Senate healthcare reform vote: 'Now, the real debate can begin'

With no Republican votes – and no votes to spare – Senate Democrats opened debate on historic overhaul of how the US healthcare system delivers services and how Americans pay for them.

The bill promises to expand access to healthcare to some 31 million Americans at no net cost to the federal government. At 2,074
pages, it’s the most wide-ranging and complex bill to come before the Congress since the New Deal.

But for majority leader Harry Reid, Saturday night’s 60-to-39 vote is only the first 60-vote hurdle in a long race to passing a bill in the Senate. It cleared the way for debate to begin after the Thanksgiving break. But comments made by several moderate Democrats – Democrats without whom the bill has little chance of passing – sought to infuse the historic moment with a measure of sobriety.

Their statements suggest the shape of the debate ahead for the Senate healthcare reform bill in the coming weeks: the existence of a public option and its size, ways to contain costs, and provisions about limiting access to abortion services, among other issues. At the same time, they highlight the enormity of the work that remains.

One of the last two Democrats on the fence to be persuaded to vote "yes" Saturday was Sen. Mary Landrieu (D) of Louisiana. In discussions with Senator Reid, Senator Landrieu won more than $100 million to help her state, still reeling from hurricane Katrina, to help pay for healthcare for the poor. Yet her support remained tepid.

“I have decided that there are enough significant reforms and safeguards in this bill to move forward, but much more work needs to be done,” said Landrieu.

The last Democrat to publicly agree to vote to begin debate on the bill, Sen. Blanche Lincoln (D) of Arkansas, announced her decision on the floor of the Senate with a significant caveat:

“I am opposed to a new government administered public healthcare plan as a part of comprehensive health care reform, and I will not vote in favor of the proposal that has been introduced by leader Reid as it is written.”

If Saturday's vote is the model of how Democrats can get to 60 votes on healthcare reform – avoiding a filibuster – then Reid will need Senator Lincoln. Yet on the left wing of the Democratic caucus, some liberals went on record saying their vote is in doubt if the public option is weakened during debate.

“While I voted to proceed to the health care legislation tonight, I have made it clear to the administration and Democratic leadership that my vote for the final bill is by no means guaranteed,” said Sen. Bernard Sanders (I) of Vermont, in a statement after the vote.

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