere six days.

Sources on and off Capitol Hill say the quick life and death of the Medicare buy-in reflects the complex politics and a brutal reality at this stage of the Senate's deliberations, in which there is little time to refine proposals that do not immediately attract the 60 votes needed for health-care legislation to pass.

The broad contours of the proposal emerged early last week from 10 liberal and moderate senators whom Reid had assigned to negotiate a bill. The group reached for the Medicare buy-in as a compromise between members who favored a new government-sponsored insurance alternative for Americans of all ages, and those who were wary of more public coverage. The buy-in, they reasoned, would create access to public insurance for people in late middle age -- a group for whom medical problems become more common and insurance is particularly expensive.

But in the following days, the proposal met resistance among Senate moderates as well as some liberals. Meanwhile, Reid made a strategic decision, ordering the negotiators to keep the details of their proposal secret until congressional budget analysts examined the impact it might have on consumers and the federal budget. That strategy, however, meant that the proposal did not attract much support from outside constituencies that have, in the past, favored letting younger people buy into Medicare.

"We were immobilized due to lack of information," said John Rother, executive vice president for policy and strategy at AARP, a lobbying group for people age 50 and older, which has endorsed buy-in proposals in the past. "We couldn't support something that we didn't know what it was."

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