On brink of passing historic health care overhaul, Obama urges pragmatism over ideology

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Senate Democrats contemplate half a loaf

WASHINGTON — History may be calling but time’s running out to act by Christmas, so Senate Democrats are trying to come to terms with the idea they won’t get everything they want from a health care overhaul.

Should they listen to former Democratic Party chairman Howard Dean, slamming the Senate bill as an insurance industry bailout? Or should they pay attention to President Barack Obama, saying the legislation achieves most of what he wants? With each day that senators churn on, the public’s doubts about the legislation only seem to grow, polls indicate.

Obama cajoled restive Democrats on Tuesday, urging them not to lose perspective amid intense intraparty battles over government’s role and reach in health care. The public plan liberals hoped for appeared dead in the Senate, as did a Medicare buy-in scheme offered as a fallback.

“The president and vice president pointed out that you take your victories when you can and nothing prevents you from fighting on for the things you believe should have been achieved,” said Sen. Sheldon Whitehouse, D-R.I. “But why spurn a victory in hand?”

“There was frustration and angst,” Sen. Jay Rockefeller, D-W.Va., a leading liberal, said after the meeting at the White House. “Everybody has things they want, and they didn’t all get what they want and that includes me, big-time.”

But Obama got their attention, said Rockefeller, describing a health care remake to cover tens of millions now uninsured as “the biggest thing since Social Security.”

“It’s hard to ignore that,” Rockefeller said.

Sen. Mary Landrieu, D-La., a moderate who had been on the fence, said Tuesday night it’s time to pass the bill.

But Majority Leader Harry Reid, D-Nev., was still scrambling to secure the 60 votes he needs to overcome a Republican filibuster. One holdout — Connecticut independent Sen. Joe Lieberman — was coming around fast. Another — Nebraska moderate Sen. Ben Nelson — was still uncommitted, criticizing the bill’s restrictions on abortion funding as too lax, even after a private meeting with the president Tuesday.

“History will be made either way,” Senate Republican Leader Mitch McConnell of Kentucky said Wednesday. “A handful of Democrat leaders press ahead in a blind rush of frantic dealmaking to find 60 votes by Christmas; a handful of other Democrats are wondering which side they really want to be standing on when the dust settles.”

Just as unhappy with the legislation was Dean, an outspoken liberal.

Interviewed on ABC’s “Good Morning America,” the physician and former Democratic presidential candidate said the Senate bill has some good provisions, “but there has to be a line beyond which you think the bill is bad for the country.”

“This is an insurance company’s dream,” Dean said. “This is the Washington scramble, and it’s a shame.”

Obama said Democrats were “on the precipice” of victory, not breakdown.

The president said differences still remain over details but described the bill as an accomplishment for the history books.

The legislation includes “all the criteria that I laid out” in a speech to a joint session of Congress earlier in the year, he said. “It is deficit-neutral. It bends the cost curve. It covers 30 million Americans who don’t have health insurance, and it has extraordinary insurance reforms in there to make sure that we’re preventing abuse.”

The meeting followed an intense two days in which Democrats struggled — apparently successfully — to keep the legislation moving forward despite a flare-up over a proposal to expand Medicare to uninsured men and women as young as 55.

Lieberman announced Sunday he opposed the proposal, and he threatened to join Republicans in opposition if it stayed in the bill. With Democrats ready to jettison the Medicare change, “I’m going to be in a position where I can say … that I’m ready to vote for health care reform,” Lieberman said Tuesday.

That left Nebraska’s Nelson as the only known potential holdout among the 60 senators who are members of the party’s caucus, a group that includes 58 Democrats, Lieberman and Sen. Bernie Sanders, I-Vt.

The White House meeting came as Democrats awaited a final cost analysis from the Congressional Budget Office on the latest version of the bill, and the full Senate defeated an amendment to permit the importing of low-cost prescription drugs from Canada and elsewhere.

At its core, the legislation is designed to spread coverage to 30 million Americans who now lack it, impose new consumer-friendly regulations on the insurance industry and try to slow the rate of growth in health care spending. Most Americans would be required to purchase insurance, and the government would establish new insurance supermarkets called “exchanges” through which consumers could shop for policies.

Large companies would not face a requirement to cover their employees. But the government would impose charges if any of them did not do so and any of their workers qualified for federal subsidies to help them afford private coverage.

It would be financed with tax increases and Medicare cuts.

Democratic leaders mapped out a timetable that envisioned passage before Christmas — but just barely. The House approved its version of the bill earlier this fall, and final negotiations between the two chambers would follow a vote in the Senate.

Associated Press writers David Espo and Erica Werner contributed to this report.