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How Laws and Sausages Are Made

Laws, they say, are like sausages. You don't really want to see how either is made. The Senate's vote last night for cloture—a procedural motion limiting the amount of time left for debate—means that there is some package off health care reforms that can command enough votes to pass and makes health care reform finally seem possible. But the process has certainly been ugly.

The debate got ugly over the summer when Sarah Palin wrote on her Facebook page that the Democrats' plan would mean that "my parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care." Any health care plan raises the real question of how our limited resources should be allocated to people who need care—it's called "triage." Right now what mainly determines whether or not we get care is our ability to pay for it. There are real questions about whether that's better than some other system that would help people get care who can't afford it on their own, or whether it's better to leave these decisions to health insurance executives or government bureaucrats. But the suggestion that the Democrats were planning to let people die who they thought weren't sufficiently valuable to society—coupled with the specter of Nazi "death panels"—was out-and-out slander. Palin maintains that it's fair to characterize the proposal as creating "death panels," although she now says she didn't mean the phrase "literally." Politifact nevertheless calls it the "Lie of the Year."

A couple of weeks later, Betsey McCaughey fueled the controversy when she told Fred Thompson that "Congress would make it mandatory—absolutely require—that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner." Presumably, she was referring to an AARP-supported proposal for Medicare to pay cover appointments with doctors to talk about living wills and end-of-life issues if people wanted them, although it's hard to see how she could equate optional end-of-life counseling with pressuring seniors into assisted suicide.

As Dana Milbank writes, last night's cloture vote brought out the worst in both parties. Sen. Sheldon Whitehouse (D-RI) suggested that the way the Republicans were acting had led in the past to atrocities, invoking the French Reign of Terror, the Nazi Kristallnacht, and southern lynch mobs all in one breath. At the same time, the Democrats had had to essentially buy Sen. Ben Nelson's (D-NE) vote by including a "Cornhusker kickback" of $100 million of extra Medicare payments for his state, which Michelle Malkin dubbed "Cash for Cloture." On the other side of the aisle, Sen. Tom Coburn (R-OK) said—as 94 year-old, ailing Sen. Robert Byrd (D-WV) struggled to get through the snow in the middle of the night to get to the Senate floor—that "what the American people ought to pray is that somebody can't make the vote tonight."

Nasty business, but that's how politics is. Health care is important. Not only are our nation's finances in the balance—health care costs already account for about a sixth of every dollar we make, and are rising fast—but our very lives as well. It's certainly not nice to misrepresent the facts or wish ill on someone with an honest disagreement with you, but with that much at stake it's understandable. The result of is a bill which is deeply flawed, from almost every perspective. But by making health care relatively affordable for more Americans—as Nate Silver and Ezra Klein both argue—it may nevertheless be an enormous improvement over the status quo. If we want something better, we'll just have to keep fighting.

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