Health Politics

HEALTH POLITICS: Everybody's Working For The Weekend

Meredith Hughes — Fri, 20 Nov 2009 18:28:00 -0500

Or, at least, the Senate will be working this weekend. The Senate plans a rare Saturday night vote on a motion to proceed with Senate Majority Leader Harry Reid's $848 billion health care reform bill, released earlier this week. The pressure is on for Senate Democrats, who need 60 votes to ensure the bill makes it to the floor to begin debate.

Reid melded the Senate Finance and HELP committee's reform bills, but his "deep personal involvement in assembling the overhaul of the health care system," makes it "Reid's bill," writes Carl Hulse in The New York Times. If Reid successfully guides the health care reform bill through the Senate, it could be the biggest victory his career, and a huge boon for Obama and the Democratic Party, writes Hulse, but if he fails, it could mean disaster for the Democrats and an even tougher re-election battle for Reid in his home state of Nevada. Many Democrats expressed faith in Reid's skills as a legislator and a tactician, according to the Times,

Colleagues say Mr. Reid's extensive knowledge of Senate tactics and well-honed understanding of what drives and divides his Democratic colleagues leave him well positioned to pull off a legislative coup that has eluded seasoned and determined lawmakers for decades.

"I don't think there are many people in the whole world other than Harry Reid who could do this," said Senator Mary L. Landrieu, Democrat of Louisiana.

Landrieu however is one of three Democratic centrists who Reid is still wooing, along with Ben Nelson (D-NE) and Blanche Lincoln (D-AR). Moderates cite concerns about the cost to states and the abortion language. Nelson has now said he will vote with Reid on the first procedural motion. Lincoln told Reid her plans, but hasn't made them public. But as CongressDaily noted,

...the fact that Democrats aren't backing away from the weekend vote suggests that Lincoln has accepted the argument from leaders that Democrats should vote to move the bill, even if they oppose it and might vote against it in the end.

As we've mentioned before, Senator Joe Lieberman (I-CT) has threatened to block the final bill if it contains a public health insurance option. But for now he's agreed to vote with Democrats to get the debate started.

Reid even struck up a compromise of sorts with Republican opponents. According to Politico, Republicans agreed not to read the 2,074 page health reform bill out loud in its entirety. Instead, Reid offered them a full day of debate on Saturday before the evening vote. That means that everyone (even us!) gets a chance to head home for Thanksgiving.

Earlier this week, top Democratic strategists, such as pollsters Mark Mellman and Geoff Garin, White House communications director Dan Pfeiffer and White House deputy chief of staff Jim Messina, met with Senate Democrats to discuss the importance of health reform, reports TIME. Mellman urged senators to remember they are all in this together. A victory on health reform is important to the American people who are struggling with health care cost and coverage. But it's also important to the president's agenda and the Democratic Party's success in the upcoming midterm elections, said Mellman. Health reform wasn't the only element in the deep and wide Democratic losses following President Clinton's failure to pass health reform in 1994, but it was a big factor.

The battle could get uglier as the health reform bill moves through the Senate, but for now it looks like the Democrats are ready to get started on this debate. Time to make history. Time to make progress.

HEALTH POLITICS: A Fresh Look at Malpractice

Joanne Kenen — Fri, 20 Nov 2009 16:46:00 -0500

Over the past year or so, we began detecting some subtle changes in how Democrats were talking about malpractice. They weren't embracing the Republican tort reform agenda, weren't about to start limiting damages and saying "Sorry Charlie" to people who had suffered heartbreaking harm. But they weren't just changing the subject either. They were recognizing a problem, and considering solutions. Liability problems as well as larger obstacles to addressing serious patient safety problems.

We posted about it a few times (here and here). I started reading more about it, and I started talking (and listening) to what doctors had to say. Not just lobbyists for doctors, but doctors. Including some progressive docs in primary care who favor health reform or a single payer system. I have a piece online in American Prospect today, outlining some alternatives to traditional malpractice lawsuits that are worth trying. (Not to replace the current court system, but to test alternatives. And while we test alternative dispute resolution or other approaches, it should be voluntary.) One of my conclusions was that malpractice is getting in the way of all sorts of other things we need to do to fix our system. Getting in the way politically and economically. And getting in the way of some of the changes we need to make to create a system that is safer, evidence-based, and less wasteful. Some doctors will resist changes to the system -- because change is hard, or change is something that they don't think applies to them, or, for some doctors in some settings, change can sock them in the wallet. Getting the malpractice piece out of the way, or at least minimizing it a bit, may remove the legal smokescreens and let us get to the heart of the change resistance.

The CBO recently did its first estimate on the price of defensive medicine. I left out that figure from this article because it was based quite specifically on potential savings from Republican legislation ($11 billion a year). I don't think there is an agreed upon overall estimate that defensive medicine in the current system costs -- to federal health programs, the privately-insured, the doctors. But for readers who want a summary of some of the recent literature on this, Factcheck.org has a good wrap.

The approaches I mentioned -- health courts, "disclose and apologize" and certificates of merit -- aren't the only ideas floating around. As we do more comparative effectiveness research, and learn more about what doctors should be doing and why or why not, we may be able to weave more "safe harbors" into the legal system. Right now, as all the current confusion about prostate screenings and mammograms illustrates, we still have a lot of trouble agreeing on and comprehending best practices.

In the near future, we're going to post a bit more on patient safety (which we wrote about the other day) and have a bit more to say on the AMA's evolving views on malpractice and health reform. For now, we're going back to watching the Senate....

QUALITY: Dying Well Beats Dying Badly. And Expensively

Joanne Kenen — Fri, 20 Nov 2009 14:01:00 -0500

As we've written a lot on end of life care, we notice when others do the same. NPR's Joseph Shapiro this week reported on La Crosse, WI where 96 percent of the adults who die have an advanced directive. That extraordinarily high figure arises from the innovations and commitment from Gundersen Lutheran hospital. Careful, sensitive discussions by trained doctors and nurses -- they use a 12 page guide -- is time consuming. Medicare doesn't reimburse them for that time, A provision in the House health care bill would change that -- the provision that was caricaturized as a "death panel." The Senate bill doesn't contain it.

Shapiro's thoughtful piece shows many aspects of end of life decision-making, but one element we liked in particular was that it shows these decisions are not static. People can reflect, and can change. That's the beauty of advanced directives or advanced care planning. Joe Hauser, one of the patients profiled in the NPR piece, initially declined dialysis for his failing kidneys. His wife Janice begged him to reconsider. So he gathered more information and spoke to a nurse. He and his wife were trying to decide whether to visit a dialysis center, and a support group. He learned that if he tried dialysis, he would always have the option of stopping. When Shapiro last spoke to him, Hauser was still leaning against dialysis. But he wasn't sure:

There's a surprise. He extends his left arm across the kitchen table. He wants to show what he calls his "buzzer." It's a spot at his wrist where you can feel the vibration from an artery and a vein that a surgeon has joined together.

It turns out that Joe Hauser's decided to be ready, if he changes his mind. And if he decides he wants dialysis, then the needle of the dialysis machine can slip right in to that spot -- the fistula -- that the surgeon has prepared at his wrist.

We should point out that the Washington Post.'s Alec MacGillis also had a fine story about LaCrosse earlier this fall. Don't think we linked to it at the time. MacGillis looked at both the economics of end of life care, and some of the local cultural traits of La Crosse. The population is full of people of German or Scandinavian descent who seem to have a pretty pragmatic view of aging and dying. And the local doctors and nurses have a culture, too, that values communicating with patients, and respecting their wishes. People in LaCrosse spend far fewer days in the hospital in their final weeks and months of life than people elsewhere in the country. Not because the Wisconsin community doesn't want to spend the money, but because that's what the people who live there, and die there, choose.

This coming Sunday (Nov 22) 60 Minutes will do a piece on end of life, featuring our occasional guest blogger Dr. Ira Byock (read his posts here and here). The short preview on the CBS website focuses a lot on costs; we suspect the televised segment will tell a moving story about quality of care, and patient choice. Because we too have accompanied Dr. Byock in that ICU, and sat in on his team meetings, and we know that quality -- and care -- is what motivates them.

One last relevant link -- Oregon Democrat Rep. Earl Blumenauer, who authored the House provision on end of life conversations, wrote an op-ed in the New York Times this week, describing how a measure that had long and deep bipartisan roots turned into political poison: "The battle lines were being drawn. Little did I know how deep the trenches would be dug, nor how truth would be one of the first, and most obvious, casualties." Live and learn.

COST: The Price is Right for Health Reform

Paul Testa — Thu, 19 Nov 2009 18:50:00 -0500

After weeks of anticipation and speculation, Senate Majority Leader Harry Reid has unveiled the legislation that will bring health reform to the Senate floor in the coming weeks.

While waiting for the details of the bill to come out Wednesday, we created a little office pool, called the Price is Right for Health Reform. In an office-wide email, we asked our peers to guess the CBO's estimates of the gross costs of the bill. Showcase Showdown rules (closest without going over) applied. We were intentionally vague in our question because estimating the true costs of the bill is inherently a difficult process.

The number we were looking for was $848 billion. The CBO's estimate of the gross cost of the bill is essentially the total cost of coverage provisions over the next 10-years. This is the number most frequently reported in the media as the "cost" of the various health reform bills being discussed. But is this really the best indicator of the true costs of health reform? Maybe not. First, timing matters: $848 billion over ten years is a lot different than a $787 stimulus bill where 90 percent of the money is spent within the first 3 years. So do deficits. How much does a bill cost if it's fully paid for and in fact reduces the deficit as is the case for both the House ($109 billion) and Senate ($130 billion) bills?

We received plenty of calls from our co-workers asking just these questions. We tried to stay quiet, because we were interested in what the educated, non-health policy wonks think about the cost of reform. True to our think tank's "post-partisan roots" we got a range of answers from "too little" to "$600 trillion, Obama lies." We got a couple of "$1" which we assume was a reference to the bill's deficit neutrality, and $90 billion which seems like a reasonable estimate of yearly costs. But the majority of the answers clustered within the $800-$900 billion range, surprisingly close to the final answer. Few people seemed willing to go above $900 billion, suggesting the power of the official price tag President Obama put on reform during his September address to a Joint Session of Congress. So who won? The answer after this non-commercial break:

Marc Goldwein, the Policy Director, Committee for a Responsible Federal Budget and Policy, took home the prize for his guess of $845 billion. Lisa Guernsey, the Director, Early Education Initiative, came agonizingly close with pick of $850 billion. New America's President Steve Coll, was the next closest with a prediction of $837 billion.

Marc's prize potentially includes a Dodge Neon from 1996, a natural wood-like dinette set from 1982, or more likely a beer and some wings from the re-opened Black Rooster Pub (take that Peace Corps!). We suspect he'll also want us to plug the excellent work he and his colleagues do on all things budget. Congratulations Marc. Help control the pet population. Have your pets spayed or neutered.

As a side bet, we also asked contestants to name which current Senator looks most like Bob Barker. What do you think?

HEALTH POLITICS: Steady as She Polls

Paul Testa — Wed, 18 Nov 2009 14:13:00 -0500

If polling on health reform were a band, we'd call it The Hold Steady.

Several new surveys out this week show the public remains as conflicted as ever on health reform -- convinced of the need for change, but worried about the impact on their lives and the lives of their family.

A Washington Post-ABC News poll released Tuesday shows 48 percent of those surveyed supported the proposed reforms; 49 percent opposed them. An AP poll released Monday found a similar split, with 41 percent in favor; 43 percent opposed and 15 percent undecided.

These even divides are consistent with past polls, suggesting that the uproar in August was more of a bump in the road than turning point. However beneath the topline questions are some interesting trends.

First, as the Washington Post points out, while public approval of President Obama's handling of health reform has declined he still holds a double digit lead over Republicans. Possibly more importantly, support for reform among seniors -- the group most critical of current proposals -- is up 13 percent from September, suggesting that some of most offensive scare tactics directed at seniors, such as death panels and socialized medicine, may be losing their edge.

As we've noted before, support for the major policies of health reform legislation remain generally strong. But the answers to these questions often depend on how the question is framed. In the AP poll 67 percent favor requiring all Americans to have some form of insurance, but 64 percent opposed a law that "would require every person to have health insurance and pay money to the government as a penalty if they did not, unless the person is very poor." The fluidity of such answers reinforces the points made by Robert Blendon in a recent column for Kaiser Health News:

[P]olls show countervailing concerns about the congressional plans. These involve the potential impact of the bills on Americans' health costs and affordability, their taxes, the extent of government interference in their health care decisions, and worries that health care for those receiving Medicare will deteriorate. Regardless of public enthusiasm for health reform as a principle, and support for many policy elements in the House bill itself, most Americans do not see their healthcare situation as getting better if this legislation is signed into law, and some see their situation as getting worse.

In the weeks ahead, Americans are unlikely to read the 2000-page House bill. Rather, they will form their judgment about the final legislation based on others' assessments. They will rely on those whom they trust as intermediaries to clarify its impact on them.

That impact is unclear as the Senate stages a sort of modern adaption of Samuel Beckett's classic work, with it's current production of "Waiting for CBO." The release of a bill and CBO cost estimate, which could come later Wednesday, should help lessen our existential unease, but the real challenge for proponents of reform will be explaining the bill in a way that makes its benefits clear and its costs worthwhile. The jury of public opinion is still out, but its verdict may come quickly.

HEALTH REFORM: Monday Morning Quarterback

Paul Testa — Mon, 16 Nov 2009 15:44:00 -0500

It's Monday, the day after Sunday, which in America means a surprisingly large number of Americans are talking trash about their fantasy football teams. (Good hustle Ben, but the Cleveland Steamers are on a roll.) So forgive us for the gridiron gab, as we reset the play clock on health reform.

As you know, the passage of H.R. 3962 in the House two Saturdays ago pushed health reform into the red zone and brought us closer to the goal line than we've ever been before. The problem, as the Senate prepares to take the field, is that the goal posts keep getting pushed back. A slow handoff between Senate Majority Leader Harry Reid (D-NV) and the CBO has delayed the bill's release, but Reid seems determined to keep the ball moving. Roll Call's Emily Pierce lays out the potential Democratic gameplan going forward:

The key vote, which Reid plans to call after he receives the CBO score, would be on a motion to limit debate -- or invoke cloture -- on a motion to proceed to the bill. The leadership aide said Reid is working under the presumption that he will have a CBO score "sooner rather than later" this week and that the Senate will be in a position to kick off debate before Members go home for Thanksgiving.

Reid wants to get the cloture vote on the motion to proceed over with before the holiday because he would like to spend all three weeks before Christmas amending and debating the health care bill. If he has to wait until after Thanksgiving to take the vote, the time-consuming procedural hoops he has to jump through could delay the start of the amendment process until the second week of December.

It's an ambitious schedule, one that will require the Nevada-native to channel another Rocky Mountain icon to engineer the final drive on health reform (a drive we're confident the people of Cleveland will actually like). Even without a shortened clock, these kind of things are never easy.

The Reid-option for a state opt-out on the public health insurance plan has some moderates worried, and the Democrats will have trouble keeping all of their members onside when tackling issues of abortion and immigration. Finally, Senate Minority Leader Mitch McConnell (R-KY) has been calling for a delay of game.

Like most armchair announcers, we're not a big fan of this kind of prevent defense, because the only thing it's intended to do is prevent Democrats from winning. But this game is about more than politics, and health reform is one issue our leaders can no longer afford to punt on. There may be a lot of close downs in the coming weeks, but we stand by our predictions: come Super Bowl XLIV, the Chamber of Commerce will have to look for something else to spend its money on.

HEALTH POLITICS: Reach for the Positive, but Visualize the Negative

Joanne Kenen — Mon, 16 Nov 2009 14:14:00 -0500

Be careful what you wish for! Maggie Mahar, who writes the Century Foundation's Healthbeat blog, had a piece in the Washington Post's Sunday Outlook section calling for a public plan option -- but telling progressives who had yearned for a fully single payer system to visualize the downside. Just imagine, she wrote, if a movement conservative like Sarah Palin ends up making the rules. That could make the current controversy about abortion in the health insurance exchange seem tame. What about coverage of contraceptives? Or the ability to decline life support? Think the government wouldn't intrude on such sensitive private decisions? Ever heard of Terri Schiavo?

Of course, we do usually have checks and balances in our system. The party that controls the White House doesn't always control Congress, and it's even rarer for one party to control the White House, the House and a filibuster-proof Senate. And as anyone who has watched the long and winding road of President Obama's health reform agenda, even a filibuster-proof Senate has a mind (and politics) of its own. Still, Maggie makes a point:

I'm very happy to have a public plan as an option. But since I don't know who will be in the White House in the years to come, I'm glad that government-run health care won't be the only game in town. If you're not happy about the Stupak [abortion] amendment, imagine what other limits a conservative government could impose on our health care.

With such an administration in power, social conservatives might move to exert pressure on health-care decisions beyond abortion. For example, could women be told that their government insurance won't cover birth control? In 2001, President George W. Bush proposed eliminating the requirement that all Federal Employees Health Benefits plans include coverage for contraception. At the time, Susan Orr, who would later become Bush's deputy assistant secretary of health and human services for population affairs, applauded the president's suggestion, saying: "We're quite pleased because fertility is not a disease. It's not a medical necessity that you have [contraception.]"

... Or take end-of-life counseling, and hospice and palliative care. Do you remember how Jeb Bush, then governor of Florida, responded when Terri Schiavo's husband fought for her right to die? It's quite possible that under a single-payer system, conservatives would push to overturn laws that allow physicians to withhold food and water if this is what a dying patient has requested. Recently, Rep. Charles Boustany Jr. (R-La.) raised this issue, objecting to the fact that the House's health-care reform legislation does not prohibit the use of federal funds to pay for end-of-life care that involves denying nutrition and hydration. Boustany, a surgeon, doesn't want patients to have that choice. So much for death with dignity.

She also points out that right and left have different views of "affordability" and how much "skin in the game" consumers should have. So while she still strongly advocates for a public plan option, for now, she's happy to have it be just that. An option.

BTW, we liked Maggie's post from earlier this month, "Health Care Reform - Looking at the Glass Half-Full." It's a lengthy post, but we particularly liked her assessment of consumer protections in House and Senate bills. The bills do a lot to help low income people, and if the subsidies aren't quite as generous to the middle class as some had hoped, they are still getting Real Insurance -- protection against a bottomless pit of medical bills, and the threat of bankruptcy or losing their home in a medical crisis.

I think it is important to recognize that we cannot expect this first piece of health reform legislation to be anything but wildly imperfect. In fact, I'm impressed by the progress Washington has made in just ten months. I've been watching the struggle for health care reform since the early 1970s, and compared to what has happened over the past 39 years, this is mind -boggling.

We've been emphasizing this ourselves. (See posts here and here for instance.) There are provisions we aren't crazy about in these bills. There are problems we will still have to solve. But there is also a lot to embrace.

HEALTH REFORM: The Big Squeeze

Joanne Kenen — Thu, 12 Nov 2009 14:19:00 -0500

One of the nice things about our jobs here at the New America Foundation is that we get paid to do things like read Gail Collins. So since today is really gray and wet and yucky here in Washington, and we're stuck in one of those capital of the free world moments of Waiting for the CBO, we're gonna share her latest column. You can pretend you are working too.

In troubled times, it is important to try to maintain a certain level of serenity. Right now we citizens have quite a lot on our plate and there is no reason to go completely crazy about the least little thing.

For instance, at that right-wing tea-party rally in Washington last week, it seemed a little weird when Jon Voight warned the crowd that if President Obama wasn't stopped, the United States would wind up with a health care system like New Zealand's.

At the time, I could not help wondering what New Zealand ever did to Jon Voight. Also if he's made any movies since the one where he got eaten by a really big snake.

Ben Nelson, Joe Lieberman and Olympia Snowe (more favorably) all make appearances in the rest of her column, although she does show some restraint and avoids urging them to feed themselves to any Anaconda s.

(P.S. According to all the work that the Commonwealth Fund does on international health comparisons, there are far worse things than healthcare in New Zealand. We wrote about some of their achievements in primary care here.)

HEALTH POLITICS: Tying it All Together

Paul Testa — Wed, 11 Nov 2009 18:56:00 -0500

First, thank you to all our veterans for their service and sacrifice.

This Veteran's day we're a bit caught up in the upkeep of grant reports, so he's a quick run down of the news and issues that caught our attention:

Tuesdays with Harry: Politico reports that Senate Majority Leader Harry Reid took procedural steps yesterday that would allow him to open debate on a bill Tuesday next week. Of course there a lot that needs to happen before then, including the release of bill with CBO scores, but still, it's a good sign that things are moving in the Senate.

My Life, Your Work: Former President Bill Clinton spoke to Senate Democrats at their weekly meeting Tuesday. His message? Git'er Done. "The worst thing to do is nothing," Clinton told reporters.

An Option You Can't Refuse? The New York Time's Kevin Sack looks at the likelihood that states would actually opt-out from a public health insurance plan. Aside from the politics, Sack argues the critical factors affecting a state's decision are its uninsured population and the amount of competition in its insurance market. Health Affairs and RWJF have put out a helpful brief explaining how a public health insurance plan would actually work.

How much for that horse of yours? Politico's Jonathan Allen and Patrick O'Connor have an excellent story on the political horsetrading that went down to secure the final passage of the House bill Saturday. Meanwhile House Whip James Clyburn (D-SC) told MSNBC that the controversial Stupak amendment on abortion netted the bill about 10 votes -- enough to push the legislation over the 218-vote threshold, but less than previous suggestions of a 40-vote swing.

If you like it then you shoulda put a cost control on it? Our colleagues have written about the existing cost control measures in the bill and the potential improvements that could be made. The New York Times' David Leonhardt weighs in with a detailed list of recommendations and one of the best explanations for why this matters:

It is not simply about bending the curve, or slowing the growth, of Medicare's projected spending. It's also about preventing thousands of needless deaths from hospital infections. It's about making sure you get the best cancer treatment, even when that treatment is not the most profitable one. It's about keeping health costs from denying most families a decent pay increase, as has happened in recent years.

Making the medical system more efficient is, in short, about saving lives and giving Americans a long overdue raise. It is arguably the single most important step that the federal government could take to improve people's lives.

Do you know where the majority of our nation's toothpicks come from? Maine, which Gardner Harris calls the Charlie Brown of Health Care:

The state's legislators have tried for decades to fix its system, but their efforts have always fallen short: health insurance premiums are still among the least affordable in the nation, health care spending per person is among the highest and hospital emergency rooms are among the most crowded. Indeed, many overhauls to the system have done little more than squeeze a balloon -- solving one problem while worsening another.

But like the Peanuts character, the state keeps trying.

We hope that includes the state's senior Senator.

HEALTH POLITICS: Making History Happen in the Senate... and Cincinnati

Paul Testa — Tue, 10 Nov 2009 18:42:00 -0500

The baton has been passed from the House to the Senate and the latest reports suggest legislation may come to the floor as early as Monday next week. The Hill's J. Taylor Rushing lays out how things could play out in the Senate:

Senior aides and senators say Democrats plan to pivot quickly and file the first procedural vote as early as Monday. A "motion to proceed" vote, which brings the bill to the floor, would require 60 votes -- a first, critical test of the caucus's unity on procedural votes.

Senators don't expect any momentum from Saturday's successful 220-215 House vote, however. They say the most realistic scenario is for a Senate vote by Christmas followed by final passage in mid-January.

That would allow sufficient time for House-Senate conference talks and final House-Senate votes during January's first weeks. Such a scenario would also put final passage around the time of President Barack Obama's State of the Union address.

Roll Call's Emily Pierce has more on the logistics and politics of this move:

By aiming to bring up the bill next week, Reid appears to be calculating that the public relations dangers of suspending debate for the weeklong Thanksgiving recess do not outweigh the need to get debate rolling, given the time-consuming roadblocks Republicans are expected to throw up.

Meanwhile, the AP reports that Bill Clinton was the guest of Senate Democrats during their weekly policy lunch Tuesday. We imagine the former president will convey the importance of action and pitfalls of failure on health reform. This is important because while Clinton may have seen this all before in 1993-94, many of his Democratic colleagues in the Senate have not. Of the 60 Senators who caucus with the Democratic Party:

A majority of today's Senators were not in office during Clinton reform efforts of 1993-94 and 26 were not in Congress.
Of the 23 senators in office, five (Feinstein, Feingold, Dorgan, Boxer, and Murray) had just been elected and three more were serving their first term (Lieberman, Kohl, and Akaka).
Eleven current Senators were Representatives in the House during 1993-94. Five were newly elected, and of these freshman, four currently serve on the Senate Finance Committee (Lincoln, Cantwell, Schumer, Menendez) and one (Brown) is on the Senate HELP Committee. (We put these lists together ourselves very painstakingly this morning, let us know if you catch any mistakes.)

One of the big differences between the Clinton years and today, however, has been the role of industry players and advocacy groups. In the past, their opposition helped write the obituary for reform with iconic ads like Harry and Louise pounding the final nails into the coffin. Today these groups are working to influence reform, and this decision is evident in the airwaves. The Washington Post reports:

The battle of the airwaves has already seen more than $150 million spent this year on television ads related to the health-care debate, according to the Campaign Media Analysis Group. As of Friday, about $63 million had been spent on ads favoring Democrats' reform plans and $52 million on ads opposed, according to the analysis group.

Those figures will only go up in the coming weeks. But while we may still be doing this in January, hopefully by the time Carson Palmer and Cincinnati beat Brett Favre and Minnesota in Super Bowl XLIV (a historic first championship for the once-beleagued Bengals), we can all go back to watching ads about talking frogs and herding cats.