Teddy's Replacement Coming Soon

The Massachusetts State Senate just passed the bill allowing for a temporary appointment to the US Senate seat held by Ted Kennedy. The Governor will sign and the Democrats will be back to 60 seats perhaps by the end of the week.

This is probably the best practice for Senate vacancies - a temporary appointment because of the disproportionate impact of losing one Senator out of 100, followed by a quick election within a few months. It ought to be the standard.

Most speculation on the seat has centered on former Governor Michael Dukakis, or someone with ties to the Kennedy family or Teddy himself, like a former staffer. At any rate, that vote will certainly be fairly Democratic.

Obviously this raises the possibility of demanding Democratic unity on allowing a final vote on health care to go forward, even if they don't approve of the final bill. There's the matter of Robert Byrd (who ought to resign and live the rest of his life in peace), but essentially, Democrats will have the votes to block a filibuster if they hang together. And if Harry Reid cannot figure out how to enable a vote the the overwhelming majority of his caucus supports, then he doesn't have any power whatsoever. Reid is still raising the possibility of reconciliation, but that's a bluff for Republicans. It's the Democrats in his own chamber who need the nudge, although perhaps reconciliation is a warning to them as well.

One Step Closer To 60

Yesterday the Massachusetts House passed a bill that would allow Deval Patrick to appoint a temporary successor for Ted Kennedy until the outcome of a special election in January. The bill now moves to the State Senate, where Democrats have an enormous advantage as well. Republicans could hold up the bill through some procedural maneuvers, but they cannot stop it. The expectation would be that final passage could happen by the middle of next week. This would obviously be a huge boost to Democrats to have a consistent voting partner and a 60-vote majority in the Senate once again.

Regardless of the appointment process, there will be a special election, with a primary in December and a general election in January. With some of the big names on the Republican side begging off the race, the winner of the Democratic primary is highly likely to win the general. Right now the field on the Democratic side includes Attorney General Martha Coakley, Rep. Michael Capuano, and co-owner of the Celtics Stephen Pagliuca. Coakley, a statewide officer, has higher name recognition and thus a big lead. But Capuano is a pretty strong progressive.

By contrast, her main rival, MA-8 congressman Mike Capuano, has a ten year record on national issues. Basically it’s a record of being really, really liberal. He’s member 18.5 in the 111th House, he was 30.5 in the 110th House, 40.5 in the 109th, 10 in the 108th, and 8 in the 107th—firmly on the left side of the Democratic caucus. He’s the former mayor of Somerville, a dense walkable urban area, who likes to talk about mass transit, he’s pushing from the left on Afghanistan and Iraq, he favors single payer health care but says he won’t “let the perfect be the enemy of the good.”

Capuano, recognizing that he needs to introduce himself to voters outside his district, has already put up an ad on statewide TV, and it's striking how hard he pushes his progressive credentials.



A Senator from Massachusetts needs to be as far to the left as possible - there aren't many states out there as blue, if any. Capuano looks pretty good to me; Coakley may be great, but she needs to reveal herself on the issues she hasn't faced as Attorney General.

From Ted To Barack

There's a lot to say about tonight, which I think ultimately was a very good night for both health care reform and liberalism. But I'm about to hit the radio, so I'll just post the letter from Ted Kennedy that Obama referenced tonight, which was like when Dean Martin would open a door on his old TV show and have Frank Sinatra standing there:

May 12, 2009

Dear Mr. President,

I wanted to write a few final words to you to express my gratitude for your repeated personal kindnesses to me – and one last time, to salute your leadership in giving our country back its future and its truth.

On a personal level, you and Michelle reached out to Vicki, to our family and me in so many different ways. You helped to make these difficult months a happy time in my life.

You also made it a time of hope for me and for our country.

When I thought of all the years, all the battles, and all the memories of my long public life, I felt confident in these closing days that while I will not be there when it happens, you will be the President who at long last signs into law the health care reform that is the great unfinished business of our society. For me, this cause stretched across decades; it has been disappointed, but never finally defeated. It was the cause of my life. And in the past year, the prospect of victory sustained me-and the work of achieving it summoned my energy and determination.

There will be struggles – there always have been – and they are already underway again. But as we moved forward in these months, I learned that you will not yield to calls to retreat - that you will stay with the cause until it is won. I saw your conviction that the time is now and witnessed your unwavering commitment and understanding that health care is a decisive issue for our future prosperity. But you have also reminded all of us that it concerns more than material things; that what we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.

And so because of your vision and resolve, I came to believe that soon, very soon, affordable health coverage will be available to all, in an America where the state of a family’s health will never again depend on the amount of a family’s wealth. And while I will not see the victory, I was able to look forward and know that we will – yes, we will – fulfill the promise of health care in America as a right and not a privilege.

In closing, let me say again how proud I was to be part of your campaign- and proud as well to play a part in the early months of a new era of high purpose and achievement. I entered public life with a young President who inspired a generation and the world. It gives me great hope that as I leave, another young President inspires another generation and once more on America’s behalf inspires the entire world.

So, I wrote this to thank you one last time as a friend- and to stand with you one last time for change and the America we can become.

At the Denver Convention where you were nominated, I said the dream lives on.

And I finished this letter with unshakable faith that the dream will be fulfilled for this generation, and preserved and enlarged for generations to come.


With deep respect and abiding affection,
[Ted]

60 Again Shortly?

We're getting closer to Massachusetts being able to appoint an interim successor until the special election that will be held January 19 fills the slot once held by Ted Kennedy. I didn't think Massachusetts lawmakers would be constrained by appearances on this one. Plus, they are fulfilling the expressed desire of the electorate to have two Senators, including one who shares Ted Kennedy's beliefs and policy positions.

By the way, the whitewash of Kennedy from a liberal lion into the great conciliator and compromiser who would have bargained away the public option in a second is truly insidious. Jed Lewison, who was there during the Medicare Part D fight, has some good thoughts on this over at Daily Kos. In short, Kennedy opposed the Medicare deal because it became an industry trough-feed at the end. Despite this, conservatives keep parroting this "compromiser" spin, particularly with respect to that vote.

The reason for Fox's lie couldn't be more obvious: they desperately want Democrats to cave on the core elements of health care reform, and they think that creating a false narrative about Ted Kennedy will make their wish come true.

Ted Kennedy probably wouldn't want us to pass meaningful health care reform solely to honor his legacy. In fact, of all the reasons health reform needs to be passed, that's probably not even on the list.

But Ted Kennedy's passion for health care reform does inspire us to achieve the goal of universal, affordable coverage. And the record shows us that despite his best efforts, Republicans cannot be trusted to be fair partners in the process of getting there.

More.

Check His Countertops

11 year-old kid recites his grandfather's words, conservatives outraged.

He probably has granite in his kitchen. Or marble!!

Time to investigate, Ms. Malkin.

Even For Huckabee, Pretty Scummy

I'm watching the memorial service for Ted Kennedy right now, and remembering how conservatives launched a full-court press this week demanding that Democrats not politicize the event and use it to rally for health care reform. Exactly what would you call this bile from Mike Huckabee other than rank politicization?

The 2008 Republican presidential candidate suggested during his radio show, "The Huckabee Report," on Thursday that, under President Obama's health care plan, Kennedy would have been told to "go home to take pain pills and die" during his last year of life.

"[I]t was President Obama himself who suggested that seniors who don't have as long to live might want to consider just taking a pain pill instead of getting an expensive operation to cure them," said Huckabee. "Yet when Sen. Kennedy was diagnosed with terminal brain cancer at 77, did he give up on life and go home to take pain pills and die? Of course not. He freely did what most of us would do. He choose an expensive operation and painful follow up treatments. He saw his work as vitally important and so he fought for every minute he could stay on this earth doing it. He would be a very fortunate man if his heroic last few months were what future generations remember him most for."

As it happens, Huckabee made his remarks shortly after he derided Democrats for using Kennedy's death to make the pitch that "Congress must hurry and pass the health care reform bill and do it in his memory,"

"That not only defies good taste," said Huckabee, "it defies logic."

Digby gets at most of what's wrong with this. Aside from the idea that "most of us" would choose an expensive operation when most of America does not have the means to use the upper tier of the health care system, it's simply disgusting to warn Democrats from making political hay out of the event of Kennedy's passing while doing exactly the same thing. Huckabee's lying about President Obama and the current bill, but even if he were talking straight, the duplicitousness is a bit much, even for him.

...I almost forgot that Huckabee was last seen claiming that evangelicals were more supportive of Israel than Jews, I guess because they want to prepare it for the Rapture more intensely.

The Meaning Of Compromise

I think everyone expected Republicans to pre-emptively accuse Democrats of politicization in the wake of Ted Kennedy's death. (By the way, please politicize my death.) But that's just the far edge of the Overton window, the bluff so Democrats won't try to take comfort and inspiration to pass the cause of Kennedy's life. The far more insidious tactic, proffered by the right in a coalition with the bipartisan fetishists in the media, is to revise Kennedy's legacy as that of the ultimate centrist, in a fashion, the bipartisan dealmaker, the Great Compromiser. They've done a full-court press on this:

Senator Judd Gregg is already hinting at the idea. In an interview with the Boston Globe, Gregg hailed the bipartisan support for legislation he and Kennedy created together, adding that Kennedy knew how to “move the ball down the road with conservatives like myself.”

Meanwhile, Karl Rove hailed Kennedy on Fox this morning for being “willing to compromise.”

Other GOPers are floating the idea in The New York Times anonymously, in a discussion of how to navigate the politics of Kennedy’s death:

Republicans also noted that Mr. Kennedy, though an ideological liberal, was a legislative pragmatist who worked with Republicans to strike compromises on difficult subjects like health care, education and immigration. They said they saw little such reaching across the aisle in his absence.

Any member of the United States Senate with a long record will have many moments of compromise, whether between the parties or intra-party. But the idea that Kennedy should be remembered for "making the right concessions," solely in the context of bipartisanship, is a media projection helped along by a right wing who wants to blame Kennedy's absence for political polarization and the eventual death of a health care bill. We see this today with Steven Pearlstein's eleventy-billionth column arguing for the wise, high Broderist, split-the-baby approach:

And while there will be plenty of liberal Democrats who will be fuming about all the compromises forced upon them, somewhere from above will come a familiar voice with that distinctly Boston accent, whispering, "The dream will never die. Take the deal."

Notwithstanding the fact that Kennedy's staff wrote the HELP Committee version of the bill, and Kennedy himself labored over it, and that includes a public option, misses the point of Kennedy's legislative style, which continued to focus on broadening his goals and moving ever forward even when the odds weren't on his side. As Jonathan Cohn writes:

But this notion that Kennedy's liberal reputation somehow belied his pragmatism--a notion already gaining traction in the media, which has turned non-partisan accommodation into a fetish-- misses the point. Kennedy compromised on means, not ends. He would negotiate because it helped achieve his broader goals--signing on to NCLB, whatever its cookie-cutter standards, because it would send money to schools in poor, underfunded districts; embracing the Medicare drug benefit because, however poorly designed, it'd save senior citizens from having to choose between medicine and food.

It was precisely because Kennedy's devotion to his notion of social justice was so clear and dependable that he could make such deals stick. Liberals trusted him because we knew he wouldn't sell out the broader cause. If it was good enough for Kennedy, we figured, it was good enough for us. We knew he didn't see pragmatism as an alternative to ideology. It was just a necessary method of fulfilling it [...]

In the hours since Kennedy's passing, his speech to the 1980 Democratic convention--his most memorable oration, along with the RFK eulogy--has gotten a lot of play. Typically the networks show the final quote, in which he promises to continue his crusade even as he gives up his quest for the presidency. But the more important passage is where he invokes Franklin Roosevelt as an unabashed defender of the common man against the forces--and, yes, the people--who would disregard his well-being. Like FDR, Kennedy was not afraid to talk about values, to talk about right and wrong. Now that Kennedy is gone, who will pick up that torch?

Blue Dogs and ConservaDems have high praise for compromise these days, but their version of it basically preserves corporate goals and sells out their constituents in the exchange. Kennedy's version was precisely the opposite. His concern was "the least among us," the poor, the elderly, the disabled, the sick, the oppressed, the downtrodden, the less fortunate. He tried to get something for them, whenever possible. Pundits can call that "bipartisanship" but they ought to understand what that means.

The deviousness of the conservative project, to lament Kennedy's passing because now wild-eyed ideologues (like Max Baucus?) will go crazy, is clear. The true scoundrels, however, are those in the press trying to position the life of the man who did as much to advance the causes of the voiceless as anyone in the history of the Senate as someone who preferred half a loaf. Democrats should take a better lesson.

No, mere words cannot honor Ted Kennedy's memory. To pretend otherwise would be to cheapen his legacy, to lie about who Ted Kennedy really was. He was, for the vast majority of his life, a fiercely ideological public servant. It was his commitment to that New Deal social compact which defined him, which made him relevant to you and me. And his actions, not his words, were what marked him as the greatest Senator of his era. To attempt to honor Ted Kennedy without striving to further his life's work is simply impossible.

When Paul Wellstone died they told us that we couldn't celebrate him him as a political actor, that to do so would be crass and opportunistic. But the entire reason we knew Paul Wellstone, the reason we were crushed by his passing, was his political activism. It would have been a lie not to celebrate that legacy. It would have been crass to act as if Paul Wellstone hadn't been first and foremost a progressive hero, to feign nonchalance over political concerns as we eulogized the man, and in so doing stripping him of his essence. Likewise, it would be a lie today to pretend that the reason we loved Ted Kennedy had nothing to do with his leadership for working people. And it would be crass to attempt to celebrate him with mere words, rather than the action he demanded from us in life. How can we not "politicize" his legacy? The man was who he was because of his wholehearted commitment to his politics. The real obscenity -- the real opportunism -- would be for his political opponents to now try and depoliticize a quintessentially political life.

...George Steph agrees: Kennedy would have ditched the public option. Amazing how Kennedy's beliefs, after his death, line up perfectly with the beliefs of the blow-dried commentariat, n'est-ce pas? Lawrence O'Donnell, by the way, has a different perspective:

"Senator Kennedy...is not an easy compromiser on health care reform. In 1994, I was in the room when he told the president that he believed the strategy should be a Democrats-only strategy and that we should not be trying to reach out and get Republican votes."

Yes, It's Hypocritical. Politicians Don't Always Care About That

The call to replace Sen. Kennedy with a temporary appointment is intensifying. Among the points I've heard bandied about by Democrats in the state is that Massachusetts cannot afford to be without representation for five months.

Um, pardon me, but wasn't Kennedy basically in a hospital bed for the past 18 months, off and on?

I don't think there's any way for Massachusetts Dems to justify changing a law they altered precisely to keep Mitt Romney from appointing a successor to John Kerry. So they... shouldn't justify it. We have an entire Internet meme called IOKIYAR - It's OK if you're a Republican - based on all of the hypocritical crap they've lodged at the country over the years. One for our side wouldn't really upset that balance.

What matters is getting the policy right. I believe Senate appointments that last for years, as we saw this year in New York and Illinois and Colorado and Delaware, are generally bad for democracy. I think a quick, or relatively quick, special election, within 4-5 months, while appointing a caretaker to represent the state in the interim, is probably a decent enough compromise. I wish all states would adopt such a measure.

What will be far more interesting is to see who runs for the seat. In addition to practically the entire Massachusetts delegation in the House (save Barney Frank, who probably has enough power where he sits already), you have former Rep. Joe Kennedy II, or even Kennedy's widow Vickie. Most of the members of Congress have been hoarding money while waiting for this opportunity, 25 years in the making, for a statewide Senate run. Marty Meehan, who left Congress last year to run Lowell University, has almost $5 million in his campaign account.

Yes, We're Going To Politicize Ted Kennedy's Death.

I'm hearing a lot of whining on the right about the wall-to-wall coverage of Ted Kennedy's death and his politics, and how it's being "politicized". They're particularly concerned that Democrats might use Kennedy's death to push their health care reform package forward.

On the first point, those of us who sat through weeklong tributes to Ronald Reagan, Gerald Ford - heck, even Jerry Falwell! - are pretty amused at this complaint. If nothing else, Ted Kennedy spent 46 years in the world's most deliberative body and has his name on over 300 pieces of major legislation. Celebrity politician deaths are practically the only time we hear anything substantive about political ideology and political positions, and there are plenty of living Republicans who will go gently into that good night someday, so it seems to me this will even out at some point. A fairly important American died. We'll get back to some guy with a sign at a town hall meeting tomorrow.

On the second point, it's similarly amusing that anyone in either party would whine and complain about events becoming "politicized." Another word for it is "the normal rhetorical connections human beings make to advance their policies." It's been done by approximately every human being in all of history. And it actually should be that way. Aimai puts this about as well as it can be put:

It's our own little dance of death. Anyone remember the fake outcry at the Wellstone Memorial's political tone? If you missed it, or can't remember, you can read all about it here. Its one of the things that really politicized Franken, and in the linked essay he draws the connection between the way the right wing treated the outpouring of grief and political activism around Wellstone's death to the way they treated Coretta Scott King's funeral. In both cases the left was lectured in how we are to understand the lives of our own members and we were ordered not to celebrate those lives, not to take up the banner of their causes, but to mourn quietly, secretly, almost shamefacedly. But funerals and memorials aren't about something quiet, private, shameful. Death and Politics are both important parts of life. Funerals and memorials are places where we gather to be together and to pursue communal goals. We mourn, but we celebrate. We gather together to remember, and to plan to leap forward.

In America, as around the world there is a natural logic to the political and social use of the funeral. The end of one life is not the end of that person's struggle. Sometimes its the key inflection point, the moment that the solitary struggle becomes public, or the moment that the lone voice, though stilled, is taken up. This is as true for the famous (see e.g. MLK, Malcolm X, JFK, BK, Ninoy Aquino, etc..etc...etc...) as it can be for the lowly member of the crowd--(Neda Soltan).

As inevitable as the use of the funeral, or the memorial, by partisans is the attempt to repress the funeral or the memorial by the forces of reaction. Wherever funerals are an important social setting--a safe place for people to turn out, grieve, communicate, and organize there will be attempts from above or below to prevent any mobilization around the body, or the cause. In Iran, to give just one example, the state decides who is a "martyr" and whose death will be publicly solemnized, and it has for years interfered with families trying to publicize or socialize the deaths of their loved ones if those deaths looked like they would cause trouble for the government. The recent death of Neda was one such occasion. In the US, of course, we have struggled for years over who owns or appropriates public deaths like those of the 9/11 victims, the Katrina dead, and our soldiers.

Funny, I seem to remember plenty of Republicans waving the bloody shirt and using the death of Neda to serve their political ends. And I remember walking back from a night of the DNC in Denver - site of Ted Kennedy's last major speech - to anti-abortion conservatives holding up pictures of dead fetuses trying to compel me to change my mind on a women's right to choose. Death has been used as a weapon by conservatives for many, many years. "Death panels," anyone?

It is perfectly normal in any society for heroes to be lauded in death and for people who admired them to honor their memory by endeavoring to secure their goals. If I die, I'd want others to politicize it by taking up the causes I favor and working to pass them. Most people would call that tribute and not an insult.

So, in the event of my passing, I want it to be clear these are my wishes:

1) Please honor me by continuing to fight for the liberal causes I held dear.
2) Explicitly state in any obituaries, memorial services, etc. that what I would have wanted was to keep the fight going
3) Impassioned speeches about the fight ahead for progressivism are especially welcome
4) Indeed, the only way to honor my memory is to double down and fight for a better world
5) Conservatives who don’t like this should shut the fuck up.

Similarly, I don't think conservatives have to necessarily stop their advocacy just because of the death of a popular opponent. It's a nice sentiment of respect, but I don't think anyone really considers it sincere. Liberals should draw inspiration from their heroes just as conservatives draw inspiration from theirs. And if each side is comfortable in their ideas, there should be no reason to censor them in the face of an untimely loss from their adversaries. We don't need loss to remind us of our goals, but it tends to put things in perspective and serve as a focal point for them. I'm assuming that leaders would want it that way.

What set Ted Kennedy apart was not his liberal scorecard or how he lined up on this issue or that issue - there are plenty of liberals who have come and gone through the Senate - but how he set his ideology in specific moral terms. Few others were willing to advocate on moral grounds for, say, the right to a living wage, or quality health care for all, or civil rights regardless of race or creed, color or class, or physical disability. He spoke not to the head but to the heart. And when someone with that worldview dies, it's perfectly natural to react in the same moral terms - to honor the legacy through carrying out his many causes, by living up to his ideal. It's how we repay the debt of a man who put himself on the line for the less fortunate.

And we shouldn't apologize for it.

Biden On Kennedy

I just read Joe Biden's tribute to Ted Kennedy, though I haven't seen the video. Biden and Kennedy shared many similarities, though I don't think even the Vice President would ask for the comparison. Both reached the Senate at the minimum required age of 30, and both spent a lifetime there. Both had moments of incredible tragedy, the death of loved ones, and moments of deep regret and wonder if they could carry on. And both worked their way through them, in their own ways. Practically every politician has released a statement today on Kennedy's passing, referring alternately to their privilege of working with him in the Senate, the long list of accomplishments, or how we must honor his memory by passing comprehensive health care reform. Biden talked about his friend, confidant, counselor and inspiration. I'm not much for speechifying, and this one includes some of Biden's signature tics - the word "literally" appears about 8 times - but this is a great statement, and an intensely personal one.

I've added it below.

Teddy spent a lifetime working for a fair and more just America. And for 36 years, I had the privilege of going to work every day and literally, not figuratively sitting next to him, and being witness to history. Every single day the Senate was in session, I sat with him on the Senate floor in the same aisle. I sat with him on the Judiciary Committee next -- physically next to him. And I sat with him in the caucuses. And it was in that process, every day I was with him -- and this is going to sound strange -- but he restored my sense of idealism and my faith in the possibilities of what this country could do.

He and I were talking after his diagnosis. And I said, I think you're the only other person I've met, who like me, is more optimistic, more enthusiastic, more idealistic, sees greater possibilities after 36 years than when we were elected. He was 30 years-old when he was elected; I was 29 years-old. And you'd think that would be the peak of our idealism. But I genuinely feel more optimistic about the prospect for my country today than I did -- I have been any time in my life.

And it was infectious when you were with him. You could see it, those of you who knew him and those of you who didn't know him. You could just see it in the nature of his debate, in the nature of his embrace, in the nature of how he every single day attacked these problems. And, you know, he was never defeatist. He never was petty -- never was petty. He was never small. And in the process of his doing, he made everybody he worked with bigger -- both his adversaries as well as his allies.

Don't you find it remarkable that one of the most partisan, liberal men in the last century serving in the Senate had so many of his -- so many of his foes embracing him, because they know he made them bigger, he made them more graceful by the way in which he conducted himself.

You know, he changed the circumstances of tens of millions of Americans -- in the literal sense, literally -- literally changed the circumstances. He changed also another aspect of it as I observed about him -- he changed not only the physical circumstance, he changed how they looked at themselves and how they looked at one another. That's a remarkable, remarkable contribution for any man or woman to make. And for the hundreds, if not thousands, of us who got to know him personally, he actually -- how can I say it -- he altered our lives as well.

Through the grace of God and accident of history I was privileged to be one of those people and every important event in my adult life -- as I look back this morning and talking to Vicki -- every single one, he was there. He was there to encourage, to counsel, to be empathetic, to lift up. In 1972 I was a 29 year old kid with three weeks left to go in a campaign, him showing up at the Delaware Armory in the middle of what we called Little Italy -- who had never voted nationally by a Democrat -- I won by 3,100 votes and got 85 percent of the vote in that district, or something to that effect. I literally would not be standing here were it not for Teddy Kennedy -- not figuratively, this is not hyperbole -- literally.

He was there -- he stood with me when my wife and daughter were killed in an accident. He was on the phone with me literally every day in the hospital, my two children were attempting, and, God willing, thankfully survived very serious injuries. I'd turn around and there would be some specialist from Massachusetts, a doc I never even asked for, literally sitting in the room with me.

You know, it's not just me that he affected like that -- it's hundreds upon hundreds of people. I was talking to Vicki this morning and she said -- she said, "He was ready to go, Joe, but we were not ready to let him go."

He's left a great void in our public life and a hole in the hearts of millions of Americans and hundreds of us who were affected by his personal touch throughout our lives. People like me, who came to rely on him. He was kind of like an anchor. And unlike many important people in my 38 years I've had the privilege of knowing, the unique thing about Teddy was it was never about him. It was always about you. It was never about him. It was people I admire, great women and men, at the end of the day gets down to being about them. With Teddy it was never about him.

Well, today we lost a truly remarkable man. To paraphrase Shakespeare: I don't think we shall ever see his like again. I think the legacy he left is not just in the landmark legislation he passed, but in how he helped people look at themselves and look at one another.

I apologize for us not being able to go into more detail about the energy bill, but I just think for me, at least, it was inappropriate today. And I'm sure there will be much more that will be said about my friend and your friend, but -- he changed the political landscape for almost half a century. I just hope -- we say blithely, you know, we'll remember what we did. I just hope we'll remember how he treated other people and how he made other people look at themselves and look at one another. That will be the truly fundamental, unifying legacy of Teddy Kennedy's life if that happens -- and it will for a while, at least in the Senate.

Mr. Secretary, you and your staff are doing an incredible job. I look forward to coming back at a happier moment when you are announcing even more consequential progress toward putting us back in a position where once again can control our own economic destiny.

Thank you all very, very much. (Applause.)

UPDATE: TedKennedy.org is up, with all sorts of speeches from the archives and tributes.

The Five Month Delay

Maybe it's crass to talk about this, but Ted Kennedy's death leaves a hole in the US Senate. A figurative one, of course, one that won't likely be filled. But there's also a literal hole, one that brings the number of Senators down to 99, with 59 on the Democratic side. Because of the rules of the state of Massachusetts, there will be no replacement for the Senate seat until January 2010.

Politico reported this morning, "[I]t appears for now that Massachusetts will be without a second senator until a special election can be held early next year.... Under the 2004 law, the governor must set a special election to fill a vacant Senate seat between 145 and 160 days after the vacancy occurs - meaning, in this case, that a special election would be held in the second half of January 2010."

All of this is of the utmost importance, of course, because of a possible vote this year on health care reform, a fight Kennedy described as "the cause of my life." The prospects of overcoming Republican obstructionism were difficult enough, but with 59 votes in the Democratic caucus, defeating a GOP filibuster may prove impossible, which in turn makes the reconciliation option more appealing.

Of course, there are certain elements that cannot be achieved through reconciliation, namely the insurance regulatory reforms, among other things. And I simply don't see any Republican watching so much of the bill passed through a 50-vote process and then invoking cloture. Unless Olympia Snowe gets religion, all Senators in the GOP will obstruct and obstruct.

I know that Kennedy's death is seen by some as a rallying cry to pass health care reform. I fear it's as doomed as ever, at least until we get a replacement in Massachusetts.

(And who will that replacement be? I'd expect the entire Massachusetts delegation in the House to run for the seat.)

...Robert Byrd has called for the health care reform bill to be named after Sen. Kennedy. That tribute will only be fitting if it passes.

"In his honor and as a tribute to his commitment to his ideals, let us stop the shouting and name calling and have a civilized debate on health care reform which I hope, when legislation has been signed into law, will bear his name for his commitment to insuring the health of every American."

...Talk of Massachusetts potentially changing the law to allow a caretaker Senator to hold office for five months, and even to give that position to former Governor Michael Dukakis. I'm actually pessimistic that this will happen. Deval Patrick is unpopular, and this will look very partisan, regardless of the outpouring of sympathy for Kennedy's death. Patrick will have a tough re-election fight coming up and may not want to deal with an appointment controversy.

Ted Kennedy And Policy

Ted Kennedy had a colorful life, with equal mixtures of success and mistake, joy and tragedy, and grew into the persona of the Liberal Lion of the US Senate. But more than anything, over his 47 years in the Senate he was a man of accomplishments and causes. He got things done. Here's a sample from the New York Times obit.

Freed at last of the expectation that he should and would seek the White House, Mr. Kennedy devoted himself fully to his day job in the Senate. He led the fight for the 18-year-old vote, the abolition of the draft, deregulation of the airline and trucking industries, and the post-Watergate campaign finance legislation. He was deeply involved in renewals of the Voting Rights Act and the Fair Housing law of 1968. He helped establish the Occupational Safety and Health Administration. He built federal support for community health care centers, increased cancer research financing and helped create the Meals on Wheels program. He was a major proponent of a health and nutrition program for pregnant women and infants [...]

His most notable focus was civil rights, “still the unfinished business of America,” he often said. In 1982, he led a successful fight to defeat the Reagan administration’s effort to weaken the Voting Rights Act.

In one of those bipartisan alliances that were hallmarks of his legislative successes, Mr. Kennedy worked with Senator Bob Dole, Republican of Kansas, to secure passage of the voting rights measure, and Mr. Dole got most of the credit.

Perhaps his greatest success on civil rights came in 1990 with passage of the Americans with Disabilities Act, which required employers and public facilities to make “reasonable accommodation” for the disabled. When the law was finally passed, Mr. Kennedy and others told how their views on the bill had been shaped by having relatives with disabilities. Mr. Kennedy cited his mentally disabled sister, Rosemary, and his son who had lost a leg to cancer.

Mr. Kennedy was one of Bill and Hillary Clinton’s strongest allies in their failed 1994 effort to enact national health insurance, a measure the senator had been pushing, in one form or another, since 1969.

But he kept pushing incremental reforms, and in 1997, teaming with Senator Hatch, Mr. Kennedy helped enact a landmark health care program for children in low-income families, a program now known as the State Children’s Health Insurance Program, or S-Chip.

He led efforts to increase aid for higher education and win passage of Mr. Bush’s No Child Left Behind Act. He pushed for increases in the federal minimum wage. He helped win enactment of the Medicare prescription drug benefit, one of the largest expansions of government health aid ever.

The concession speech at the 1980 Democratic National Convention is remembered for those final words, about how the cause lives on and the dream shall never die. But he also laid out his first principles, the causes that animated him, not only in the campaign but throughout his Senate career.

We are the Party -- We are the Party of the New Freedom, the New Deal, and the New Frontier. We have always been the Party of hope. So this year let us offer new hope, new hope to an America uncertain about the present, but unsurpassed in its potential for the future.

To all those who are idle in the cities and industries of America let us provide new hope for the dignity of useful work. Democrats have always believed that a basic civil right of all Americans is that their right to earn their own way. The Party of the people must always be the Party of full employment.

To all those who doubt the future of our economy, let us provide new hope for the reindustrialization of America. And let our vision reach beyond the next election or the next year to a new generation of prosperity. If we could rebuild Germany and Japan after World War II, then surely we can reindustrialize our own nation and revive our inner cities in the 1980's.

To all those who work hard for a living wage let us provide new hope that their price of their employment shall not be an unsafe workplace and a death at an earlier age.

To all those who inhabit our land from California to the New York Island, from the Redwood Forest to the Gulf stream waters, let us provide new hope that prosperity shall not be purchased by poisoning the air, the rivers, and the natural resources that are the greatest gift of this continent. We must insist that our children and our grandchildren shall inherit a land which they can truly call America the beautiful.

To all those who see the worth of their work and their savings taken by inflation, let us offer new hope for a stable economy. We must meet the pressures of the present by invoking the full power of government to master increasing prices. In candor, we must say that the Federal budget can be balanced only by policies that bring us to a balanced prosperity of full employment and price restraint.

And to all those overburdened by an unfair tax structure, let us provide new hope for real tax reform. Instead of shutting down classrooms, let us shut off tax shelters. Instead of cutting out school lunches, let us cut off tax subsidies for expensive business lunches that are nothing more than food stamps for the rich [...]

Finally, we cannot have a fair prosperity in isolation from a fair society. So I will continue to stand for a national health insurance. We must -- We must not surrender -- We must not surrender to the relentless medical inflation that can bankrupt almost anyone and that may soon break the budgets of government at every level. Let us insist on real controls over what doctors and hospitals can charge, and let us resolve that the state of a family's health shall never depend on the size of a family's wealth.

The President, the Vice President, the members of Congress have a medical plan that meets their needs in full, and whenever senators and representatives catch a little cold, the Capitol physician will see them immediately, treat them promptly, fill a prescription on the spot. We do not get a bill even if we ask for it, and when do you think was the last time a member of Congress asked for a bill from the Federal Government? And I say again, as I have before, if health insurance is good enough for the President, the Vice President, the Congress of the United States, then it's good enough for you and every family in America.

This speech came at the edge of the Reagan Revolution, and maybe if Kennedy ran a better campaign, maybe if this speech were a model for how he attacked the Reagan agenda, maybe, just maybe there would have been no Reagan revolution. But the Senate would have felt a great loss, and the legislation he passed would have had nobody to carry it.

Kennedy was a legend because of the policy that bears his name. As we try once again to realize the cause of his life, that above all should be remembered.

...The Immigration and Nationality Act of 1965 transformed this country, allowing it to live up to the ideals inscribed on Ellis Island, Emma Lazarus' poem The New Colossus, "Give me your tired, your poor/ your huddled masses yearning to breathe free/ the wretched refuse of your teeming shore/ Send these, the homeless, tempest-tost to me/
I lift my lamp beside the golden door!" The country is better for it, regardless of the insular fear of the xenophobes.

And The Dream Will Never Die

Ted Kennedy dies at the age of 77.

His 2008 DNC speech, from one year ago today.

This is awful, awful news.

...the cause of his life was to have quality and affordable health care for all of our citizens. He passed before he could see the bill signing.

Statement from the family:

“Edward M. Kennedy – the husband, father, grandfather, brother and uncle we loved so deeply – died late Tuesday night at home in Hyannis Port. We’ve lost the irreplaceable center of our family and joyous light in our lives, but the inspiration of his faith, optimism, and perseverance will live on in our hearts forever. We thank everyone who gave him care and support over this last year, and everyone who stood with him for so many years in his tireless march for progress toward justice, fairness and opportunity for all. He loved this country and devoted his life to serving it. He always believed that our best days were still ahead, but it’s hard to imagine any of them without him.”

...Bob Shrum, who actually wrote the 1980 DNC concession speech, has a great rememberance of Kennedy's surprise speech last year in Denver. I wasn't in the arena, but I was in the Daily Kos' Big Tent, and the response was deafening. Kennedy came out during the California primary to stump for Barack Obama in a Latino section near East LA, and I planned to make it but ended up bailing.

Idiot, me.

I believe today is the first day without a Kennedy in the US Senate since 1953.

The Limits Of Comity

Even a "split-the-bill" strategy would require 60 votes for cloture on the more non-controversial items of health care reform. And as I noted, Republicans like Jon Kyl are objectively pro-discrimination against people with pre-existing conditions. Furthermore, expecting GOPers to go along with certain health insurance reform items after getting cut out of other elements of the bill is a fantasy. So those 60 votes will have to come from Democrats.

And all Democrats ought to stick with the wishes of their party rather than join a Republican filibuster. But there's one very sad detail - Ted Kennedy is fighting cancer. He's very sick. He didn't attend his sister's funeral. And while I believe he'd get wheeled in on a gurney if it meant the passage of his life's work, this letter shows that he's preparing for every eventuality. And here he runs up against Massachusetts state law.

A cancer-stricken Sen. Edward M. Kennedy has asked Massachusetts leaders to change state law to allow a speedy replacement of him in the Senate, fearing a months-long open seat will deny Democrats a crucial vote on President Barack Obama's health care overhaul.

In a note to Gov. Deval Patrick and other state leaders, Kennedy wrote "it is vital for this commonwealth to have two voices speaking for the needs of its citizens and two votes in the Senate during the approximately five months between a vacancy and an election." [...]

Kennedy's letter acknowledges the state changed its succession law in 2004 to require a special election within five months to fill any vacancy. At the time, legislative Democrats — with a wide majority in both chambers — were concerned because then-Republican Gov. Mitt Romney had the power to directly fill any vacancy created as Democratic Sen. John Kerry ran for president.

I'm a bit all over the map on this. I actually think the Senate appointment process for vacancies is anti-democratic and wrong. But a five-month open seat does not serve the interests of Massachusetts residents either. Also, Kennedy, mindful of his cancer fight, could have resigned months ago. It's very sad that such choices have to be made given the process we have.

The real problem, of course, is that we have a system where everybody knows Ted Kennedy's position on health care - his committee staff helped write the Senate HELP bill - and he could easily indicate his position on elements of the bill from a hospital bed or through a staffer, but his specific presence on the Senate floor is required. The Senate is supposed to be about "relationships" and "comity" but the members cannot allow a colleague of 40-plus years the ability to make his preferences known given his medical condition. Ezra Klein adds:

That is to say, where Kennedy’s great friend Orrin Hatch would have voted to uphold a filibuster, now he will vote to shut it down, as that’s how the vote would have gone if Ted Kennedy were still alive, and it is neither decent nor small-d democratic to doom health care because the bill’s greatest advocate contracted incurable brain cancer.

Such a trade would not only be a grand show of respect for Kennedy’s life work, but it would uphold the outcome that Americans chose when they voted 60 Democrats into office in 2008. Conversely, if not one Republican can be found who feels enough loyalty to Kennedy to make sure that his death doesn’t kill the work of his life, then what are all those personal relationships and all that gentility really worth?

But Hatch was specifically asked this last night, and he ignored the question, saying that "The Democrats should be able to pass it. They have overwhelming majorities in the House, and they have 60 solid votes in the Senate." But they don't. Ted Kennedy is sick. He's barred from voting. And Orrin Hatch, supposedly this great friend of his, plays dumb about it. I guess blood - or the bloody shirt of partisanship - is thicker than water.

It shouldn't come to this at all - the filibuster was not designed to automatically require 60 votes on every piece of legislation, that's a recent development. But the next time you hear some member of the Senate club go on and on about "the great civility of this chamber" and "working with my esteemed colleagues on the other side," keep in mind that it's all a bunch of horseshit.

A Small Victory

The F-22 fighter is built in 44 states. The military contractors who build it and provide supplies spend many millions in lobby costs. Armed Services Committee appropriators in particular get slathered in special interest money and reward their contributors with as many contracts as possible. The overall trajectory of military spending since World War II is that the military part of the budget is magic and we can spend whatever we want on it. As a result, we spend more on the weapons and tools of war than every other country on Earth, combined.

So it's not every day that a major weapons program gets phased out through the appropriations process. It happened today, as 58 Senators voted to cancel additional spending on the F-22 fighter, a plane which the Pentagon doesn't want, which the Air Force doesn't want, which hasn't flown a single mission in Iraq and Afghanistan, and which has been found in tests to be vulnerable to rain.

It was a parochial vote that had more to do with whether a Senator's state builds major portions of the F-22 than anything else. And it will not signal any kind of near-term sea change in the military budget, which will increase this year. A lot of the F-22 money will just re-route into other fighters like the F-35 and unmanned aerial drones. But there's a symbolic significance here. The President and the Secretary of Defense took on the military-industrial complex by threatening to veto the entire defense bill if this funding stayed intact, and in this case they won. If we're ever going to break their stranglehold on the process, we have to win this kind of vote. Over time, we may even have a President that says "hey, it's kind of insane to spend more on the military than every other country combined" - don't laugh, it could happen - and by showing the ability to cancel weapons projects like this, it will be easier for that future President to maneuver. And I particularly like some of the language Obama used in his comments about this, saying that our budget is a zero-sum game and our "citizens lose" if more money goes to unnecessary weapons systems. With all the talk from the fiscal scolds, there is an opportunity to channel that toward a military budget full of bloat and waste.

It's a good first step, nothing more. But showing we can get by without weapons systems designed for the Cold War is important.

...some additional good news here. Though he voted against stripping the funding, Robert Byrd took a vote on the bill. We've been hearing with respect to health care that Democrats really only have 58 Senators, due to two ill members. Byrd is now back and voting. And you cannot tell me that wild horses could keep Ted Kennedy from a health care vote. The Democrats will have 60 votes. What they do with them is their choice.

Slightly Less Queasy On Health Care

The House health care bill has been received favorably by advocates and, more importantly, the President:

Today, the Chairs of several Committees in the House of Representatives unveiled their health care reform proposal. This proposal would improve the affordability, availability, and quality of health care and represents a major step toward the our goal of fixing what is broken about health care while building on what works.

Jon Cohn has more. At some point, Obama needs to stop giving favorable nods at the Congress and step hard into this debate. But I feel better about this today than yesterday. Doctors are nodding toward working with Obama, and they are the most respected constituency on this issue. Just getting the AMA to back off and not follow the Chamber of Commerce, wackjob Betsy McCaughey (it's amazing she's running the same shtick from 1993 all over again) and other right-wing groups who want to keep the status quo would be positive.

Igor Volsky has a great comparison of the three bills - the House tri-committee bill, the Senate Finance Committee and the Senate HELP Committee. If we can get it through HELP, two of them will include a public option. Basically it comes down to a freshman Democratic Senator fulfilling Ted Kennedy's lifelong dream:

With Ted Kennedy too sick to come down to DC and make the committee vote, Democrats will need every Senator on the HELP committee to produce a strong bill, a bill that fights for what Teddy Kennedy has been fighting for his entire life. The last holdout is Kay Hagan, who represents a state (NC) that is one of the worst in the country in terms of percent of people without health insurance. The insurance companies are lobbying Hagan against the bill, because they don't like having to compete with a public option. My simple question is this: Teddy Kennedy is too sick to be there, Senator Hagan, so he is relying on your vote for the issue that he has fought for passionately his entire life. Will you betray him to help the insurance companies? You need to make up your mind now.

Sounds like a simple question for Kay Hagan.

Trigger'd

We're nearing a real fulcrum point in the health care debate. The sensible centrists and the corporate whores are trying to sink the public option by instead suggesting that it only be achieved through a "trigger" that would be pulled if the insurers didn't provide a base level of care and access.

As a starting point for his bill, Mr. Kennedy favors a public plan that looks like Medicare, the government-run program for older Americans created in 1965, when he was a young senator.

By contrast, Senator Max Baucus, the Montana Democrat who is chairman of the Finance Committee, has been working for months with the panel’s senior Republican, Charles E. Grassley of Iowa, in the hope of forging a bipartisan bill, which would probably play down the option of a public plan.

Mr. Grassley opposes creation of a new government insurance program and says “we cannot afford the public health plan we have already,” referring to Medicare.

President Obama has championed a public plan, saying it would help “keep the private sector honest,” though he has indicated he will be flexible on the details.

House Democratic leaders, including three committee chairmen drafting the House bill, are close to Senator Kennedy’s position.

Democrats on the Finance Committee said Mr. Baucus was exploring a possible compromise. Under this proposal, the public plan would be created only if private insurance companies had not made meaningful, affordable coverage available to all Americans within several years.

Senate Democrats said they believed that Mr. Baucus might settle for this “fallback plan,” which could win some support on both sides of his committee, from people like Senator Ron Wyden of Oregon, a Democrat, and Senator Olympia J. Snowe of Maine, a Republican.

Obama met with both Kennedy and Baucus today before leaving for the Middle East. (UPDATE: Dodd sat in for Kennedy)

A trigger mechanism is simply absurd. The insurers have had decades to provide decent coverage and have demurred every time. They have shown themselves to be untrustworthy that entire time, including just last month, when they backpedaled on the cost controls they vowed to offer. Mike Lux, who has seen these battles up close, senses that this is the big proxy fight right now.

The insurance lobby has had multiple tactics for stopping the public option idea, which they despise because they know if regular folks have choice to go to a public option, insurance companies won't have the same ability to treat their customers like garbage when they get sick. The first tactic was just to try to kill the public option outright, and the good news is that they appear to have failed at that. This so-called trigger proposal is the second tactic: the idea is to write a "trigger" that will allow for a public option only under certain conditions, but write the legislation so that those conditions would never get met in the real world. It's a classic DC tactic, right up there with calling for a commission to study something. Olympia Snowe is carrying the insurance industry water on their trigger proposal, proposing triggers that would only get tripped in some fairyland none of us have ever visited.

The great thing for the insurance companies in a tactic like this is that it gives "centrist" Senators (centrist in Washington, DC usually means those who have taken massive amounts of campaign contributions from the affected industry) an excuse to help the insurance industry while looking like they are open to the public option that their constituents have been demanding.

Barack Obama and Democrats in Congress have gotten some good things done so far, and are building real momentum in getting us moving in the right direction on health care. But if conservative Democrats force the adoption of the trigger, it will destroy Democratic unity and doom health care reform, because progressives will start attacking Democrats rather than insurance companies. We really are at a critical moment.

Baucus himself stayed away from dozens of town hall meetings on health care out in Montana in the last week, mainly because constituents were openly hostile to his vision of sham reform. Most everyone at these meetings argued in favor of single-payer, and Baucus obviously has no interest in that. But adding this trigger would shut off the only way for a single-payer system to flourish, through a robust public option that can be scaled up. Lux describes it perfectly.

The Progressive Caucus in the House has really stepped up, declaring their votes on health care only available in the event of a public option. But they have not determined what form that public option will take. The public needs to demand action without Washington compromises. This is worth calling your Congresscritter about.

...I remain convinced that health care will really hit the rocks when we start determining how to pay for reform, but I'll leave that for a later post.

...The Maryland Women's Coalition for Health Reform is calling on AARP to support a public plan. Advocacy groups like this would be vital in this fight. It's yet another pressure point.

HELP's Health Care Bill

Ted Kennedy's committee will try and influence the debate on health care with the release of their comprehensive legislation, which includes some pretty solid proposals.

Sen. Edward M. Kennedy (D-Mass.) is circulating the outlines of sweeping health-care legislation that would require every American to have insurance and would mandate that employers contribute to workers' coverage.

The plan in the summary document, provided by two Democrats who do not work for Kennedy, closely resembles extensive changes enacted in the senator's home state three years ago.

In many respects it adopts the most liberal approaches to health reform being discussed in Washington. Kennedy, for example, embraces a proposal to create a government-sponsored insurance program to compete directly with existing private insurance plans, according to one senior adviser who was not authorized to talk to reporters.

The draft summary also calls for opening Medicaid to those whose incomes are 500 percent of the federal poverty level, or $110,250 a year for a family of four.

If you're looking for the left-most counterpart to whatever happens in Max Baucus' Senate Finance Committee, this is it. MassCare is doing decently, but not getting the job done on its subsidies because a small state has no chance to drive down costs in any meaningful way. The cost controls - and how to pay for the subsidies - are the two keys here.

But it's notable that Kennedy includes a robust public option. Howard Dean today painted Chuck Schumer's compromise public option as the limits of where he would allow the conversation to go.

As a sticking point, he's insistent that any reform effort include a public plan. The public entity would provide insurance that, by avoiding the demands of the private market, could help control cost and expand coverage. Cognizant that such a proposal will engender stiff -- if not universal -- opposition from Republicans in the Senate, Dean said he had no objection to Schumer's modified version.

"If we can get Schumer's proposal out of the Senate, I think that would be a very good thing," he told the Huffington Post. "It can't be any weaker than that though. We don't want what would be a fake public option."

As one of the leading progressive voices on health care reform, Dean's endorsement of the Schumer proposal is no small thing. The New York Democrat has envisioned a plan for insurance coverage that, while run on public funds, is self-sustaining and subject to private market rules. Money would come from the payments and premiums of consumers. The same officials who ran the plan would be forbidden from regulating it. And a reserve fund would be set up to handle a potential influx of claims.

The stipulations, Dean said, would assuage critics without actually diminishing the public option itself.

"[Schumer's proposal] is still run by the public," he added. "But it is subjected to insurance rules that are there in order to protect the public from for-profit institutions, which is obviously not necessary if you are running your plan on the public side. Because the consumer needs the protection because of the profit-motive, but they don't need protections from a non-profit or the government. So Chuck has those things in there to level the playing field. I understand that. And I don't think we need to be doctrinaire about this. But I think, the bottom line is a public option is run by the public and financed by the public, it is not administered by the private sector."

I'm not quite as sanguine as Dean about Schumer's public option because it would act much like a nonprofit, without getting the Medicare bargaining rates needed to drive down costs. It would represent an improvement, but only a slight one. However, framing the conversation as a choice between Schumer's version or Kennedy's, not Schumer's version or nothing, is crucial. That's the importance of the Kennedy bill.

The Piercing Problem Of Funding Health Care

The Administration has largely stayed out of the details of the health care debate, preferring to forward a list of "priorities" and let Congress sort out the details. Max Baucus has set to work at the Senate Finance Committee, trying to build his legacy by creating a fundamental change in policy, building a system that "doesn't exist, really" to bend the cost curve, increase access and improve quality. And Ted Kennedy's Health, Education, Labor and Pensions (HELP) Committee will release a bipartisan bill on Friday. While the fate of the public option is unclear, advocacy groups have attached themselves to that element of the policy like Rottweilers and have actually made some progress. So things are moving along.

Except that nobody really has a clear picture of how to pay for this reform, the single biggest issue lawmakers face. People can announce support for reform, but without the dollars, it will wither on the vine. Cost projections of up to $150 billion per year need to be met with revenue, and the troubles with maintaining costs in Massachusetts' universal health care reform, which is an analogue to the national program, show how hard it is to even get the numbers down to that level. The supposed vows of the health care industry to do away with $2 trillion in costs is hopeful, but may run into legal antitrust issues involving collusion to hold down those costs, and anyway the industry has softened their tone in recent weeks, claiming that they were just "suggesting" the cost comedown.

Why does health care cost so much in America? Atul Gawande has an amazing piece in the New Yorker looking at this very problem. Often similar cities in the same state have wild variances in costs. Gawande looks at McAllen, Texas, with some of the highest costs for health care in the country, despite similar cities like El Paso having the same vital statistics and much less of a cost burden. Why? Here's a great excerpt:

One night, I went to dinner with six McAllen doctors. All were what you would call bread-and-butter physicians: busy, full-time, private-practice doctors who work from seven in the morning to seven at night and sometimes later, their waiting rooms teeming and their desks stacked with medical charts to review.

Some were dubious when I told them that McAllen was the country’s most expensive place for health care. I gave them the spending data from Medicare. In 1992, in the McAllen market, the average cost per Medicare enrollee was $4,891, almost exactly the national average. But since then, year after year, McAllen’s health costs have grown faster than any other market in the country, ultimately soaring by more than ten thousand dollars per person.

“Maybe the service is better here,” the cardiologist suggested. People can be seen faster and get their tests more readily, he said.

Others were skeptical. “I don’t think that explains the costs he’s talking about,” the general surgeon said.

“It’s malpractice,” a family physician who had practiced here for thirty-three years said.

“McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.

That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down?

“Practically to zero,” the cardiologist admitted.

“Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.

The surgeon came to McAllen in the mid-nineties, and since then, he said, “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’"

Essentially, doctors can cut corners by offering up batches of tests and spending way over what they need to provide care. Of course, many patients would decry having a test being held from them. It's a real conundrum, and having some comparative effectiveness research, so we know which treatments work better and why, would help, but still you would see a lot of these outcries. And doctors have a financial interest in more care. We have an overtreated society, but in many ways we want it that way. And more does not equal better.

Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care.

In a 2003 study, another Dartmouth team, led by the internist Elliott Fisher, examined the treatment received by a million elderly Americans diagnosed with colon or rectal cancer, a hip fracture, or a heart attack. They found that patients in higher-spending regions received sixty per cent more care than elsewhere. They got more frequent tests and procedures, more visits with specialists, and more frequent admission to hospitals. Yet they did no better than other patients, whether this was measured in terms of survival, their ability to function, or satisfaction with the care they received. If anything, they seemed to do worse.

That’s because nothing in medicine is without risks. Complications can arise from hospital stays, medications, procedures, and tests, and when these things are of marginal value the harm can be greater than the benefits. In recent years, we doctors have markedly increased the number of operations we do, for instance. In 2006, doctors performed at least sixty million surgical procedures, one for every five Americans. No other country does anything like as many operations on its citizens. Are we better off for it? No one knows for sure, but it seems highly unlikely. After all, some hundred thousand people die each year from complications of surgery—far more than die in car crashes.

You can find a similar conundrum in how to actually pay for care. Employer-based insurance is an historical accident from the 1940s aimed at avoiding wage controls. And the deduction to employers for health care costs a tremendous amount of money for the government. Yet try to touch it, and public employee unions and I assume workers with health care from their employers will attack. Ezra makes an important point:

Wyden, after all, is a liberal Democrat. AFSCME is a left-leaning union. Both are desperate for health reform. But AFSCME is spending its time attacking Wyden. Why? Because Wyden wants to replace the employer tax exclusion (I told you that thing was important!) with a progressive tax deduction that all Americans, not just those with good employer benefits, would get. That means the poorest among us would get slightly more and AFSCME's members might get slightly less.

But AFSCME isn't really attacking Wyden. The bill Wyden co-sponsored -- the Wyden-Bennett Healthy Americans Act -- has fallen out of the conversation. The energy right now is in Sen. Max Baucus's (D-Mont.) process, and maybe Sen. Ted Kennedy's (D-Mass.) coming proposal. Everyone expects the final legislation out of the Senate to include a cap of some kind on the employer tax exclusion. And that's really what AFSCME is going after here. They're hitting Wyden to demonstrate their willingness to attack anyone who touches their tax benefit. This is less an assault on Wyden than a warning to Wyden's colleagues.

Reasonable people can disagree on whether capping or eliminating the employer tax deduction is a good idea. I tend to go for capping. But reasonable people can disagree on ALL funding streams for health care. And at the end of the day, when everyone disagrees, nothing happens and health care reform dies.

Hopefully, this is just the normal course of sausage-making. But I'm concerned that meaningful reform and the protective interests of advocacy groups - or the protective interests of people who want to keep what they have - work at cross purposes.

Excellent

Ted Kennedy's coming back to the US Senate.

Sen. Edward Kennedy’s brain cancer is in remission and he is expected back in the Senate after the Memorial Day recess to spearhead healthcare reform, according to Democratic colleagues.

Senate Majority Leader Harry Reid (D-Nev.) said Tuesday that he spoke with Kennedy’s wife, Vicki, in the past few days and was told the 77-year-old lawmaker is “doing fine.” [...]

Kennedy, the chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee, has been mostly absent from the chamber for the past year, recovering in Florida and Massachusetts.

He is expected to lead a markup of highly anticipated health reform legislation in his first month back - one of the biggest bills of the year and a signature domestic initiative for President Obama.

Not only is it great to see Ted Kennedy back up and around, we sorely need his leadership on health care reform. We need a Ted Kennedy to balance out a Max Baucus. I'd like to see Teddy bring his moral authority to bear on these financing options for health care, for example. Right now it's sealed off - the health care system is paying for health care reform. And that might work in the short term. But when the industries involved fail to cut costs, or the numbers don't add up, someone in the room will need to talk about the need for those who use the commons the most, the wealthiest among us, to kick in. Similarly, we need someone with authority to tell the unions to back off of Democrats trying to figure out how to fund this thing, for example by capping the tax exemption on employer benefits.

That man is Ted Kennedy. And he's our best hope for really getting this done sensibly. It'll be good to see him back.