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HEALTH REFORM: Notes from Senate HELP Markups

So many of us have gotten so immersed in aspects of the health reform conversation—costs, crowd-out, public health insurance plan, mandates—that it's easy to overlook the following:

For the first time in 15 years, a Congressional committee has taken up legislation that seeks to provide affordable health coverage for all Americans while controlling costs and improving value.

Senators on both sides of the aisle in the Senate HELP Committee acknowledge historic nature of today as they started marking up the American Health Choices Act (615-page pdf) this morning. They paid tribute to the absent Senator Edward Kennedy for his tireless work on this issue. They acknowledged the opportunity before them and the imperative for action. Then, they started the process of trying to craft legislation that could reshape and redefine health care in America.

Senator Chris Dodd, the Connecticut Democrat who has been leaading the effort on Kennedy's behalf, began by acknowledging the difficulty of the task, but he stressed, "I don't think there's an ounce of difference about the principles we are trying to achieve," and assured members that "when it comes down to it we're going to get this right."  Paraphrasing Edward Murrow, Dodd concluded: "The one excuse that history will never forgive you for is that the problem's too hard."

The Committee will reconvene at 2:30 pm and continue with opening statements. A webcast of the session is available here. The events are also being broadcast as C-Span 3 and you can follow our live play-by-play on Twitter. Here's a quick rundown of this morning's highlights:

  • Prevention and wellness: The Committee will begin the markup process looking at the Prevention and Wellness provisions in Title III of the bill. Senator Tom Harkin (D-IA)—who Kennedy deputized to help draft the provisions on prevention and public health—called it an overarching goal, and one which enjoyed strong bipartisan support. Many Republicans emphasized the importance of prevention and wellness in their opening remarks. Senator Richard Burr (R-NC) said that the focus needed to be on "keeping people healthy and well, instead of treating them when they get sick," and that a real investment had to be made in order for prevention, wellness, and disease management to work. So far 171 amendments have been submitted for the wellness and prevention provisions of the bill (there's a reason they call the Senate deliberative...) Expect the debate to revolve around issues of personal vs. communal responsibility, as well as what incentives and tools can change individual behavior, how to reward good health behavior without being too punitive to those who face health challenges.  Some of this debate is laid out nicely in this article by Roll Call's Kate Ackley (subscription required).
  • Schedules and scores: Dodd said he expected the markup to last through the end of next week. Many of the Republicans said that's too rushed. They pointed to the difficulty of marking up legislation with only a preliminary score from the CBO that did not address key portions of the bill. They also noted that the Senate Finance committee had decided to push back its markups until after the July 4 recess. Dodd assured them that the legislation would be scored and part of the reason to move forward with the markups was to actually reach compromises on those contentious issues.
  • From the department of mixed metaphors: Senator Judd Gregg likened the legislation to something you'd get if "Rube Goldberg, Ira Magaziner, and Karl Marx" got together to which Senator Barbara Mikulski replied, "Our current system is a combination of Adam Smith, Darth Vader and the Invasion of the Body Snatchers."