Not only does the Senate magnify the power of minorities to obstruct decision-making, the filibuster multiplies it. The bicameral legislature is a stupid, stupid idea, probably the most obsolete idea of the Founding Fathers. What other organization runs with two boards of directors? But since we are unlikely to get rid of the Senate until the world changes, let's talk about the filibuster. Its history is particularly ugly - it was used most notably to protect slavery and segregation. But now, it's developed into a standard maneuver. Unlike the old days, very few filibusters even go through the spectacle of extended debate or result in a cloture vote, which at least provides some measure of accountability. The minority party simply makes its intent to filibuster known, and the bill is never brought to the floor.

This is a recipe for minority obstructionism, and that's exactly how it has been used and is being used away. And to come back to Ted Van Dyk's point, I think America spoke as clearly as it ever does in the last election. It was about a new direction for health care, energy use, foreign policy, education, etc., and the result was a clear majority nationwide and in the majority of congressional districts. The nation is not as divided as the Senate. I understand the filibuster could be eliminated by simple majority vote. That would be a great gift to democratic, accountable government. We are treading water because every decision requires a supermajority of 60 in the Senate, not because Americans are undecided about the direction they want the country to take.

Good point by Vince about use of the filibuster. Both political parties have abused it. As Vince says, even the threat of a filibuster in recent years has been enough to keep legislation from coming to a Senate vote.

I should have stressed more greatly, in my piece, the effect that rising
federal deficits have had in recent months on opinion regarding all issues.
Vince is quite right that the 2008 election provided a mandate for change.
Since then, however, voters of all persuasions have become sensitized to the huge accumulation of federal debt that has taken place in a few short months. It is anxiety about this debt---more than the substance of matters relating to health-care reform, cap-and-trade, and Afghanistan, for instance---that lies behind much of the opposition to anything having fresh spending attached to it.

I wrote at the outset of the Obama presidency that I hoped he would proceed, first, to take measures to stabilize our financial/economic systems before launching other unrelated proposals. I take no satisfaction that I may have been right. It is spending attached to these proposals, as much as the proposals themselves, that are contributing to renewed polarization and gridlock.

Weren't "we" anxious about debt when the Bush tax cuts were approved? When the Iraq war was being debated? When the "defense" budget topped $650 billion, as it will in 2009? Why is "pay as you go" now the principle that might kill a SELF-FUNDED public health care plan? I doubt if the howling mobs could even estimate the federal debt of the United States within an order of magnitude. Concern about the debt is just propaganda of the minority party, within a governance structure that magnifies its power beyond its electoral attraction.

I think it's sad that tiny-state senators like Baucus and Grassley have gatekeeper influence over legislation. One might hope they would rise to the occasion; realize that they are not Montana or Iowa senators, but US Senators who happen to be from Montana or Iowa. After all, their paychecks are signed by the Treasurer of the United States, not the treasurers of Montana or Iowa. But, as in other realms, a bad decision-making structure results in a bad decision-making process and bad decisions.

So, respectfully, I disagree that public is confused or ambivalent about our direction as a nation. I think the Senate is broken.

The reconciliation process allows budget-related bills to be considered without threat of filibuster. The Senate is considering using it to pass a health care reform bill without sufficient R votes to reach 60. See http://en.wikipedia.org/wiki/Reconciliation_(U.S._Congress).

dn is correct except for this complicator: If reconciliation were used, the bill would have to be split into at least two parts---with the
budget/spending part being separated from the rest of the legislation.

Another problem with use of reconciliation: Major legislation, such as
health-care reform legislation, has always been passed with bipartisan, consensus backing. As now being discussed, it involves systemic changes which would be difficult to sustain if passed with solely Democratic votes.
(One presumes, for instance, that historic trends will apply and that Republicans will pickup some Senate and House seats in 2010. A 2009 Democrats-only bill, attached to reconciliation, would likely be reversed promptly). Obama and Democratic congressional leaders know this and, thus, are not likely to use the reconciliation process accordingly.

Mr. Van Dyk argues that new presidents don't necessarily know a lot about particular issues but he himself needs to bone up on health policy. He argues for limited insurance reforms rather than comprehensive reform including covering all Americans. But any serious health policy expert could tell him --and the insurance industry has said repeatedly -- that health insurers cannot accept all comers unless everyone is required to carry insurance. Otherwise people will buy coverage only when they know they need expensive care. That's a surefire way for insurers to lose money. In addition, no serious political observer still thinks that the Republicans had or have any interest in negotiating a health care bill with the Democrats. Let's drop that argument, shall we? Mr. Van Dyk also needs to stop asserting that health care reform will cost a trillion dollars. The CBO costed out the House Democratic bill, including the offsetting cuts, at $239 billion over 10 years. And the ultimate bill is likely to have a net cost of much less than that, or even zero. Let's tell the truth here, and stop making these disingenous arguments about why Obama should not have attempted health reform. This is a disservice to the readers of Crosscut.

Harris: You are determined to find reason for argument in anything I write or do not write about health care. I have written often that everyone should be covered...think of the auto-insurance analogy whereby individuals are required to have coverage or, otherwise, pay to be included in a pool. I also believe, as many legislators now do, that
health coverage should be thru individuals, not thru employers, according to the old industrial-corporation model before workers became more mobile, were in small business, or were independent contractors.

I first got involved in health-care policy in the LBJ administration when we passed Medicare and Medicaid. I wrote the health-policy and other planks over a 30-year period for several Democratic national candidates and national platforms. I served on the four-person board of a non-profit established by Sen. Ted Kennedy to further understanding of health-care issues. I ran a couple national think tanks which looked into health policy and edited the papers published on the subject. I ran a D.C. consulting firm for a number of years which had, among others, health-issue-related clients. So, when I write about health-care and associated issues, I am not doing it off the seat of my pants.

President Johnson began his efforts toward Medicare and Medicaid passage by finding Republican co-sponsors for it. Ted Kennedy, with his health-care and other Senate initiatives, always began on the same basis. Both Johnson and EMK knew that big systemic changes could not be successful on a one-party basis. You say the GOP has no interest in a health-care bill.
Had GOP input been sought at the outset of this process, a number of
GOP sponsors and co-sponsors might have been found for legislation. But, since they were frozen out and their suggestions and amendments rejected,
they now are in general opposition---although the Baucus bill in the Senate may yet attract some bipartisan support.

My arguments are not disingenuous. They are informed. Your own comments, by contrast, seem to come from your reading of highly partisan sources.
I urge you to get past bumper-sticker-level rhetoric and argumentation.

Mr. Van Dyk, I don't believe in arguing based on the "I'm an expert" approach because readers must evaluate the evidence on its own merits. That said, I've been covering health care for more than 25 years for national publications, including the AMA and AHA publications, have won national journalism awards for my health reporting, and have read and talked with the top experts and have been through all the nuts and bolts. Enough with that discussion about who knows more, and I hope you'll drop that too.

In none of your recent articles have I seen you express support for covering everyone. Instead, you repeatedly argue that Obama and the Dems should forget about comprehensive health reform, meaning universal coverage, and instead focus on incremental changes such as insurance reform and med mal reform. Here is my short analysis that ran in today's Chicago Sun-Times on GOP bills that would do this. They won't work.
http://www.suntimes.com/news/otherviews/1717891,CST-EDT-open16.article. Here's a longer analysis I recently did. http://www.thehealthcareblog.com/the_health_care_blog/2009/09/an-analysis-of-the-gop-plan.html#comments. The excellent NPR health reporter Julie Rovner did a very similar analysis last week.

Obama has explained, and many health policy and business experts also have explained, why health reform is essential for the future health of the broader economy. You continue to ignore that in insisting that the Dems should focus on repairing the economy and forget about health reform.

The Republicans of your political heyday in the 60s and 70s -- or even of the early 90s -- were very different from the Republicans of today. Richard Nixon proposed a universal coverage system. So did Bob Dole and John Chafee in the early 90s, and even the first President Bush proposed a pretty decent health reform package in 1992. No current GOP leader would get anywhere near those responsible health reform proposals, except perhaps Olympia Snowe.

You may not have noticed, but Republican input was sought near the beginning of the current reform process. Sen. Baucus published his white paper last fall, and he started serious discussions with Republicans on Senate Finance this spring. Republicans have had at least six months to weigh in with compromise proposals. According to Time Magazine, Obama even offered GOP leaders "tort reform" in May and they walked away with no counteroffer.

Today's Republican Party has 0 interest in health care reform. Didn't do a thing about it from 1994 when they controlled Congress, and especially since 2000 when they were in control of House, Senate, and Presidency. Even those non-ideological R senators who might have some interest in working on health care have received and accepted the message that the tactical advantage is to kill health care reform. This is not the 1960s, when there was a credible liberal wing in the Republican party.

My suggestion would be to expand Medicare to everyone under 25, with a corresponding increase in the payroll tax. This would help out state budgets by eliminating Medicaid for this population, and get rid of S-Chip as well. It would provide universal coverage to kids, who shouldn't be held responsible for whether their parents can afford or want to buy health coverage. It would provide preventive services and wellness programs where they could affect health care costs for a lifetime. Since most young adults are healthy, including them wouldn't cost very much either.

Republicans wouldn't vote for this either, but no matter. It would be so popular that it would lead to single payer universal health care in 10 years anyway.

Couple of things I want to add: first, perhaps it would have been better to divide health care reform into separate bills from the start. One dealing with insurance practices, one with expanded coverage, one setting up the insurance exchanges, and so forth. And the apparent desire for every committee to have its say hasn't worked too well either. We must have about 5,000 pages in the five bills. When every idea is on the table, none are really on the table. Except, of course, single payer - that one's always off the table.

Second, if the Dems were united, the R's would follow, at least a few of them would, I think. They don't all want to be on the wrong side of history, as they were with Social Security, Medicare, the Clinton budget, and the stimulus package. But I wish Obama would give a version of the St. Crispin's day speech.

"The fewer men, the greater share of honour.
God's will! I pray thee, wish not one man more...And gentlemen in England now-a-bed
Shall think themselves accurs'd they were not here,
And hold their manhoods cheap whiles any speaks
That fought with us upon Saint Crispin's day."

Any Dem who works to perpetuate the status quo on health care or energy use in this country deserves neither honor nor re-election. Sadly, I fear the conservative element of the party will have to re-learn the lesson it forgot from 1994: that if a voter has to choose between a Republican and a Republican, he might as well choose the Republican.

VinceInSeattle, thank you for quoting a beautiful and apt passage of Shakespeare to get us past the ugly name-calling! I totally agree on the issue of Democratic Party unity. I intensively covered the Clinton health reform battles, and am amazed that Democrat Jim Cooper and his Blue Dog colleagues haven't learned the brutal political lesson from that debacle. Though I don't agree on breaking health reform up into separate bills, because as I've learned from many years of reporting on health policy, all these things are interconnected and if, say, the insurance exchange and insurance reform pieces pass but adequate insurance subsidies and cost saving measures don't pass, it won't have the political support and it won't work.

Aww, thanks Harris. This thread got me thinking about how a modern organization makes decisions. As I already wrote, they don't have two boards of directors. The political theory of the Founding Fathers was that no action is better than hasty action (also, of course, that the country is a federation of states rather than a single nation). Life moves too fast now for bicameral legislatures, and they don't provide the accountability required.

As you probably know, the filibuster is not in the Constitution - it is a Senate rule that overlays the undemocratic nature of the Senate with a supermajority requirement. Modern organizations only use supermajority for the most extreme moves, not for day to day decisions.

Faced with issues that don't easily fit within their existing governance structure, a modern organization appoints a project team to bring the best proposal to its stakeholders. And this is exactly how Congress should have tackled health care. Rather than shuttling it through five committees, the majority and minority leaders should have appointed a Joint Select Committee to form a proposal that both houses could vote on. The existing process has proven itself incapable of forming a single coherent proposal. Lots of turf wars, and when there are too many leaders, no one's a leader. Max Baucus is certainly not a leader - he has no followers, although he doesn't seem to have noticed. Corporations and non-profits have turf conflicts too, but the occasional near-death experience seems to concentrate their collective minds and enable innovation in both decision-making and results. A Joint Select Committee would also have the advantage of front-loading the conference committee, which is an ugly back-room hall of favors that we can look forward to if both houses ever disgorge some kind of health care bill.

Congress has experimented with different kinds of decision-making in the past - I'm thinking of the military base closing commissions, which present an up-or-down vote on a list of closures. Congress should work harder on its own management. Neither the filibuster, committee structure, nor conference committees are defined in the Constitution, and could all be changed. If Congress were a professional association, it would be losing members in droves for its fecklessness.